Nursing Services Requirements for the State of Oklahoma
310:675-9-1.1.Nursing and personal
care services
(a) The
facility shall ensure that resident rights are respected in
the provision of care.
(b) Basic nursing and personal care
shall be provided for residents as needed.
(1)Nursing care shall include, but
not be limited to:
(A) Encouraging residents to be
active and out of bed for reasonable time periods.
(B) Weighing all residents and
taking temperature, blood pressure, pulse and respirations
at least once every thirty days or as conditions warrant,
with the results recorded in the clinical record.
(C) Offering fluids, and making
fluids available, to maintain proper hydration.
(D) Following proper nutritional
practices for diets, enteral and parenteral feedings and
assistance in eating.
(E) Providing proper skin care to
prevent skin breakdown.
(F) Providing proper body alignment.
(G) Providing supportive devices to
promote proper alignment and positioning.
(H) Turning bed residents every two
hours or as needed, to prevent pressure areas, contractures, and
decubitus.
(I) Performing range of motion exercises
in accordance with individual assessment and care plans.
(J) Ensuring that residents
positions are changed every two hours or as needed when in a
chair and are toileted as needed.
(K) Establishing and implementing
bowel and bladder programs to promote independence, or
developing toileting schedules to promote continence.
(L) Performing catheter care with
proper positioning of bag and tubing at all times.
(M) Recording accurate intake and
output records for residents with tube feedings or
catheters.
(N) Assessing the general mental and
physical condition of the resident on admission.
(O) Updating the assessment and
individual care plan when there is a significant change in
the resident's physical, mental, or psychosocial
functioning.
(P) Recognizing and recording signs
and symptoms of illness or injury with action taken to treat
the illness or injury, and the response to treatments and
medications.
(2)Personal care shall include, but
not be limited to:
(A) Keeping residents clean and free
of odor.
(B) Keeping bed linens clean and
dry.
(C) Keeping resident's personal
clothing clean and neat.
(D) Ensuring that residents are
dressed appropriately for activities in which they
participate; bedfast/chairfast residents shall be
appropriately dressed and provided adequate cover for
comfort and privacy.
(E) Ensuring that the resident's
hair is clean and groomed.
(F) Providing oral hygiene,
including denture care, daily, and when necessary, and
ensuring that oral care equipment and supplies are
available.
(G) Keeping toenails and fingernails
clean and trimmed.
(c) The facility shall assist the
resident in securing other services recommended by a
physician such as, but not limited to, optometry or
ophthalmology, audiology or otology, podiatry, laboratory,
radiology or hospital services. The administration shall,
through social services or other means, assist each resident
desiring or needing medical related services.
[Source: Added at 9 Ok Reg 3163, eff 7-1-92
(emergency); Added at 10 Ok Reg 1639, eff 6-1-93]
310:675-13-5.Nursing service
(a) General. The nursing facility
shall be organized, staffed, and equipped to provide nursing
and health related services to all residents on a continuous
basis.
(b) Licenses. All licensed nurses
shall hold a current license issued by the Oklahoma Board of
Nursing.
(c) Director of nursing.
(1)A registered nurse or licensed
practical nurse shall be designated as the director of
nursing.
(2)The director of nursing shall be
on duty on the day shift and be responsible for all resident
care including, but not limited to, the physical, mental,
and psycho-social needs.
The director of nursing or designee shall
be available by telephone when needed by facility staff.
(3)When necessary, the director of
nursing may work other than the day shift but for no more than
three shifts a week. This exception shall not exceed three
consecutive weeks in a three month period.
(d) Licensed nurses.
(1)The facility shall employ licensed
nurses for a sufficient number of hours to meet the residents'
needs.
(2)A licensed nurse shall supervise
direct care staff and shall direct nursing care for the
residents.
(3)The facility shall use licensed
practical nurses only for the medical procedures for which they
are trained.
(e) Consultant registered nurse.
(1)If the director of nurses is a
licensed practical nurse, a registered nurse shall be employed
for at least eight hours per week as a consultant.
(2)A consultant registered nurse shall
evaluate and consult with the director, of nursing concerning
residents' needs and shall coordinate the assessment and care
plan of each resident.
(3)A consultant registered nurse's
visit shall document the date and the hours spent in
consultation. The documentation shall be signed and reviewed by
the director' of nursing.
(f) Certified medication aide.
(1)Each medication aide shall be a
certified nurse aide who has passed a Department approved
medication administration program.
(2)A graduate nurse or a graduate
practical nurse, who has not yet been licensed, may administer
medications if the nurse has passed an approved competency test
for medication administration.
(3)A certified medication aide may
administer physician ordered medications and treatments under
the direction of a licensed nurse.
(4)The facility shall have a licensed
nurse or physician on-call to handle medical emergencies. The
charge person shall notify the designated person when a medical
emergency arises.
(5)A certified medication aide shall
complete eight hours of continuing education a year that is
approved by the Department.
(g) Nurse aide.
(1)No facility shall use, on a
full-time basis, any person as a nurse aide for more than 120
days unless that person is enrolled in a training program.
(2)No facility shall use, on a
temporary, per diem, or other basis, any person as a nurse aide
unless the individual is listed on the Department's nurse aide
registry.
(3)The facility shall contact the
Department's nurse aide registry prior to employing a nurse aide
to determine if the person is listed on the registry, and if
there is any record of abuse, neglect, or misappropriation of
resident property.
(h) Nursing students. Facilities
participating in a state approved nursing education program may
allow nursing students to administer medications to residents.
The facility shall have a written agreement with the nursing
education program. The agreement shall specify the scope of
activities, education level, and required supervision. The
facility shall maintain a current roster of nursing students in
the program. Details about the
program and its operation within the facility
shall be included in the facility's policy and procedure manual. (i)
Inservice. The facility shall
provide all direct care staff with two hours of inservice
training specific to their job assignment per month. This
training shall include, at least, the following:
(1)Fire safety and first aid classes
semi-annually.
(2)Resident
rights and resident adjustment to institutional life annually.
(3)Cardiopulmonary resuscitation and
Heimlich maneuver procedures annually.
(4)All supervisory staff shall receive
training in regards to applicable local, state, and federal
regulations governing the facility.
[Source: Added at 9 Ok Reg 3163, eff 7-1-92
(emergency); Added at 10 Ok Reg 1639, eff 6-1-93] |
