Section 481.58.19. Required nursing services for residents.

The resident shall receive and the facility shall provide, as appropriate, the following required nursing services under the 24-hour direction of qualified nurses with ancillary coverage as set forth in these rules:

         58.19(1) Activities of daily living.

            a.               Bathing; (II, III)

            b.               Daily oral hygiene (denture care); (II, III)

            c.               Routine shampoo; (II, III)

            d.               Nail care; (III)

            e.               Shaving; (III)

            f.                Daily care and application of prostheses (glasses, hearing aids, glass eyes, limb prosthetics, braces, or other assistive devices); (II, III)

            g.               Ambulation with equipment if applicable, or transferring, or positioning; (I, II, III)

            h.               Daily routine range of motion; (II, III)

            i.                Mobility (assistance with wheelchair, mechanical lift, or other means of locomotion); (I, II, III)

            j.                Elimination.

             (1)             Assistance to and from the bathroom and perineal care; (II, III)

             (2)             Bedpan assistance; (II, III)

             (3)             Care for incontinent residents; (II, III)

             (4)             Bowel and bladder training programs including in-dwelling catheter care (i.e., insertion and irrigation), enema and suppository administration, and monitoring and recording of intake and output, including solid waste; (I, II, III)

            k.               Colostomy care (to 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); (I, II, III)

            l.                Ileostomy care (to 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); (I, II, III)

            m.              All linens necessary; (III)

            n.               Nutrition and meal service.

             (1)             Regular, therapeutic, modified diets, and snacks; (I, II, III)

             (2)             Mealtime preparation of resident; (II, III)

             (3)             Assistance to and from meals; (II, III)

             (4)             In-room meal service or tray service; (II, III)

             (5)             Assistance with food preparation and meal assistance including total assistance if needed; (II, III)

             (6)             Assistance with adaptive devices; (II, III)

             (7)             Enteral nutrition (to be performed by a registered nurse or licensed practical nurse only); (I, II, III)

             (8)             Sufficient fluid intake to maintain proper hydration and health; (I, II, III)

            o.               Promote initiation of self-care for elements of resident care; (II, III)

            p.               Oral suctioning (to 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). (I, II)

         58.19(2) Medication and treatment.

            a.               Administration of all medications as ordered by the physician including oral, instillations, topical, injectable (to be injected by a registered nurse or licensed practical nurse only); (I, II)

            b.               Provision of the appropriate care and treatment of wounds, including pressure sores, to promote healing, prevent infection, and prevent new sores from developing; (I, II)

            c.               Blood glucose monitoring; (I, II)

            d.               Vital signs, blood pressure, and weights; (I, II)

            e.               Ambulation and transfer; (II, III)

            f.                Provision of restraints; (I, II)

            g.               Administration of oxygen (to 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); (I, II)

            h.               Provision of all treatments; (I, II, III)

            i.                Provision of emergency medical care, including arranging for transportation, in accordance with written policies and procedures of the facility; (I, II, III)

            j.                Provision of accurate assessment and timely intervention for all residents who have an onset of adverse symptoms which represent a change in mental, emotional, or physical condition. (I, II, III)

[ARC 1398C, IAB 4/2/14, effective 5/7/14; ARC 2560C, IAB 6/8/16, effective 7/13/16]