Current through Register Vol. 43, No. 12, March 20,
2024
Each resident shall receive and the nursing facility shall
provide the necessary care and services to attain or maintain the highest
practicable physical, mental, and psychosocial well-being in accordance with
the comprehensive assessment and the plan of care.
(a) Activities of daily living. Based on the
comprehensive assessment of the resident, the facility shall ensure all of the
following:
(1) Each resident's abilities in
activities of daily living improve or are maintained except as an unavoidable
result of the resident's clinical condition. This shall include the resident's
ability to perform the following:
(A) Bathe;
(B) dress and groom;
(C) transfer and ambulate;
(D) toilet;
(E) eat; and
(F) use speech, language, or other functional
communication systems.
(2) Each resident is given the appropriate
treatment and services to maintain or improve the level of functioning as
described above in paragraph (1).
(3) Any resident who is unable to perform
activities of daily living receives the necessary services to maintain good
nutrition, grooming, and personal and oral hygiene. The facility shall ensure
all of the following:
(A) Residents are
bathed to ensure skin integrity, cleanliness, and control of body odor.
(B) Oral care is provided so that
the oral cavity and dentures are clean and odor is controlled.
(C) Residents are dressed and groomed in a
manner that preserves personal dignity.
(D) Residents who are unable to eat without
assistance are offered fluids and food in a manner that maintains adequate
hydration and nutrition.
(E) The
resident's abilities to obtain fluid and nutrition in a normal manner are
preserved or enhanced.
(b) Urinary incontinence. The facility shall
ensure all of the following:
(1) Residents
who are incontinent at the time of admission or who become incontinent after
admission are assessed, and based on that assessment a plan is developed and
implemented to assist the resident to become continent, unless the resident's
clinical condition demonstrates that incontinency is unavoidable.
(2) Residents who are incontinent receive
appropriate treatment and services to prevent urinary tract infections.
(3) Residents who are admitted to
the facility without an indwelling catheter are not catheterized, unless the
resident's clinical condition demonstrates that catheterization is necessary.
(4) Residents with indwelling
catheters receive appropriate treatment and services to prevent urinary tract
infections and to restore normal bladder function, if possible.
(c) Pressure ulcers. Based on the
comprehensive assessment, the facility shall ensure all of the following:
(1) Any resident who enters the facility
without pressure ulcers does not develop pressure ulcers, unless the resident's
clinical condition demonstrates that they were unavoidable. The facility shall
report in writing the development of any pressure ulcer to the medical
director.
(2) Any resident with
pressure ulcers receives the necessary treatment and services to promote
healing, prevent infection, and prevent new ulcers from developing.
(3) A skin integrity program is developed for
each resident identified to be at risk for pressure ulcers. The program shall
include the following:
(A) Frequent changes
of position at least one time every two hours;
(B) protection of the skin from items that
could promote loss of skin integrity;
(C) the use of protective devices over
vulnerable areas, including heels, elbows, and other body prominences; and
(D) methods to assist the resident
to remain in good body alignment.
(d) Stasis ulcers. Based on the comprehensive
assessment of the resident, the facility shall ensure both of the following:
(1) Any resident who is identified on the
comprehensive assessment as being at risk for development of stasis ulcers does
not develop stasis ulcers, unless the resident's clinical condition
demonstrates that the stasis ulcers were unavoidable.
(2) Any resident with stasis ulcers receives
the necessary treatment and services to promote healing, prevent infection, and
prevent new ulcers from developing.
(e) Range of motion. Based on the
comprehensive assessment of a resident, the facility shall ensure all of the
following:
(1) Any resident who enters the
facility without a limitation in range of motion does not experience a
reduction in range, unless the resident's clinical condition demonstrates that
a reduction in range of motion is unavoidable.
(2) Any resident with a decrease in range of
motion receives appropriate treatment and services to increase range of motion,
if practicable, and to prevent further decrease in range of motion.
(3) Any resident who is identified as at risk
for experiencing a decrease in range of motion is provided appropriate
treatment and services to prevent the decrease.
(f) Mobility. Based on the comprehensive
assessment of the resident, the facility shall ensure all of the following:
(1) A resident's level of mobility does not
decrease after admission, unless the resident's clinical condition demonstrates
that a reduction in mobility is unavoidable.
(2) Any resident with a limitation in
mobility receives the appropriate treatment and services to maintain or
increase the resident's mobility.
(3) Any resident who is identified by the
comprehensive assessment to be at risk for a reduction of function in the area
of mobility is provided the treatment and services to prevent or limit that
decrease in function.
(g) Psychosocial functioning. Based on the
comprehensive assessment of the resident, the facility shall ensure both of the
following:
(1) A resident's level of
psychosocial functioning does not decrease after admission, unless the
resident's clinical condition demonstrates that a reduction in psychosocial
functioning is unavoidable.
(2)
Any resident who displays psychosocial adjustment difficulty receives
appropriate treatment and services to achieve as high a level of psychosocial
functioning as possible within the constraints of the resident's clinical
condition.
(h) Gastric
tubes. Based on the comprehensive assessment of a resident, the facility shall
ensure that each resident meets either of the following criteria:
(1) Has been able to eat enough to maintain
adequate nutrition and hydration independently or with assistance is not fed by
a gastric tube, unless the resident's clinical condition demonstrates that use
of a gastric tube was unavoidable; or
(2) is fed by a gastric tube and receives the
following appropriate treatment and services:
(A) To prevent the following:
(i) Aspiration pneumonia;
(ii) diarrhea;
(iii) vomiting;
(iv) dehydration;
(v) metabolic abnormalities;
(vi) nasal and pharyngeal ulcers; and
(vii) ulceration at a gastrostomy
tube site; and
(B) to
restore, if possible, normal feeding function.
(i) Accidents. The facility shall ensure both
of the following:
(1) The resident's
environment remains free of accident hazards.
(2) Each resident receives adequate
supervision and assistive devices to prevent accidents.
(j) Nutrition. Based on the resident's
comprehensive assessment, the facility shall ensure all of the following for
each resident:
(1) Maintenance of acceptable
parameters of nutritional status, including usual body weight and protein
levels, unless the resident's clinical condition demonstrates that this is not
possible;
(2) a therapeutic diet
as ordered by the attending physician when there is a nutritional problem or
there is a potential for a nutritional problem; and
(3) for residents at risk for malnutrition,
the provision of monitoring and appropriate treatment and services to prevent
malnutrition.
(k)
Hydration. The facility shall provide each resident with sufficient fluid
intake to maintain proper hydration and health.
(1) Fresh water, with or without ice
according to the preference of the resident, shall be accessible to each
resident at all times except when not appropriate due to resident's clinical
condition.
(2) Any resident at
risk for dehydration shall be monitored, and appropriate treatment and services
shall be provided to prevent dehydration.
(l) The facility shall ensure that each
resident receives proper treatment and care for special services, which shall
include the following:
(1) Parenteral
injections. Parenteral injections shall be performed by licensed nurses and
physicians;
(2) Intravenous fluids
and medications. Intravenous fluids and medications shall be administered and
monitored by a registered nurse or by a licensed practical nurse who has
documented successful completion of training in intravenous therapy;
(3) colostomy, ureterostomy, or ileostomy
care;
(4) tracheostomy care;
(5) tracheal suctioning;
(6) respiratory care;
(7) podiatric care;
(8) prosthetic care;
(9) skin care related to pressure ulcers;
(10) diabetic testing; and
(11) other special treatments and
services ordered by the resident's physician.
(m) Drug therapy. The facility shall ensure
that all drugs are administered to residents in accordance with a physician's
order and acceptable medical practice. The facility shall further ensure all of
the following:
(1) All drugs are administered
by physicians, licensed nursing personnel, or other personnel who have
completed a state-approved training program in drug administration.
(2) A resident may self-administer drugs if
the interdisciplinary team has determined that the resident can perform this
function safely and accurately and the resident's physician has given written
permission.
(3) Drugs are prepared
and administered by the same person.
(4) The resident is identified before
administration of a drug, and the dose of the drug administered to the resident
is recorded on the resident's individual drug record by the person who
administers the drug.
(n) Oxygen therapy. The facility shall ensure
that oxygen therapy is administered to a resident in accordance with a
physician's order. The facility shall further ensure all of the following:
(1) Precautions are taken to provide safe
administration of oxygen.
(2) Each
staff person administering oxygen therapy is trained and competent in the
performance of the required procedures.
(3) Equipment used in the administration of
oxygen, including oxygen concentrators, is maintained and disinfected in
accordance with the manufacturer's recommendations.
(4) A sign that reads "oxygen no smoking" is
posted and visible at the corridor entrance to a room in which oxygen is stored
or in use.
(5) All smoking
materials, matches, lighters, or any item capable of causing a spark has been
removed from a room in which oxygen is in use or stored.
(6) Oxygen containers are anchored to prevent
them from tipping or falling over.
