Is the registered nurse (RN) allowed to delegate enteral tube feedings, related medication administration, stoma care, venting, and irrigation/flushing of a Gastrostomy tube (G-tube), such as Percutaneous Endoscopic Gastrostomy (PEG) tube, and Jejunostomy tube (J-tube), and Jejunostomy/Gastronomy (J-G) tube 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 G-tube feedings, irrigation/flushing, stoma care, and venting with a syringe or venting with a gastric venting system to the NA-R/NA-C or HCA-C in any setting. The RN may delegate medication administration through G-tubes to the NA-R/NA-C and HCA-C only in community-based* and in-home care settings. The RN must consider the condition of the G-tube (such as maturity of stoma site, patency, and sustained skin integrity) to determine whether it’s safe to delegate. Further, delegation may only occur for patients with a mature stoma site.
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 those 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