TX HHS Form 8585. RN Delegation Worksheet for 22 TAC Chapter 225

The TX HHS Form 8585, RN Delegation Worksheet for 22 TAC Chapter 225, helps registered nurses (RNs) delegate tasks to unlicensed personnel while ensuring patient safety. This form should be completed by the RN and attached to a comprehensive assessment.

This worksheet outlines nursing tasks that require professional judgment and cannot be performed by anyone other than a licensed nurse. Delegated tasks are those that do not require professional nursing judgment and can be provided by unlicensed personnel who have been taught and monitored by an RN. The form also addresses Health Maintenance Activities (HMAs) exempt from delegation, which must be related to stable and predictable conditions.

The form includes sections for recording individual information, such as date and shading boxes indicating unavailable selections. It also covers Activity of Daily Living (ADL) tasks, including self-administration of medications, which requires the individual to know how to safely take each medication independently or with ancillary aid. The RN comments section allows for additional notes regarding self-administration of medications.