Health Care Assistant Law 18.135 RCW was passed in 1984 to provide a legal mechanism for individuals not otherwise licensed to puncture the skin. Click on the following link to connect to Washington State Department of Health. The term "health care assistant" encompasses the various health care occupations, such as medical technologist, medical technician, medical assistant, laboratory technician and also individuals that have been trained on the job to perform invasive procedures.
Performing invasive procedures is limited to licensed individuals. Therefore, an individual not otherwise licensed must be certified as a "health care assistant" to legally perform invasive procedures. The Health Care Assistant Law grants limited authority, under appropriate supervision, to administer skin tests and subcutaneous, intradermal, intramuscular, and intravenous injections and to perform minor invasive procedures to withdraw blood.
A health care assistant must be supervised by a "delegator". The delegator may be a physician (MD or DO), a podiatrist, or an Advanced Registered Nurse Practitioner (ARNP) with prescriptive ability. The delegator must be physically present and immediately available during the administration of injections, but need not be present during withdrawal of blood. Only those licensees that can order a procedure may delegate the responsibility to the health care assistant.
Categories and minimum qualifications
There are six categories, or performance levels, outlined in the rules. Individuals may be certified in one or several categories on a single certification. Certifications are issued for two years.
Category A - Performs venous and capillary invasive procedures for blood withdrawal
Educational requirements
High school education. Ability to read and write in English.
Occupational requirements
Physical ability to perform the skills.
Training and instruction
On the job training and instruction.
Work experience
Practice and observe under a qualified trainer and all training must be documented.
Category B - Performs arterial invasive procedures for blood withdrawal.
Educational requirements
High school education. Additional education in anatomy, physiology, concepts of asepsis, and microbiology. Ability to read and write in English.
Occupational requirements
Physical ability to perform the skills.
Training and instruction
On the job training and instruction.
Work experience
Practice and observe under a qualified trainer and all training must be documented.
Category C - Performs intradermal (including skin tests), subcutaneous, and intramuscular injections for diagnostic agents.
Educational requirements
Nine hundred hours of formal education at the post secondary level to include anatomy, physiology, basic pharmacology, concepts of asepsis, and microbiology. Ability to read and write in English. Must possess a basic knowledge of mathematics
Occupational requirements
Physical ability to perform the skills. .
Training and instruction
Formal training and instruction to include ethics, patient confidentiality, procedures of injections and medications, terminology, medical practices and safety.
Work experience
Simulated practice. Observe and perform on patients under qualified trainer until proficient. All training must be documented.
Category D - Performs intravenous injections for diagnostic agents.
Educational requirements
Two academic years of formal education at the post secondary level to include anatomy, physiology, basic pharmacology, mathematics, chemistry, concepts of asepsis, and microbiology. Ability to read and write in English.
Occupational requirements
Physical ability to perform the skills.
Training and instruction
Formal training and instruction to include ethics, patient confidentiality, procedures of injections and medications, terminology, medical practices and safety.
Work experience
Simulated practice. Observe and perform on patients under qualified trainer until proficient. All training must be documented.
Category E - Performs intramuscular, intradermal (including skin tests), and subcutaneous, injections for therapeutic agents.
Educational requirements
Nine hundred hours of formal education at the post secondary level to include anatomy, physiology, pharmacological principles and medication administration, mathematics, concepts of asepsis, and microbiology. Ability to read and write in English. Must possess a basic knowledge of mathematics.
Occupational requirements
Physical ability to perform the skills.
Training and instruction
Formal training and instruction to include ethics, patient confidentiality, procedures of injections and medications, terminology, medical practices and safety.
Work experience
Simulated practice. Observe and perform on patients under qualified trainer until proficient. All training must be documented.
Category F - Performs intravenous injections for therapeutic agents.
Educational requirements
Two academic years of formal education at the post secondary level to include anatomy, physiology, pharmacological principles and medication administration, chemistry, mathematics, concepts of asepsis, and microbiology. Ability to read and write in English. Must possess a basic knowledge of mathematics.
Occupational requirements
Physical ability to perform the skills.
Training and instruction
Formal training and instruction to include ethics, patient confidentiality, procedures of injections and medications, terminology, medical practices and safety.
Work experience
Simulated practice. Observe and perform on patients under qualified trainer until proficient. All training must be documented.
Category G - Performs hemodialysis
Educational requirements
High school or equivelent, ability to read, write, and converse in English, basic math including use of fractions and decimal points.
Occupational requirements
Physical ability to perform the skills
Training and instruction
Formal training and instruction to encompass all core competencies described within WAC 246-826-303. The training must be provided by a licensed health care practitioner and must be a minimum of 6 weeks in both didactic and supervised clinical instruction.
Work experience
Simulated practice. Observe and perform on patients under qualified trainer until proficient. All training must be documented.
Grandfather Clause
Health care assistants currently certified to perform any of the practices authorized may continue to be certified or recertified by demonstrating proficiency in the appropriate classification to a delegator. Retraining or completion of a training program is not required. Eligibility for recertification will not be restricted by change of employment.
Health care assistants must have seven hours of AIDS education. (Note: Washington Administrative Code 296-826-12005 also states that emloyers need to update occupational exposure training programs annually. Click here for a link to WAC 296-823-12005)
All categories require clinical training which must be obtained under the supervision of a qualified trainer. Training may be obtained within the training programs provided by accredited or approved post-secondary schools, community colleges, and public or private vocational schools. The delegator is responsible for assuring that the health care assistant is appropriately trained.
The delegator is ultimately responsible for the actions of the certified health care assistant under his or her supervision. Disciplinary action may be taken against a health care practitioner's license for aiding and abetting unlicensed practice if the individuals being directed to perform invasive procedures are not appropriately licensed or certified.
