Nursing Services Requirements for the State of Alaska

07 AAC 012.270. Staff Duties.

(a) The nursing facility staff shall encourage and assist residents to achieve and maintain their highest level of self-care and independence. A registered nurse, in conjunction with an interdisciplinary team, shall, within 14 days of admission of a resident, ensure completion of the comprehensive resident assessment instrument approved by the department. The assessment shall be reviewed by the nurse and interdisciplinary team no less frequently than quarterly and the plan of care revised as necessary. A reassessment shall be completed, by the nurse and interdisciplinary team, after any major permanent change in condition of the resident, but no less frequently than annually.

(b) The nursing facility staff shall give residents the necessary care to prevent pressure ulcers, contractures, and deformities.

(c) The nursing facility staff shall implement procedures to prevent and reduce incontinence of residents. These procedures must include

(1) a written assessment by a registered nurse within two weeks after admission of an incontinent resident's ability to participate in a bowel or bladder training program;

(2) an individualized bowel or bladder training plan for each resident, as appropriate; and

(3) a monthly written summary of a resident's performance in the training program.

(d) The nursing facility staff shall observe the hydration status of residents, and shall record deviations from the normal status and report the deviations to the charge nurse.

History -Eff. 11/19/83, Register 88; am 5/28/92, Register 122.
Authority:
AS 18.20.010
AS 18.20.060

07 AAC 012.275. Nursing and Medical Services.

(a) Except as otherwise specified in this section, a nursing facility must have a registered nurse on duty seven days a week on the day shift and five days a week on the evening shift. A licensed practical nurse must be on duty during all shifts when a registered nurse is not present. A nursing facility must have telephone access to at least one registered nurse at all times and must post the names and phone numbers of those registered nurses at each nurse's station.

(b) A nursing facility with more than 60 occupied beds must have two registered nurses on duty during the day shift and one registered nurse on duty during other shifts.

(c) A nursing facility that shares the same building as a hospital must have a registered nurse on duty in the nursing facility seven days a week on the day shift. On the evening and night shift, a licensed practical nurse may serve as charge nurse. However, an on-duty registered nurse from the hospital must be available to make rounds at the nursing facility and to be otherwise available as needed during the evening and night shifts when a licensed practical nurse is serving as charge nurse. A nursing facility with 14 or fewer occupied beds may use an on-duty registered nurse from the hospital to meet the night shift nursing requirement set out in this subsection.

(d) A nursing facility must have a contract for diagnostic services with a laboratory and x-ray provider approved by the department.

(e) A nursing facility must have a contract with a licensed dentist to provide consultation and necessary dental services to residents.

(f) In addition to the requirements of this section, a governing body of a facility must provide resources and personnel as necessary to meet resident needs under 7 AAC 12.630(b)(6).

History -Eff. 11/19/83, Register 88; am 5/28/92, Register 122.
Authority:
AS 18.20.010
AS 18.20.060

7 AAC 12.670 NURSING SERVICE.

(a) A licensed nurse shall write a patient care plan for each patient in consultation with other patient care personnel and the patient.

(b) The patient care plan must reflect analysis of patient problems and needs, treatment goals, medication prescribed and, upon discharge, instructions given to the patient and the patient's family regarding medication management, including any risks, side effects, and benefits expected, and including any recommended activities and diet.

(c) Each facility must have a registered nurse as the director for nursing services. The director shall perform the following duties:

(1) assure that all nurses comply with the requirements of (a) of this section;

(2) provide a sufficient number of registered nurses to meet patient needs;

(3) write an annual evaluation on the performance of each nurse;

(4) maintain records on the number of nurses employed and the hours and weeks of employment;

(5) delegate to a registered nurse the responsibility to plan, assign, supervise, and evaluate the nursing care for each patient;

(6) select and promote nursing personnel based on their qualifications and terminate employees when necessary; and

(7) establish and implement a standard procedure for the safe administration of medications.

(d) Only a registered nurse who has been appropriately trained may perform a blood transfusion. All other nursing services may be performed only under the direction of a registered nurse. A licensed practical nurse may administer medications, or perform limited infusion therapy functions, if

(1) the licensed practical nurse is authorized under AS 08 to perform these services;

(2) these services are authorized in the facility program standards; and

(3) the program standards have been approved by the hospital administrator and the pharmacist.

(e) Licensed nursing personnel who meet the requirements under (d) of this section to administer medications, and who have been authorized in writing by the hospital administrator and the pharmacist, may perform the following services if a pharmacist is not available:

(1) inventory and restocking of emergency drugs at least every 30 days; and

(2) removal of a single dose of a prescribed drug for a patient or any drug packaged by a pharmacist from the licensed pharmacy or drug room.

(f) If licensed nursing personnel perform a service described in (e)(2) of this section, a pharmacy or drug room record must be kept and signed by the licensed nurse showing the name, strength and amount of the drug, the date and time taken, and the patient to whom the drug is administered.

(g) Except as provided in (i) of this section for a critical access hospital or 7 AAC 12.275 for a nursing facility, a facility that provides a nursing service must have a registered nurse on duty at all times.

(h) The nursing staff shall hold regular meetings to review and evaluate ways of improving nursing care. Minutes of the meetings must be made available to staff members.

(i) The department will waive the requirement of (g) of this section for a critical access hospital if the hospital establishes to the department’s satisfaction that

(1) to have a registered nurse on duty at all times is not financially feasible for the hospital;

(2) the community served by the hospital was involved in the decision to discontinue having a registered nurse on duty at all times and is aware that the hospital's emergency department may close on occasion;

(3) the hospital's emergency medical service plan submitted under 7 AAC 12.612(c)(6) assures that a registered nurse will be available at the hospital's emergency room to receive patients delivered by local emergency services personnel; and

(4) the hospital will have a registered nurse on duty whenever an inpatient is present in the facility.

History - Eff. 11/19/83, Register 88; am 5/28/92, Register 122; am 5/4/97, Register 142; am 8/2/2000, Register 155

Authority ­AS 18.05.040 AS 18.20.010 AS 18.20.060