(a) Administration of medication to a resident of a facility may be performed only by:
  (1) a person who holds a license under state law that authorizes the person to administer medication;
  (2) in a facility, as defined in §557.101 of this title (relating to Introduction):
    (A) a person who holds a permit issued under Texas Health and Safety Code §242.610 (relating to Issuance and Renewal of Permit to Administer Medication) and acts under the authority of a person described in paragraph (1) of this subsection; or
    (B) a person who is exempt from licensure or permit requirements in accordance with Texas Health and Safety Code §242.607 (relating to Exemptions for Nursing Students and Medication Aide Trainees);
  (3) a person to whom an RN has delegated the administration of medication under 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments) or Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions); or
  (4) in a facility with a licensed or certified capacity of less than 14 residents, an unlicensed person who administers medication in accordance with Texas Human Resource Code, Chapter 161, Subchapter D-1 (relating to Administration of Medication for Clients with Intellectual and Developmental Disabilities).
(b) An unlicensed person may administer medication without the requirement that an RN delegate or oversee each administration if:
  (1) the medication is:
    (A) an oral medication;
    (B) a topical medication; or
    (C) a metered dose inhaler;
  (2) the medication is administered to a resident for a stable or predictable condition;
  (3) the resident has been personally assessed by an RN initially and in response to significant changes in the resident's health status, and the RN has determined that the resident's health status permits the administration of medication by an unlicensed person; and
  (4) the unlicensed person has been:
    (A) trained by an RN or LVN under the direction of an RN regarding proper administration of medication; or
    (B) determined to be competent by an RN or LVN under the direction of an RN regarding proper administration of medication, including through a demonstration of proper technique by the unlicensed person.
(c) An RN or an LVN under the supervision of an RN must review the administration of medication to a resident by a person described in subsection (a)(4) of this section at least annually and after any significant change in the resident's condition.

Source Note: The provisions of this §551.43 adopted to be effective September 1, 2012, 37 TexReg 3871; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1883; amended to be effective February 24, 2022, 47 TexReg 787