R432-300-13. Nursing Care

  (1) Each Type N facility must provide nursing care services to meet the needs of the residents.

  (2) A licensed nurse must be on-site working directly with residents on a daily basis in accordance with each resident's care plan and individual needs.

  (3) Nursing practice must be in accordance with the Utah Nurse Practice Act 58-31b.

  (4) Licensed nurses have the following responsibilities:

  (a) direct the implementation of physician's orders;

  (b) develop and implement an individualized care plan for each resident within seven calender days of admission, and direct the delivery of nursing care, treatments, procedures, and other services to meet the needs of the residents;

  (c) review and update at least every six months the health care needs of each resident admitted to the facility and develop resident care plans according to the resident's needs and the physician's orders;

  (d) review each resident's medication regimen as needed and immediately after medication changes to ensure accuracy;

  (e) ensure that nursing notes describe the care rendered including the resident's response;

  (f) supervise staff to assure they perform restorative measures in their daily care of residents;

  (g) teach and coordinate resident care and rehabilitative care to promote and maintain optimal physical and mental functioning of the resident; and

  (h) plan and conduct documented orientation and in-service programs for staff.

  (5) The licensed nurse must develop and maintain a current health services policy and procedure manual that is to be reviewed and updated by the licensed nurse at least annually.

  (a) The manual must be accessible to all staff and be available for review by the Department.

  (b) The policy and procedure manual must address the following:

  (i) bathing;

  (ii) positioning;

  (iii) enema administration;

  (iv) decubitus prevention and care;

  (v) bed making;

  (vi) isolation procedures;

  (vii) blood sugar monitoring procedures;

  (viii) telephone orders;

  (ix) charting;

  (x) rehabilitative nursing;

  (xi) diets and feeding residents;

  (xii) oral hygiene and denture care;

  (xiii) medication administration;

  (xiv) Alzheimer's/dementia care;

  (xv) universal precautions and blood-borne pathogens; and

  (xvi) housekeeping and cleaning procedures.

  (6) Each resident's care plan must include measures to prevent and reduce incontinence.

  (a) The licensed nurse must assess each resident to determine the resident's ability to participate in a bowel and bladder management program.

  (b) An individualized plan for each incontinent resident shall begin within two weeks of the initial assessment.

  (c) The licensed nurse must document a weekly evaluation of the resident's performance in the bowel/bladder management program.

  (d) Fluid intake and output must be recorded for each resident and evaluated at least weekly when ordered by a physician or nurse.

  (7) The licensee must ensure that staff are trained in rehabilitative nursing.

  (a) The licensee must provide daily and document rehabilitative nursing services for residents who require such services.

  (b) Rehabilitative nursing services shall include the following:

  (i) turning and positioning of residents as per physician's or nurse's orders;

  (ii) assisting residents to ambulate;

  (iii) improving resident's range of motion;

  (iv) restorative feeding;

  (v) bowel and bladder retraining;

  (vi) teaching residents self-care skills;

  (vii) teaching residents transferring skills; and

  (viii) taking measures to prevent secondary disabilities such as contractures and decubitus ulcers.