Is registered nurse (RN) delegation required for the nursing assistant-registered/nursing assistant-certified (NA-R/NA-C) or home care aide-certified (HCA-C) to apply over the counter (OTC) skin creams, body lotions, or sunscreens in a community-based* or in-home care setting?
It depends. The laws and rules allow the RN to delegate administration of OTC skin creams, body lotions, or sunscreens without a prescription when used for personal hygiene based on nursing assessment only in community-based* and in-home care settings to the NA-R/NA-C or HCA-C. An prescription is required from authorized health care practitioner for the RN to delegate prescription skin creams, body lotions, or sunscreens in community-based* and in-home care settings to the NA-R/NA-C or HCA-C.
It is important to understand that some products, such as lotions, soaps, cleaners, and other products used daily may be classified by the Food and Drug Administration (FDA) as a cosmetic, an OTC/non-prescription drug, or a prescription drug depending on how they are made and how they are intended to be used. For example, soaps and cleansers marked as “antibacterial” are classified as OTC/non-prescription drugs (such as dandruff shampoos, acne medications, and antibacterial soaps). Lotions, moisturizers, ointments, and creams intended to affect the structure of the body, or for therapeutic purposes, may also be identified as an OTC/non-prescription drug. Examples include sunscreens and lip balms. Products used for oral care may also be classified as an OTC/non-prescription drug (such as toothpaste with fluoride and mouthwash). See the FDA Products website for more information.
The Washington State Board of Nursing (WABON) determines that RN delegation is not required for OTC/non-prescription drugs if they are used for personal hygiene purposes. The WABON determines that RN delegation is required for the RN to delegate OTC/non-prescription drugs if used for treatment of a condition rather than for personal hygiene.
Is It a Cosmetic, a Drug, or Both? (Or Is It Soap?) | FDA
The RN must follow the nurse delegation process. The following statute and WACs are applicable to delegation in community-based* and in-home care settings:
RCW 18.79.260: Registered Nurse—Activities Allowed—Delegation of Tasks
WAC 246-840-940: Community-Based and In-Home Care Nursing Delegation Decision Tree
WAC 246-840-950: How to Make Changes to Delegated Tasks
WAC 246-840-960: Rescinding Delegation
WAC 246-840-970: Accountability, Liability, and Coercion
*Community-based settings include adult family homes, assisted living facilities, and residential homes for individuals with developmental disabilities (RCW 18.79.260).
The HCA-C is allowed to work only in community-based*, in-home care settings, and enhanced service facilities. The following statutes and WACs are applicable to nurse delegation to the HCA-C in addition to the statute and WACs noted above:
RCW 18.88B.070: Nurse Delegated Tasks
WAC 246-980-130 Provision of Delegation of Certain Tasks to the HCA-C
WAC 246-980-140: Scope of Practice for Long-Term Care Workers