Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
facility shall assure that an appropriate licensed health professional
participates in the on-site review and evaluation of the residents' health
status, care plan, and care provided for residents requiring one or more of the
following personal care tasks:
(1) applying
and removing ace bandages, TED hose, binders, and braces and splints;
(2) feeding techniques for residents with
swallowing problems;
(3) bowel or
bladder training programs to regain continence;
(4) enemas, suppositories, break-up and
removal of fecal impactions, and vaginal douches;
(5) positioning and emptying of the urinary
catheter bag and cleaning around the urinary catheter;
(6) chest physiotherapy or postural
drainage;
(7) clean dressing
changes, excluding packing wounds and application of prescribed enzymatic
debriding agents;
(8) collecting
and testing of fingerstick blood samples;
(9) care of well-established colostomy or
ileostomy. For the purpose of this Rule, "well-established colostomy or
ileostomy" means having a healed surgical site without sutures or
drainage;
(10) care for pressure
ulcers, up to and including a Stage II pressure ulcer, which is a superficial
ulcer presenting as an abrasion, blister, or shallow crater;
(11) inhalation medication by
machine;
(12) forcing and
restricting fluids;
(13)
maintaining accurate intake and output data;
(14) medication administration through a
well-established gastrostomy feeding tube. For the purpose of this Rule,
"well-established gastrostomy feeding tube" means having a healed surgical site
without sutures or drainage and through which a feeding regimen has been
successfully established;
(15)
medication administration through subcutaneous injection in accordance with
Rule.1004(q) except for anticoagulant medications;
(16) oxygen administration and
monitoring;
(17) the care of
residents who are physically restrained and the use of care practices as
alternatives to restraints;
(18)
oral suctioning;
(19) care of
well-established tracheostomy, not to include endotracheal suctioning. For the
purpose of this Rule, "well-established tracheostomy" means the stoma is
well-healed and the airway is patent;
(20) administering and monitoring of tube
feedings through a well-established gastrostomy feeding tube in accordance with
Subparagraph (a)(14) of this Rule;
(21) the monitoring of continuous positive
air pressure devices (CPAP and BIPAP);
(22) application of prescribed heat
therapy;
(23) application and
removal of prosthetic devices except as used in post-operative treatment for
shaping of the extremity;
(24)
ambulation using assistive devices that requires physical assistance;
(25) range of motion exercises;
(26) any other prescribed physical or
occupational therapy;
(27)
transferring semi-ambulatory or non-ambulatory residents; or
(28) nurse aide II tasks according to the
scope of practice as established in the Nursing Practice Act and rules
promulgated under that Act in
21 NCAC
36.
(b) The appropriate licensed health
professional, as required in Paragraph (a) of this Rule, is:
(1) a registered nurse licensed under G.S.
90, Article 9A, for tasks listed in Subparagraphs (a)(1) through (28) of this
Rule;
(2) an occupational therapist
licensed under G.S. 90, Article 18D or physical therapist licensed under
G.S.
90-270.90, Article 18E, for tasks listed in
Subparagraphs (a)(17) and (a)(22) through (27) of this Rule;
(3) a respiratory care practitioner licensed
under G.S. 90, Article 38, for tasks listed in Subparagraphs (a)(6), (11),
(16), (18), (19), and (21) of this Rule; or
(4) a registered nurse licensed under G.S.
90, Article 9A, for tasks that can be performed by a nurse aide II according to
the scope of practice as established in the Nursing Practice Act and rules
promulgated under that Act in
21 NCAC
36.
(c) The facility shall assure that
participation by a registered nurse, occupational therapist, respiratory care
practitioner, or physical therapist in the on-site review and evaluation of the
residents' health status, care plan, and care provided, as required in
Paragraph (a) of this Rule, is completed within 30 days after admission or
within 30 days from the date a resident develops the need for the task and at
least quarterly thereafter, and includes the following:
(1) performing a physical assessment of the
resident as related to the resident's diagnosis or current condition requiring
one or more of the tasks specified in Paragraph (a) of this Rule;
(2) evaluating the resident's progress to
care being provided;
(3)
recommending changes in the care of the resident as needed based on the
physical assessment and evaluation of the progress of the resident;
and
(4) documenting the activities
in Subparagraphs (1) through (3) of this Paragraph.
(d) The facility shall follow-up and
implement recommendations made by the licensed health professional including
referral to the physician or appropriate health professional when indicated.
The facility shall document follow-up on all recommendations made by the
licensed health professional.
