Is the registered nurse (RN) allowed to delegate orogastric/nasogastric (OG/NG) tube enteral tube feedings, irrigation/flushing, or related medication administration to the nursing assistant-registered/nursing assisted-certified (NA-R/NA-C) or home care aide-certified (HCA-C)?
It depends on the setting. The RN is allowed to delegate OG/NG enteral tube feedings and related tasks (e.g., irrigation/flushing of the tube) to the NA-R/NA-C and HCA-C in any setting. The RN is allowed to delegate medication administration to the NA-R/NA-C or HCA-C only in community-based* and in-home care settings. Verification of OG/NG tube placement is required prior to each tube 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 RN must consider the risk of complications for the specific patient 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.
Chapter 17 Enteral Tube Management - Nursing Skills - NCBI Bookshelf (nih.gov)
In all settings, the RN must follow the nurse delegation process outlined in RCW 18.79.260 (3)(a) to make that determination.
In addition, the following statute and WACs are applicable to nurse 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 statute and WACs are applicable to nurse delegation to the HCA-C in addition to the 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