TX HHS Form 8007. ICF/IID RN Delegation Worksheet for 22 TAC Section 225 (Example Form)

The TX HHS Form 8007, ICF/IID RN Delegation Worksheet for 22 TAC Section 225, is a practical tool designed to help registered nurses (RNs) delegate tasks to unlicensed personnel in the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) setting. This form helps solve the problem of ensuring that essential nursing tasks are performed safely and effectively by authorized staff.

The form requires RNs to assess the complexity of various health maintenance activities (HMAs) and activity of daily living (ADLs), and then delegate those tasks that do not require professional nursing judgment. Key features include a list of HMAs and ADLs, as well as guidelines for determining which tasks can be delegated to unlicensed personnel. The form also emphasizes the importance of monitoring and evaluating the delegation process to ensure patient safety.

This worksheet is typically used in ICF/IID settings where multiple rotating staff members may not have the necessary training or expertise to perform certain nursing tasks. By using this form, RNs can ensure that essential tasks are performed safely and effectively, while also promoting autonomy and independence for individuals with intellectual disabilities. Key points to note include:

• The form is used in ICF/IID settings to delegate HMAs and ADLs to unlicensed personnel.
• RNs must assess the complexity of tasks before delegating them to unlicensed staff.
• The form emphasizes the importance of monitoring and evaluating the delegation process for patient safety.