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Question
Is the school registered nurse (RN) allowed to delegate orogastric/nasogastric (OG/NG) enteral tube feedings, irrigation/flushing, and related medication administration to a non-credentialed staff in school settings?
Answer

Yes. The school RN is allowed to delegate OG/NG enteral tube feedings and related tasks (e.g., medication administration, irrigation/flushing of the tube) to a non-credentialed employee following the nurse delegation process in public and private schools, kindergarten-twelve (K-12) grade. The school RN must follow the nurse delegation process. Verification of OG/NG tube placement is required prior to each feeding following clinical practice standards. One method is by performing a pH test of gastric aspirates. The RN is allowed to delegate pH testing to the NA-R/NA-C or HCA-C with instructions specific to the results with what actions to take if the results are not within defined parameters. The school RN must consider the risk of complications for the specific student based on nursing assessment such as aspiration, tube malpositioning, dislodgement, refeeding syndrome, medication-related complications, insertion-site infection, agitation, and other factors to determine whether if it is safe to delegate this task to a specific non-credentialed employee.

Registered Nurse Delegation in School Settings Advisory Opinion

The school RN must verify tube placement following clinical practice standards.

Evidence-Based Strategies to Prevent Enteral Nutrition Complications, American Nurse Journal Volume 16, Number 6

Chapter 17 Enteral Tube Management - Nursing Skills - NCBI Bookshelf (nih.gov)

Preventing Errors When Preparing and Administering Medications Via Enteral Feeding Tubes | Institute for Safe Medication Practices

RCW 28A.210.255: Provision of Health Services in Public and Private schools—Employee Job Description

RCW 28A.210.260: Public and Private schools—Administration of Medication—Conditions

RCW 28A.210.270: Public and private schools—Administration of Medication—Immunity from Liability—Discontinuance, Procedure

RCW 28A.210.275: Administration of Medications by Employees not Licensed under Chapter 18.79 RCW—Requirements—Immunity from Liability

FAQ Category
School Nursing
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