Coordinated Care — The LPN/LVN Role

Practical nurses operate under the supervision of a Registered Nurse (RN) or licensed physician/nurse practitioner. The NCSBN 2022 Practice Analysis defines six core LPN activities: (1) data collection and ongoing assessment, (2) basic care, (3) medication administration (with state-specific limitations on IV push), (4) wound care, (5) client education reinforcement, and (6) reporting changes to the RN/MD.

The 5 Rights of Delegation (NCSBN)

1. Right Task — within delegatee's scope, predictable outcome.
2. Right Circumstance — stable client, appropriate setting.
3. Right Person — competent delegatee for this specific task.
4. Right Direction/Communication — clear, concise, specific.
5. Right Supervision/Evaluation — appropriate monitoring and feedback.

Per NCSBN National Guidelines for Nursing Delegation (2019): "The licensed nurse cannot delegate nursing judgment, the nursing process, or any task that requires nursing assessment, planning, or evaluation."
Source: ncsbn.org/nursing-regulation/practice/delegation

Scope of Practice — Who Does What

Safety & Infection Control

Standard Precautions (CDC 2007)

Applied to ALL clients regardless of diagnosis: hand hygiene before/after contact, PPE based on anticipated exposure, safe injection practices, respiratory hygiene/cough etiquette, sharps safety, environmental cleaning.

Transmission-Based Precautions

According to CDC Guideline for Isolation Precautions (2007, updated 2019): "Hand hygiene with alcohol-based hand rub is ineffective against C. difficile spores; soap and water with mechanical friction is required."
Source: cdc.gov/infectioncontrol/guidelines/isolation

National Patient Safety Goals (TJC 2024)

• NPSG.01.01.01 — Identify patients correctly (2 identifiers).
• NPSG.02.03.01 — Report critical results timely.
• NPSG.03.06.01 — Medication reconciliation at every transition.
• NPSG.07.01.01 — Hand hygiene per CDC/WHO.
• NPSG.15.01.01 — Identify suicide risk in behavioral health settings.
• Universal Protocol — Pre-procedure verification, marking, time-out.

Healthcare-Associated Infections (HAI)

• CLABSI (Central Line-Associated Bloodstream Infection) — prevented by full barrier precautions during insertion + daily necessity review + chlorhexidine site care.
• CAUTI (Catheter-Associated UTI) — prevented by removing Foley catheters as early as possible (most common HAI).
• VAP (Ventilator-Associated Pneumonia) — HOB elevation 30-45°, oral care q2h with chlorhexidine 0.12%, sedation vacation.
• SSI (Surgical Site Infection) — chlorhexidine bath, prophylactic antibiotics within 1h pre-incision, normothermia.
• CDI (Clostridioides difficile Infection) — contact precautions, soap & water hand wash, bleach-based environmental cleaning.

Restraint Use & Client Safety

Physical or chemical restraints require: (1) physician order within 1 hour of initiation (for behavioral); (2) least restrictive option first; (3) continuous monitoring; (4) PRN orders prohibited; (5) face-to-face re-evaluation q4h (adult behavioral), q2h (child 9-17), q1h (child <9); (6) renewal q24h for non-behavioral, q4-8h for behavioral.

Per CMS 42 CFR §482.13(e): "Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the patient or others from harm."
Source: eCFR Title 42 §482.13

Disaster Triage — START Method

Key Takeaways

• LPN cannot delegate assessment, judgment, or teaching to UAP.
• Apply the 5 Rights of Delegation for every assignment decision.
• C. difficile requires soap & water, NOT alcohol-based rub.
• Airborne = N95 + negative-pressure room (TB, measles, varicella).
• Droplet = surgical mask within 3 ft (influenza, meningitis).
• 2 identifiers, time-out, medication reconciliation — TJC NPSG core.
• RED tag = transport first in mass-casualty triage.

Further Reading

• CDC Guideline for Isolation Precautions
• The Joint Commission — National Patient Safety Goals
• NCSBN National Guidelines for Nursing Delegation