Can DSPs pass medications in Texas?

Can unlicensed staff give medications in a Texas HCS group home?

Yes. Texas has two legal paths. The Human Resources Code lets a paid unlicensed caregiver give certain medications without RN delegation of each dose, and the Texas Board of Nursing lets an RN delegate other tasks under 22 TAC Chapter 225.

The HCS Program Billing Requirements name both paths. For residential support and supervised living, a billable activity is helping with the administration of the individual's medication, or doing a task an RN delegated, "in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225" or "the Human Resources Code, §161.091-.093, as applicable."

Which path applies depends on the medication, the route, and how stable the individual's health is. That call is made by an RN after assessing the individual, not by the DSP or the house manager.

Which medications can a DSP give without RN delegation?

Under Human Resources Code Chapter 161, Subchapter D (passed as SB 1857), a paid unlicensed caregiver in HCS or TxHmL may give oral medications, topical medications, and metered dose inhalers without RN delegation or oversight of each dose, if every condition in the law is met.

HHSC's HCS and TxHmL nursing FAQ lists the conditions. The medication must be for a stable or predictable condition. That includes PRN medications the individual uses routinely, but not PRN medications used to manage behavior.

An RN must personally assess the individual first, and again when the individual's health changes, and decide that their health status allows an unlicensed person to give medications. The DSP must be trained by an RN, or by an LVN under an RN's direction, or be found competent by one of them, for example by demonstrating the right technique.

• Oral medications
• Topical medications
• Metered dose inhalers
• For a stable or predictable condition (routine PRNs allowed, behavior PRNs excluded)
• RN assessment first and after any health change
• DSP trained or found competent by an RN, or an LVN under RN direction

What is 22 TAC Chapter 225?

22 TAC Chapter 225 is the Texas Board of Nursing rule for RN delegation to unlicensed personnel in independent living environments for people with stable and predictable conditions. The Board says an independent living environment includes a home or group home, a foster home, an assisted living facility, or a school.

An RN may use Chapter 225 only when three things are true: the individual is in an independent living environment; the individual, if 16 or older, or their responsible adult is willing and able to take part in decisions about their health care; and the task is for a stable, predictable condition.

If the individual develops an acute condition, Chapter 224 applies to that condition instead. The Board says an RN can use both chapters for the same person: Chapter 224 for the acute problem and Chapter 225 for the ongoing stable conditions.

Chapter 225 also sets limits. The Board of Nursing FAQ notes that injectable medications may not be delegated under Chapter 225, except subcutaneous medications prescribed to treat diabetes.

What must the RN do before delegating?

The RN must assess the individual first. Based on that assessment, the Board of Nursing says the RN may call a task a health maintenance activity that needs no delegation, delegate it to an unlicensed person, or have a nurse do it. The decision to delegate belongs to the RN, not the employer.

In HCS, HHSC says a comprehensive nursing assessment must be done by an RN when there are nursing units on the IPC, and repeated at least annually. The RN develops the nursing service plan. LVNs cannot write the plan and cannot delegate, though an LVN may assist with training and supervising staff.

The Board of Nursing FAQ is clear that employer policies and job descriptions cannot force an RN to delegate. The Board also does not set a fixed schedule for supervisory visits, except for delegated insulin. The RN decides how much supervision is needed, and when another agency's rule is stricter, the stricter rule wins.

For PRN medications, HHSC says an RN may delegate certain PRNs once the assessment and a nursing service plan with written protocols are in place. Before giving a PRN prescribed to manage behavior, the unlicensed staff member must call the RN, and that use must be in a behavior support plan.

What training do DSPs need before passing medications?

The DSP must be trained or checked for competence by an RN, or an LVN under an RN's direction, on proper medication administration. For delegated tasks, the RN also verifies the staff member can do the specific task safely and supervises them.

HHSC says training and supervising delegated tasks is the RN's responsibility, and on-site supervisory visits must be conducted and documented for each paid unlicensed person. An LVN may help, but the RN keeps overall accountability.

When an RN supervises a staff member that someone else delegated to, the Board says the RN's duty is met by verifying the staff member's training, verifying they can do the task without risk to the individual, and supervising them adequately.

How should medication administration be documented on the MAR?

Who records each dose on the medication administration record (MAR) is set by the provider's policy. The Board of Nursing says its delegation rules do not specify who documents delegated care, and it does not recommend that an RN co-sign entries for care the RN did not see.

Nurses have their own documentation duties. HHSC's FAQ lists what nursing records must show, including the individual's status, care given, orders, medications and treatments given, and the individual's response. In HCS, one of the RN's billable activities is checking medications when they arrive from the pharmacy against the doctor's order and the MAR.

The MAR does not replace the DSP's service log. HCS billing rules list "a medication log" among the things that are not acceptable as the description of activities in a written service log, so the daily note still has to describe what staff did.

How does Sereniq support medication administration and delegation?

Sereniq gives DSPs an eMAR on their phone and keeps the nursing paperwork in one place. Each dose is charted with its state, such as taken, refused, home visit, or hospital, and the month prints as HHSC Form 3092.

A refused dose sends a critical alert to supervisors and nurses right away, so a person decides what follow-up is needed. It does not create an incident report on its own. Delegation forms are uploaded to the nursing binder and tracked with expiry dates, so the nurse sees what is due before a survey.

When the pharmacy sends a new MAR, Sereniq's AI reads it into medication lines, and a nurse or supervisor confirms each line before anything lands in the record. Sereniq does not decide what can be delegated. That judgment stays with the RN.