Current through Register Vol. 43, No. 39, September 26, 2024
(a) General
provisions. If the hospital provides a long-term care service, such service
shall be provided in a manner that meets the medical, rehabilitative, and
social needs of the patient.
(b)
Scope of services.
(1) The long-term service
shall have a written program of restorative nursing care. This program shall be
an integral part of nursing services and shall be directed toward assisting the
patient to achieve and maintain an optimum level of self-care and independence.
(2) In addition to restorative
services, the unit shall provide or arrange for specialized rehabilitation
services by qualified personnel as needed by patients to improve and maintain
functioning. Services shall include physical therapy, speech pathology,
audiology, and occupational therapy and shall be provided by qualified
personnel.
(3) A written, overall
care plan shall be developed for each long-term care patient from an
interdisciplinary assessment of the patient. The interdisciplinary assessment
shall consist of medical, nursing, dietary, activities, and psychosocial
diagnoses or evaluations.
(c) Medical direction. A member of the
medical staff shall be assigned responsibility for the medical direction of the
service. The director shall be responsible for the overall coordination of
medical care in the unit and shall participate in the development of policies
and procedures for patient care, including the delineation of responsibilities
of attending physicians.
(d)
Nursing services.
(1) The nursing services
director shall have the overall responsibility of providing nursing services.
The immediate supervisor of nursing personnel assigned to long-term care
services shall be a registered nurse employed on the day shift and whose
responsibilities shall be limited to the long-term care unit. Licensed nursing
personnel shall be in the building at all times to be available as needed to
provide services in the long-term care unit.
(2) Nursing personnel shall be assigned
duties consistent with their education and experience. Each nurse aide shall be
trained and examined in accordance with K.A.R. 28-39-79 and K.A.R. 28-39-80.
Each nurse aide trainee who provides direct, individual care to patients shall
be under the direct, onsite supervision of a licensed nurse. Each nurse aide
trainee shall complete requirements for and obtain certification as a nurse
aide within six months of employment.
(3) Each patient shall receive direct,
individual patient care at a minimum weekly average of 2.0 hours per 24 hours,
and a daily average of not fewer than 1.85 hours during any 24-hour period.
Only care provided by personnel exclusively assigned to the long-term care
service, including nursing personnel, the activities director, and the social
services designee, shall be considered in meeting the care requirements.
(e) Restraints. A
signed physician's order shall be required for any restraint. The order shall
include justification, type of restraint, and duration of application. A
patient shall not be restrained unless, in the written opinion of the attending
physician, restraints are required to prevent injury to the patient or to
others.
(f) Patient care and
hygiene. The long-term care service shall provide supportive services to
maintain the patients' comfort and hygiene as follows:
(1) Patients confined to bed shall receive a
complete bath every other day or more often as needed.
(2) Incontinent patients shall be checked at
least every two hours and shall be given partial baths and clean linens
promptly when the bed or clothing is soiled.
(3) Pads shall be used to keep the patients
dry and comfortable.
(4) Rubber,
plastic, or other types of protectors shall be kept clean, completely covered,
and not in direct contact with the patients.
(5) Soiled linen and clothing shall be
removed immediately from the patients' rooms to prevent odors.
(6) Fresh water shall be available for each
patient. For each non-ambulatory patient, fresh water or other fluids shall be
available at the bedside at all times unless fluids are restricted by
physician's order.
(7) Each
patient shall be assisted with oral hygiene to keep mouth, teeth, or dentures
clean. Measures shall be taken to prevent dry, cracked lips.
(8) A written, ongoing program for skin care
shall be implemented as follows:
(A) Bony
prominences and weight-bearing parts, such as heels, elbows, and back, shall be
bathed and given care frequently to prevent discomfort and the development of
pressure sores.
(B) Treatment for
pressure sores shall be given according to written physician's orders.
(C) The position of each patient
confined to bed shall be changed at least every two hours during the day and
night.
(D) Each patient shall be
positioned in good body alignment.
(E) Precautions shall be taken to prevent
foot drop in bed patients.
(g) Restorative nursing care. Each nursing
personnel shall receive regular staff development training sessions in
restorative techniques. Documentation of such training shall be maintained.
(h) Specialized rehabilitative
services.
(1) Rehabilitation needs shall be
met either through services provided directly by the hospital or through
arrangements with qualified outside resources.
(2) Commensurate with the services offered,
adequate space and equipment shall be available.
(3) Each rehabilitative service performed
shall be recorded in the patient's record and shall be signed and dated by the
person providing the service.
(4)
Written policies and procedures shall be developed for specialized
rehabilitative services with input from qualified therapists and
representatives of the medical, administrative, and nursing staffs.
(5) A written plan of care, initiated by the
attending physician and developed in consultation with the therapist or
therapists involved and with nursing services, shall be developed for each
patient receiving rehabilitative services. A report of the patient's progress
shall be communicated to the attending physician within two weeks of the
initiation of the service. Thereafter, the patient's progress shall be reviewed
and revised on not less than a quarterly basis.
(i) Social services. The long-term care
service shall have methods for identifying the medically-related, psychosocial
needs of each patient. Needs shall be met by qualified staff of the hospital or
by referral to an outside resource through established procedures.
