Current through Register Vol. 43, No. 12, March 20,
2024
Each nursing facility shall conduct at the time of admission,
and periodically thereafter, a comprehensive assessment of a resident's needs
on an instrument approved by the secretary of health and environment.
(a) The comprehensive assessment shall
include at least the following information:
(1) Current medical condition and prior
medical history;
(2) measurement
of the resident's current clinical status;
(3) physical and mental functional status;
(4) sensory and physical
impairments;
(5) nutritional
status and impairments;
(6)
special treatments and procedures;
(7) mental and psychosocial status;
(8) discharge potential;
(9) dental condition;
(10) activities potential;
(11) rehabilitation potential;
(12) cognitive status; and
(13) drug therapy.
(b) A comprehensive assessment shall be
completed:
(1) not later than 14 days after
admission;
(2) not later than 14
days after a significant change in the resident's physical, mental, or
psychosocial condition; and
(3) at
least once every 12 months.
(c) The nursing facility staff shall examine
each resident at least once every three months, and as appropriate, revise the
resident's assessment to assure the continued accuracy of the assessment.
(d) Changes in a resident's
condition which are self-limiting and which will not affect the functional
capacity of the resident over the long term do not in themselves require a
reassessment of the resident.
(e)
The nursing facility shall use the results of the comprehensive assessment to
develop, review, and revise the resident's comprehensive plan of care under
subsection (h).
(f) The nursing
facility shall conduct or coordinate each assessment with the participation of
appropriate health professionals.
(g) A registered professional nurse shall
conduct or coordinate each comprehensive assessment and shall sign and certify
that the assessment has been completed.
(h) Comprehensive care plans.
(1) The facility shall develop a
comprehensive care plan for each resident that includes measurable objectives
and timetables to meet a resident's physical, mental, and psychosocial needs
that are identified in the comprehensive assessment.
(2) The comprehensive care plan shall be:
(A) Developed within seven days after
completion of the comprehensive assessment; and
(B) prepared by an interdisciplinary team
including the attending physician, a registered nurse with responsibility for
the care of the resident, and other appropriate staff in other disciplines as
determined by the resident's needs, and with the participation of the resident,
the resident's legal representative, and the resident's family to the extent
practicable.
(i) The services provided or arranged by the
facility shall:
(1) Meet professional
standards of quality; and
(2) be
provided by qualified persons in accordance with each resident's written plan
of care.
(j) Discharge
summary. When the facility anticipates discharge of a resident, a discharge
summary shall be developed which includes the following:
(1) A recapitulation of the resident's stay;
(2) a final summary of the
resident's status which includes the items found in the comprehensive
assessment, K.A.R. 28-39-151 (a). This summary shall be available for release
at the time of discharge to authorized persons and agencies, with the consent
of the resident or the resident's legal representative; and
(3) a post-discharge plan to assist the
resident in the adjustment to a new environment. The resident, and when
appropriate, the resident's family, shall participate in the development of the
plan.
