Current through Vol. 42, No. 1, September 16, 2024
Types of Skilled Nursing Services in the waiver programs
offered by the Oklahoma Department of Human Services' Developmental
Disabilities Services Division (DDSD) are:
(1)
Extended Duty Skilled Nursing
Care. Extended Duty Skilled Nursing Care allows a licensed nurse to
provide direct services in a community setting up to 24 hours per day.
(A) Extended Duty Skilled Nursing Care must
be:
(i) provided only to those service
recipients who have health-related issues that require skilled treatment or
other intervention by a licensed nurse more frequently than every two
hours;
(ii) ordered by a licensed
medical physician, osteopathic physician, physician assistant, or advanced
practice nurse;
(iii) justified in
amount by the review done in accordance with OAC
340:100-5-26;
and
(iv) documented in the service
recipient's Plan of Care.
(B) When Extended Duty Skilled Nursing Care
is medically indicated in accordance with subparagraph (A) of this paragraph,
Extended Duty Skilled Nursing Care includes:
(i) skilled nursing care and interventions
rendered directly to the service recipient by the nurse;
(ii) monitoring, evaluation, and
documentation of the service recipient's physical or mental status;
(iii) administration of medication or
treatments or both as ordered by the licensed medical physician, osteopathic
physician, physician assistant or advanced practice nurse;
(iv) documentation of medication or treatment
administration, skilled nursing interventions, service recipients's responses
to medication or treatment, and any adverse reactions, or other significant
changes;
(v) implementation of all
tasks and objectives of the written nursing plan of care; and
(vi) performance of training and general care
to the service recipient during periods in which skilled nursing tasks and
interventions are not being performed.
(2)
Intermittent Skilled Nursing
Care. Intermittent Skilled Nursing Care involves performance of
intermittent skilled tasks or interventions that only a licensed nurse can
perform according to Section 1020 of Title 57 of the Oklahoma Statutes and OAC
340:100-5-26.3.
(A) Intermittent Skilled Nursing Care must
be:
(i) ordered by a licensed medical
physician, osteopathic physician, physician assistant or advanced practice
nurse;
(ii) justified in amount by
the review done in accordance with OAC
340:100-5-26;
and
(iii) documented in the service
recipient's Plan of Care.
(B) Intermittent Skilled Nursing Care
includes:
(i) skilled nursing care and
interventions rendered directly to the service recipient, as ordered by the
licensed medical physician, osteopathic physician, physician assistant, or
advanced practice nurse;
(ii)
health-related assessments;
(iii)
administration of medication or treatments ordered by the licensed medical
physician, osteopathic physician, physician assistant, or advanced practice
nurse;
(iv) documentation of
medication or treatment administration, the service recipient's response to
medication or treatment, and any adverse reaction or other significant changes;
and
(v) implementation of all tasks
and objectives of the nursing plan of care.
(3)
Individualized Skilled Nurse
Training and Evaluation. Individualized Skilled Nurse Training and
Evaluation provides individualized evaluation and oversight of health care
needs by a licensed nurse and specific, individualized health training by a
licensed nurse to the service recipient or the service recipient's family or
paid caregivers in accordance with Section
1020
of Title 56 of the Oklahoma Statutes and OAC
340:100-5-26.3.
(A) The licensed nurse assesses the service
recipient's training needs prior to initiating competency-based training and
develops a nursing plan of care that outlines the methods, goals, and
objectives of the training to be performed. The nurse exercises prudent
judgment in making the final decision as to what may be trained and delegated
to community service workers, as provided by Section
1020
of Title 56 of the Oklahoma Statutes.
(B) Services include:
(i) individualized nurse training or
evaluation or both provided directly to the service recipient, family or paid
caregiver(s), as identified in the individual plan and the nursing plan of
care;
(ii) evaluation and
documentation of the competency of individuals trained through return
demonstration, written test, verbalization of understanding, or other means
suitable to the type of training performed;
(iii) professional monitoring and supervision
to the community service worker in accordance with the applicable licensing
requirements and evaluation of:
(I) the
stability of the condition of the service recipient;
(II) the training and capability of the
person receiving training;
(III)
the nature of the task being trained; and
(IV) the proximity and availability of the
licensed nurse to the person when the task is being performed; and
(iv) attendance at required
meetings as specified in the individual plan.
Added at 12 Ok Reg
751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
7-27-95; Amended at 16 Ok Reg 3283, eff 6-1-99 (emergency); Amended at 17 Ok
Reg 1204, eff 5-11-00; Amended at 24 Ok Reg 80, eff 8-2-06 (emergency); Amended
at 24 Ok Reg 926, eff 5-11-07