Utah Admin. Code 432-200-16

Current through Bulletin 2024-23, December 1, 2024

Section R432-200-16 - Nursing Care

(1) Each licensee shall provide nursing care services commensurate with the needs of the residents served.

(2) The licensee shall ensure that each licensed nursing staff member maintains a current Utah license to practice nursing.

(3) The health services supervisor as defined in Rule R432-1 shall:

(a) direct the implementation of physician's orders;

(b) plan and direct the delivery of nursing care, treatments, procedures, and other services to assure that each resident's needs are met;

(c) review the health care needs of each resident admitted to the facility and formulate with other professional staff a resident care plan according to the attending physician's orders;

(d) review the medication system for completeness of information, accuracy in the transcription of physician's orders, and adherence to stop-order policies;

(e) ensure that nursing notes describe the care provided, including the resident's response;

(f) instruct the staff on the legal requirements of charting;

(g) supervise clinical staff to assure they perform restorative measures in their daily care of residents;

(h) teach and coordinate habilitative and rehabilitative care to promote and maintain optimal physical and mental functioning of the resident;

(i) keep the administrator and attending physician informed of significant changes in the resident's health status;

(j) plan with the physician, family, and health-related agencies the care of the resident upon discharge;

(k) coordinate resident services through the quality assurance committees;

(l) assign qualified supervisory and supportive staff throughout the day and night to assure that the health needs of residents are met;

(m) develop written job descriptions for any health service personnel and orient each new personnel to the facility and their duties and responsibilities;

(n) evaluate and document the performance of each member of the staff at least annually and ensure that the evaluation is available for departmental review; and

(o) plan, conduct, and document orientation and in-service training programs for staff.

(4) The licensee shall ensure that required staffing hours are compliant with the following:

(a) each licensee that provides nursing care shall provide at least two hours of nursing staff coverage for each registered nurse, licensed practical nurse and aide per resident per 24 hours, of which 20% or 24 minutes per resident shall be provided only by licensed staff; and

(b) a licensee providing rehabilitative or habilitative care shall:

(i) provide adequate staff care and supervision to meet the resident's needs based on the resident care plan;

(ii) conform to the specific program requirements in the appropriate supplement; and

(iii) ensure adequate coverage with additional staff in the event of staff illness, turnover, sudden increase in resident population, or similar event.

(5)

(a) The licensee shall ensure that nursing and health care services are compliant with this subsection.

(b) The health services supervisor shall review and annually update the nursing and health services procedure manual.

(c) The licensee shall make the manual accessible to any clinical staff and available for review by the department.

(d) The nursing and health services procedures shall address the following:

(i) bathing;

(ii) positioning;

(iii) enema administration;

(iv) decubitus prevention and care;

(v) bed making;

(vi) isolation procedures;

(vii) clinical test procedures;

(viii) laboratory requisitions;

(ix) telephone orders;

(x) charting;

(xi) rehabilitative nursing;

(xii) diets and feeding residents;

(xiii) oral hygiene and denture care; and

(xiv) nasogastric tube insertion and care is done only by a registered nurse, a licensed practical nurse, with appropriate training, or a physician.

(6)

(a) The licensee shall implement measures to prevent and reduce incontinence for each resident in compliance with this subsection.

(b) A licensed nurse shall provide a written assessment to determine the resident's ability to participate in a bowel and bladder management program.

(c) An individualized plan for each incontinent resident shall begin within two weeks of the initial nurse's assessment.

(d) A licensed nurse shall record a weekly evaluation of the resident's performance in the bowel or bladder management program.

(e) A licensed nurse shall record fluid intake and output for each resident as ordered by the physician or charge nurse.

(f) A licensed nurse shall evaluate intake and output records at least weekly and record each evaluation in the resident's record.

(g) A physician or nurse shall periodically reevaluate any physician's or nurse's orders.

(7)

(a) The licensee shall ensure nursing personnel receive rehabilitative nursing training and that any rehabilitative nursing services comply with this subsection.

(b) Nursing personnel shall perform and document rehabilitative nursing services daily for residents who require such services.

(c) Nursing personnel shall provide rehabilitative services to maintain the resident's level of functioning or to improve the resident's ability to carry out the activities of daily living.

(d) Rehabilitative nursing services shall include the following:

(i) turning and positioning of residents;

(ii) assisting residents to ambulate;

(iii) improving resident's range of motion;

(iv) restorative feeding;

(v) bowel and bladder retraining;

(vi) teaching residents' self-care skills;

(vii) teaching residents transferring skills;

(viii) teaching residents self-administration of medications, as appropriate; and

(ix) taking measures to prevent secondary disabilities such as contractions and decubitus ulcers.

Utah Admin. Code R432-200-16

Amended by Utah State Bulletin Number 2024-03, effective 1/22/2024