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Comparison of State Requirements
[TOP]
The
Federal
regulations on quality of life are extremely detailed, and cover a
diverse array of topics; moreover, these topics overlap with State
detail related to other Federal regulations such as Pharmacy
Services (related to psychoactive drugs and unnecessary
medications), Nursing Services (related to ADL care, hygiene,
rehabilitative nursing, and prevention and treatment of decubitus
ulcers and contractures, among other things), Dietary Services
(related to nutrition, hydration, special menus, and feeding tubes),
Special Rehabilitation Services (related to range of motion and
maximizing function). They even overlap somewhat with State
regulations on Resident’s Rights and on Resident Behavior and
Facility Practices (i.e. physical and pharmacological restraints)
As always, all
nursing homes must meet federal requirements for quality of care,
even if they do not reiterate them in State regulations. However,
many States repeat the entire federal quality of care regulation as
part of their own State regulations, sometimes with minimal
additions to one section or another.
A search of
the regulations of various States yields additional content related
to many subparts of the Federal quality of care regulation.
Sometimes the additions are terse, say, a statement of frequency for
bathing or for turning residents, and sometimes the additions are
detailed, say, an entire protocol for preventing and treating
bedsores. Most frequently the added detail concerns the
subcategories of ADL care and basic hygiene; prevention and
treatment of decubitus ulcers; prevention and treatment of
contractures; and bowel and bladder care.
General
issues
[TOP]
Most States indicate
that the quality of care provisions will be implemented with
reference to the comprehensive resident care plan. Some States add
other language to the Federal quality of life regulations at the
beginning or in multiple sections to clarify that these rules are
being applied in ways that allow residents to refuse certain
services.
For example:
►
Washington rules qualify the
requirements to optimize resident physical, mental, and social
functioning with the language, “as consistent with residents’
rights.”
►
Indiana regulations repeat the
phrase “based on a resident's comprehensive assessment and care
plan, but subject to the resident's right to refuse” at various
places. They also offer a general caveat as well that “the resident
has the right to refuse care and treatment to restore or maintain
functional abilities after efforts by the facility to counsel and/or
offer alternatives to the resident,” and that “refusal of such care
and treatment should be documented in the clinical records.”
[NHRegsComments:
Recognition of the residents right to refuse various treatment
regimens is an important bow to resident autonomy, though best, if
coupled with expectations for educating and informing residents on
various treatments.]
►
In
Illinois the language “all nursing staff shall assist and
encourage residents” is inserted in front of most of the major
clauses of its Quality of Life regulation.
►
Maine adds the notion of
measurement and timetables and evokes the American Nurses
Association standards at various intervals. The statement reads
each resident must receive, and the facility must 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 plan of care for
each resident that includes measurable objectives and timetables to
meet a resident’s medical, nursing and psychosocial needs that are
identified in the comprehensive assessment and that is in
conformance with the current standards of the Gerontological Nursing
Practice of the American Nurses Association.
Several States introduce the
idea that residents should be free from pain as part of their
quality of care regulations.
►
New Jersey
regulations contain a preamble that says that “the facility shall provide and ensure that
each resident receives all care and services needed to enable the
resident to attain and maintain the highest practicable level of
physical (including pain management), emotional and social
well-being, in accordance with individual assessments and care
plans.
►
Oregon includes “optimum freedom
from pain” in the list of other goals that are in the federal
quality of care regulation.
Several States include an
explicit stipulation that the facility be aware of changes in the
acute health status of the resident. For example:
►
In
North
Carolina, acute changes in the
patient's physical, mental or psychosocial status shall be evaluated
and reported to the physician or other persons legally authorized to
perform medical acts.
►In
Maryland, nursing personnel and
responsible persons shall constantly be alert to the condition and
health needs of patients and residents and shall promptly report to
the nurse or person in charge any untoward patient conditions or
symptoms such as dehydration, fever, drug reaction or
unresponsiveness.
The Federal quality of care
regulation repeatedly uses language that a resident shall not
develop a particular condition unless its development is
“unavoidable.” Recognizing that whether a condition is unavoidable
is a judgment call.
►
Michigan identified a process
by which the State helps facilities determine what is unavoidable.
In the language of its regulations, to
improve consistency and to avoid disputes over “avoidable” and
“unavoidable” negative outcomes, nursing homes and survey agencies
must have a common understanding of accepted process guidelines and
of the circumstances under which it can reasonably be said that
certain actions or inactions will lead to avoidable negative
outcomes. If the “state operations manual” or “the guidance to
surveyors” published by the federal centers for Medicare and
Medicaid services is not specific, a nursing home's overall
documentation of adherence to a clinical process guideline with a
process indicator adopted pursuant to subsection (18) is relevant
information in considering whether a negative outcome was
“avoidable” or “unavoidable” and may be considered in the
application of that term. Further the State, in consultation with
the clarification work group appointed under the previous section,
shall develop and adopt clinical process guidelines that shall be
used in applying the terms set forth in subsection. The areas for
which the department shall establish and adopt clinical process
guidelines and compliance protocols will include but not be limited
to the following topics: (a) Bed rails; (b) Adverse drug effects;
(c) Falls; (d) Pressure sores; (e) Nutrition and hydration
including, but not limited to, heat-related stress; (f) Pain
management; (g) Depression and depression pharmacotherapy; (h)
Heart failure; (i) Urinary incontinence; (j) Dementia; (k)
Osteoporosis; (l)
Altered mental states; and (m) Physical and chemical restraints.
Bedsore and Contractures
[TOP]
Prevention and treatment of decubitus ulcers (i.e. bedsores) and of
contractures are separate but related topics since some of the
strategies to prompt mobility deal with both problems
simultaneously. Federal rules merely state that if residents come
to the facility without the condition they should not incur it
unless unavoidable, and if they are admitted with the condition or
incur it, they should be treated actively for it. Some State
regulations provide more detail. A common form of detail is to
specify frequency for turning residents and/or getting them out of
bed. For example:
► Idaho holds that to prevent
decubitus ulcers or deformities or to treat them, the resident’s
position should be changed every 2 hours when confined to bed or
wheelchairs and they should have opportunity to exercise to promote
circulations.
►
Kansas calls for frequent changes
of position, at least one time every two hours.
Maryland also
requires position changes every two hours.
►
Massachusetts stipulates
encouraging and assisting bedfast patients to change positions at
least every two hours during waking hours (7:00 A.M. to 10:00 P.M.)
in order to stimulate circulation, and prevent decubiti and
contractures.
►Oklahoma calls for turning bed
residents [sic] every two hours or as needed, to prevent pressure
areas, contractures, and decubitus, and ensuring that residents
positions are changed every two hours or as needed when in a chair
and are toileted as needed.
►
Arkansas and
Wyoming also
specifies round-the-clock turning every two hours. In
Arkansas, in
addition to running every two hours day or night, each mattress and
pillow shall be moisture proof or must have a moisture proof cover.
Rubber or plastic sheets shall be cleaned often to prevent
accumulation of odors. Clean cloth draw sheets shall be used over
the rubber or plastic sheet. Arkansas also requires that each
patient shall be up and out of bed for at least a brief period
everyday unless the physician has written an order for him/her to
remain in bed.
►
Wyoming requires encouraging and
assisting dependent residents, as appropriate, to change position at
least every two hours, day and night, to stimulate circulation and
prevent decubitus and deformities.
Wyoming also requires making
every effort to keep residents active and out of bed for reasonable
periods of time, except when contraindicated by physician’s orders,
and encouraging residents to achieve independence in activities of
daily living by teaching self care, transfer, and ambulation
activities; and assisting residents to carry out the prescribed
therapy regimen between visits of the physical, occupational, and
speech therapists. [NHRegsPlus Comments: This specification that PT, OT, and ST regimens
should be reinforced is an important caveat.]
► In the
District of Columbia,
requirements are for encouraging and assisting bedridden residents
or those residents that are confined to a chair to change position
at least every two hours or more often as the resident’s condition
warrants, “day and night,” to stimulate circulation; prevent bed
sores, pressure ulcers and deformities; and to promote the healing
of pressure ulcers. Other stipulations are encouraging residents to
be active and out of bed for reasonable periods of time, except when
contraindicated by physician’s orders; and encouraging residents to
be independent in activities of daily living by teaching and
explaining the importance of self-care, ensuring and assisting with
transfer and ambulating activities, by allowing sufficient time for
task completion by the residents, and by encouraging and honoring
resident’s choices.
[NHRegsComments: the reference to teaching residents the importance of
self-care, and assuring enough time to assist with ADL is a welcome
addition to promote resident-centered care.]
► In
West Virginia, nursing
personnel shall employ appropriate nursing management techniques to
promote the maintenance of skin integrity and to prevent development
of decubiti. Specified techniques may include periodic position
change, massage therapy and regular monitoring of skin integrity.
► In
Maryland, the tasks of the
required Restorative Nursing Care Program are laid out and include
encouraging and assisting patients to keep active and out of bed for
reasonable periods of time, within the limitations permitted by
physicians' orders, and encouraging patients to achieve independence
in activities; and (5) assisting patients to adjust to their
disabilities, to use their prosthetic and assistive devices, and to
redirect their interests, if necessary.
[NHRegs Comments: This reference to helping residents adjust
to their prosthetic devices and redirect interests seems unique to
Maryland.]
Detailed protocols are
built into regulations in
Colorado,
California, and
New Jersey. For
example:
► In
Colorado, the detailed quality
instructions cross-references the section on assessment and care
planning and for decubitus ulcers says:
(1) For residents whose decubitus
ulcers developed while resident was in the facility, the facility
shall have: (a) assessed the potential for skin breakdown; and (b)
provided preventative measures before the ulcer developed to
residents identified in the assessment section.
Colorado describes
residents at risk of decubiti (i.e. a resident exhibiting three or
more of the following symptoms; underweight, incontinence,
dehydration, disorientation or unconsciousness, or limited
mobility).
(2) For all residents with decubitus
ulcers, the facility shall: (a) have developed an individualized
treatment plan designed to alleviate the condition; (b) be provided
active treatment to improve the condition in accordance with the
treatment plan; (c) be evaluating the resident's progress and
treatment at least weekly and revising the treatment plan as needed.
Colorado stipulates that for
all residents who are incontinent or immobile, have impaired
sensation, compromised nutritional or fluid status, or inadequate
hygiene, the facility shall: (a) have completed an initial skin
evaluation upon admission and re-evaluated the condition at least
weekly; (b) be providing measures to prevent the excoriation,
including: (1) maintenance of clean, dry, well lubricated skin; (2)
taking incontinent residents to the bathroom on a regular
individualized schedule; (3) evaluating the need for daily baths;
(4) determining potential trouble spots where microbial growth may
occur (breasts, gluteal folds, skin folds). For residents with
excoriations, the facility shall: (a) develop and be implementing an
individualized treatment plan as part of the care plan for the
excoriation; (b) evaluate the resident's progress at least daily and
review, and revise the treatment plan as needed; (c) enter a
progress note at least weekly in the health record.
Colorado specifies that for
residents requiring devices and/or personal assistance to ambulate,
the facility shall provide and maintain the devices in good repair,
and assist the residents to obtain appropriate footwear. [NHRegsComments: Equipment is often in poor working order
in nursing homes, and this is an important specification to promote
individual functioning.]
► In
California, each patient shall
be given care to prevent formation and progression of decubiti,
contractures and deformities, which shall include: (1) changing
position of bedfast and chair-fast patients with preventive skin
care in accordance with the needs of the patient; (2) encouraging,
assisting and training in self-care and activities of daily living;
(3) maintaining proper body alignment and joint movement to prevent
contractures and deformities; (4) using pressure-reducing devices
where indicated; (5) providing care to maintain clean, dry skin free
from feces and urine; (6) changing of linens and other items in
contact with the patient, as necessary, to maintain a clean, dry
skin free from feces and urine; and (7)carrying out of physician's
orders for treatment of decubitus ulcers. The facility shall notify
the physician, when a decubitus ulcer first occurs, as well as when
treatment is not effective, and shall document such notification.
►
New Jersey provides definitions
for wound care and for the various stages of pressure ulcer within
its regulations. It requires that the measures to prevent
contractures shall be used, and contractures shall be identified,
documented, and managed by rehabilitative nursing and physical
therapy. [NHRegsPlus Comments: this provision seems to suggest that rehabilitative
nursing or PT should be in place to oversee programs of physical
maintenance, not just Medicare-funded rehabititation.]
ADL Care, Grooming, and Personal
Hygiene
[TOP]
The federal rules require assistance to retain and/or promote daily
functioning and assistance with grooming, but provide little
additional detail. Some States supply that detail quite
extensively.
►Many States, namely
Arkansas,
California,
Idaho,
Kansas,
Maine,
New Jersey,
Virginia, and
West
Virginia specify that the resident shall be kept free from offensive
odors. Nebraska qualifies this with the statement that the resident
should be “free of odors not caused by a clinical condition.
Some States stipulate a
minimum number of baths or showers, usually weekly. For example:
► In
Illinois, each resident shall
have at least one complete bath and hair wash weekly and as many
additional baths and hair washes as necessary for satisfactory
personal hygiene
► In
New Jersey, each resident shall
receive at least one bath (tub or shower) per week unless
contraindicated.
Indiana and
Virginia require
more frequent than weekly bathing as a minimum: mandate baths twice
weekly:
► In
Indiana, each resident shall be
bathed or assisted to bathe as frequently as is necessary, but at
least twice weekly. Also each resident shall have at least one (1)
shampoo every week and more often if needed or requested as part of
the resident's normal bathing schedule.
► In
Virginia, each resident shall
receive tub or shower baths as often as needed, but not less than
twice weekly. Residents whose medical conditions prohibit tub or
shower baths shall have a sponge daily. Further, residents who are
incontinent shall have a partial bath, clean clothing and linens
each time their clothing or bed linen is soiled.
[NHRegsComments:
In our nursing home research, we found that most nursing homes
schedule baths weekly, and a few schedule them twice a week.
Relatively few States require a weekly bath and only two required
baths twice a week.]
Other States besides
Virginia
specify frequency of linen changes and also assert that residents
shall have clean clothing.
► In
West Virginia,
beds shall be made daily, with a complete change of linen to be
provided as often as necessary, but at least once each week.
Residents shall have clean clothing as needed to present a neat
appearance and to be free of odors. Residents who are not bedfast
shall be dressed each day, in their own clothing, if available, as
appropriate to their activities, preferences, and comforts.
► In
New Jersey, clean linens shall
be provided for residents at least once a week or whenever linen are
soiled or wet. In Idaho, also bed linens must be changed weekly,
and more if necessary.
Further detail specifies what
constitutes good hygiene.
► In
California each patient shall
be provided care which shows evidence of good personal hygiene,
including care of the skin, shampooing and grooming of hair, oral
hygiene, shaving or beard trimming, cleaning and cutting of
fingernails and toenails.
► In
Maine, good personal hygiene
is required, such as clean, well-groomed hair, cleaned, trimmed
fingernails, clean skin, and freedom from offensive odors, clean
mouth and teeth, and absence of dry cracked lips.;
► In
Idaho, good grooming and
cleanliness of body, skin, nails, hair, eyes, ears, and face,
including the removal or shaving of hair in accordance with
patient/resident wishes or as necessitated to prevent infection.
Each resident shall have clean suitable clothing in order to be
comfortable, sanitary, free of odors, and decent in appearance.
Unless otherwise indicated by his/her physician, this should be
street clothes and shoes.
► In
Arkansas, attention is given to
keeping personal equipment clean. Bedpans, urinals, and wash basins
shall be name-labeled, cleaned after each use, properly stored in
the patient's bedside cabinet, and sanitized at least weekly. Any of
these utensils not name-labeled and stored in individual bedside
cabinets must be sterilized after each use.
► In
Indiana, each resident shall be
dressed in clean garments. Residents who are not bedfast shall be
encouraged to be dressed each day. The resident shall be encouraged
or assisted to be as independent as possible, including having
self-help and ambulation devices readily available to meet the
current needs of the resident with the devices in good repair. Each
resident shall have personal care items such as combs and brushes,
cleaned as appropriate. Also each resident may retain personal care
items if in the original container labeled by the manufacturer.
[NHRegsComments: This last proviso is somewhat ambiguous, but if it
refers to resident toiletries, the requirement that they be kept in
the manufacturer’s packages seems to interfere with a resident’s
common sense wish to keep things in drawers or in toilet bags on
shelves. The rationale for the requirement is understandable,
however; to keep lists of ingredients and other use instructions
intact.]
Bowel and Bladder Care
[TOP]
Some States have specified bowel and
bladder care in more detail.
► In
Alaska, a written assessment is
done by a registered nurse within two weeks after admission of an
incontinent resident's ability to participate in a bowel or bladder
training program; an individualized bowel or bladder training plan
for each resident is initiated , as appropriate; and a monthly
written summary of a resident's performance in the training program.
► In
Nebraska, it is specified that
the facility must residents free of fecal impactions and signs of
discomfort from bowel constipation.
►
California is prescriptive in its
regulations for bowel and bladder programs. A written assessment
by a licensed nurse to determine the patient's ability to
participate in a bowel and/or bladder management program must be
initiated within two weeks after admission of an incontinent
patient. An individualized plan, in addition to the patient care
plan, is initiated for each patient in a bowel and/or bladder
management program. A weekly written evaluation in the progress
notes by a licensed nurse of the patient's performance in the bowel and/or
bladder management program. ) Fluid intake and output shall be
recorded for each patient if ordered by the physician, or for each
patient with an indwelling catheter. Intake and output records
shall be evaluated at least weekly and each evaluation shall be
included in the licensed nurses' progress notes.
After 30 days the patient shall be
reevaluated by the licensed nurse to determine further need for the
recording of intake and output.
Diet, Weight, Hydration, and Feeding
Tubes
[TOP]
Some States detail
frequency and ways to monitor weight changes.
► In
Colorado the facility shall:
(1) evaluate the resident to determine the cause of the weight
change; (2) develop and implement an individualized plan of care as
part of the care plan (including appropriate intervention by other
appropriate disciplines); evaluate resident progress and revise the
plan, as needed; (3) observe food and fluid intake and provide
encouragement to residents with eating problems; (4) provide
reasonable choices of foods to meet personal preferences and
religious needs; (5) if nourishments are provided as part of the
care plan, between meals and at bedtime, document the nourishments
provided, and whether they are consumed; (6) provide assistance in
eating of adaptive eating devices and assist residents in obtaining
dentures, or dental care, as appropriate to the individual resident;
and for residents with mouth or gum problems, meet the requirements
of the dental services section.
► In
New Jersey, residents shall be
weighed accurately every month. Whenever there is a gain or loss of
five percent or more, a note shall be entered into the medical
record stating whether the care plan should be modified.
► In
Oregon, facilities are required
to weigh each resident on admission and quarterly, thereafter, or
more if the resident’s condition warrants it.
Regarding fluids and hydration:
► In
Arkansas, fluids shall be
offered at frequent intervals when the patient is unable to obtain
them. Water pitchers shall be refilled at least once each shift and
should be kept in reach of patients. Clean drinking glasses shall be
kept with each water pitcher.
► In
New Jersey, each resident shall
have access to fresh drinking water or juice at all times, unless
contraindicated. New Jersey also provides detail of a quality
nutrition program for an Alzheimer’s unit. The Alzheimer's/dementia
program provides nutritional intervention as needed, based upon
assessment of the eating behaviors and abilities of each resident.
Interventions may include 1) Verbal and non-verbal eating cues; 2)
modified cups, spoons, or other assistive devices; and 3) simplified
choices of foods or utensils. The Alzheimer's/dementia program
provides a small dining room, separate room, or designated dining
area furnished to meet the needs of the residents, with staff
members or trained volunteers to assist.
New Jersey provides considerable
detail on nasogastric and percutaneous feedings, which are required
required “to treat the individual’s
condition after all non-invasive avenues to improve the nutritional
status have been exhausted with no improvement.” The clinical record
shall document the non-invasive measures provided and the
individual’s poor response. The record shall also indicate the
medical condition for which the feedings are ordered. Included in
this service is the routine care of the tube site and surrounding
skin of the surgical gastrostomy. Detail is also given for the use
of IV tubes.
New York regulations
discuss appropriate use of enteral and nasogastric feeing tubes,
including the complications to prevent (aspiration pneumonia,
diarrhea, significant regurgitation, vomiting, dehydration,
metabolic abnormalities, and nasal-pharyngeal ulcers), and the
stipulations for review of the use of such tubes and the restoration
of normal feeding functions. It is specified that the registered
professional nurse, social worker, and dietitian assess patients
using these tubes as needed but no less than every six weeks for
possible return to normal feeding function. If the nasogastric
feeding is continued longer than 95 days, permanent enteral feeding procedures such as surgical
gastrostomy or jejunostomy shall be considered. Nasogastric tube
feeding formulations shall be given in accordance with the
manufacturer's instructions or at a rate appropriate to the physical
size of the resident and the amount of fluid and nutrients necessary
to meet the assessed caloric and fluid needs of the resident. To
minimize resident discomfort, nasogastric tubes used for resident
feeding purposes shall: (i) be the smallest gauge appropriate for
the patient and shall not exceed 3.96 millimeters (#12 French) in
outside diameter unless medically indicated; (ii) be made of a soft,
flexible material such as medical grade polyurethane or silicone;
and (iii) be specifically manufactured for nasogastric feeding
purposes.
The facility is to l develop and
follow policies and procedures for nasogastric tube feedings which
are written in accordance with prevailing standards of professional
practice and in consultation with the medical, nursing, dietary and
pharmacy services of the facility. Medical practitioners shall be
informed of such policies and procedures governing the use of
nasogastric tubes for resident feeding. The policies and procedures
shall address as a minimum: (i) types and sizes of nasogastric tubes
and the various types of feeding formulations available at the
facility; (ii) the need to assess each resident's clinical and
nutritional status to determine the size of the nasogastric tube and
type of feeding appropriate for that individual; (iii) standard
techniques for inserting a nasogastric tube and confirming the
correct placement of the tube; (iv) procedures for administering
nasogastric feedings including positioning the resident and the need
for resident observation and monitoring before, during and following
the feeding; and (v) infection control policies related to tube
feedings.
Medications
[TOP]
Alaska provides detail on the
resident’s right to be free from psychoactive drugs
administered for purposes of discipline. The record must contain
evidence of an interdisciplinary team's identification of less
restrictive approaches to be used before or in conjunction with the
use of psychoactive drugs. If, after a trial period of less
restrictive measures, a nursing facility decides that a psychoactive
drug would enable and promote greater functional or social
independence, the nursing facility must explain the use of the
psychoactive drug to the resident, before its use. If the resident
has a legal representative, the explanation must also be given to
the resident's legal representative, before its use. The explanation
must include a description of the risks and benefits of the use of
the drug. Approval of the use of a psychoactive drug by a resident
or legal representative must precede its use, except in the case of
a medical emergency in which there is a risk of harm to the resident
or others. The approval, or the circumstances of the emergency, must
be documented in the resident's medical records at the nursing
facility. A resident's medical records must contain evidence of an
interdisciplinary team's periodic reassessment of the psychoactive
drug to determine its effectiveness and appropriateness for
continued use.
Indiana’s discusses
“administration of drugs and treatments, including alcoholic
beverages
[emphasis supplied
by NHRegsPlus],
nutrition concentrates, and therapeutic supplements. These are
ordered by the attending physician and shall be supervised by a
licensed nurse as follows and any error is recorded in the record.
(Thus it appears that non-prescribed use of alcohol is a medication
error.) The physician shall be notified of any error in medication
administration when there are any actual or potential detrimental
effects to the resident.
Nebraska includes a long
section on ensuring quality of care when non-licensed staff are used
as medication assistants.
Miscellaneous [TOP]
► In
Kentucky, a resident who
displays psychosocial adjustment difficulty, receives appropriate
treatment and services to achieve as much remotivation and
reorientation as possible.
► In
Connecticut, every two years,
visual acuity is grossly tested, for near and distant vision for
sighted patients; and every five years screening audiometry is done
for patients without a hearing aide; and tonometry for sighted
patients 40 years and over.
►
Colorado requires that for
residents at high risk for accidents, the facility shall have
identified the risk in the care plan and taken reasonable
precautions to prevent common accidents before the accident
occurred. The State specifies residents at high risk of accidents
to include the blind, the deaf, those with seizure disorders, those
with accidents in the last 6 months, the totally confused but
ambulatory, new amputees, and residents on psychoactive drugs.
►
New Jersey provides detailed
requirements for ventilator services, including specification of
pulmonary function testing and blood gas analysis when these
procedures are performed within the ventilator care unit; requiring
methods that assist in the removal of secretions from the bronchial
tree, such as hydration, breathing and coughing exercises, postural
drainage, therapeutic percussion and vibration, and mechanical
clearing of the airway through proper suctioning technique;
requiring recognition of and attention to the psychosocial needs of
residents and their families; and requiring that facility shall
ensure that each ventilator is equipped with an alarm, designed to
alert the nursing station, on both the pressure valve and the volume
valve. In order to operate a ventilator unit, a facility shall
develop and the Department of Health shall approve a plan of
operation which shall include: (a) a description of the services to
be provided; (b) a description of the staffing pattern; (c) a
description of the qualification, duties and responsibilities of
personnel; (d) a quality assurance plan which shall include: (1)
assignment of responsibility for monitoring and evaluation
activities; (2) identification of indicators and appropriate
clinical critical criteria for monitoring the most important
aspects; and (3) establishment of thresholds (levels or trends) for
the indicators that will trigger evaluation of care.
[NHRegsComments: the reference to meeting the psychosocial needs of
residents and families when the resident is on ventilator care seems
important.]
Maryland
has a similarly detailed set of requirements for ventilator units
and the competences required for those who work in them.
► Various States have language
requiring equipment of different kinds, or requiring that equipment
is in working order. Some of the requirements seem obvious, such as
Georgia’s expectation that each patient shall be provided adequate
supplies and equipment for proper oral hygiene, including a
toothbrush or a denture brush and a denture receptacle when needed.
Georgia also requires that wheelchairs, walkers, and mechanical
lifters be provided by the home when needed.
Massachusetts
requires that all catheters, irrigation sets, drainage tubes, or
other supplies or equipment for internal use, and as identified by
the manufacturer as one-time use only, will be disposed of in
accordance with the manufacture’s recommendations. Disposable
syringes used for feeding purposes shall also be disposed of in
accordance with the manufacturer's recommendations. An adequate
number of commode chairs, wheelchairs, walkers, foot soak basins,
foot boards, cradles, armboards, and other such equipment to meet
patient or resident needs.
►
Illinois requires 60 hours of
training for the nurse in charge of the restorative nursing program.
►
Iowa establishes requirements that
colostomy or ileostomy care or oral suctioning may only be performed
only by a registered nurse or licensed practical nurse or by a
qualified aide under the direction of a registered nurse or licensed
practical nurse.
[Summarized:
September 2008]
Table Comparing States
[TOP]
Note: If the States in this table are not
hyper-linked, their provisions do not appear to address the topic, and
therefore, do not alter the Federal Regulatory scope. The
Table summarizes content on Administration by State (with a link to each
State's specific language).
Link to a downloadable PDF
containing all State regulation on Administration is at the bottom
of the Table.
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