R432-650-7. Required Staffing

  (1) Each patient shall be under the continuing supervision of a physician. A physician shall be available in medical emergency situations through a current telephone call roster readily accessible to the nursing staff.

  (2) Physician assistants and advanced practice registered nurses may provide services in ESRD facilities in association with the supervising or consulting nephrologist, and in accordance with state law.

  (3) Each ESRD facility shall provide sufficient qualified clinical staff to meet patient care needs. A minimum of two clinical staff personnel, one a registered nurse for supervision of patient clinical care, shall be on duty whenever patients are receiving dialysis services.

  (a) A registered nurse may not supervise the clinical care of more than 10 patients if arranged in an open setting, or 12 patients if arranged in three pods of four patients.

  (b) A registered nurse may not supervise patient clinical care, or provide unsupervised patient clinical care until the nurse has completed training and demonstrated competency as determined by facility policy.

  (c) Dialysis technicians and licensed practical nurses may not be assigned patient clinical care for more than four patients at a time.

  (d) Dialysis technicians and licensed practical nurses must complete training and demonstrate competency according to facility policy prior to providing patient care.

  (4) Each ESRD facility must orient all employees to specific job requirements and facility policies. The facility shall document initial and on-going employee orientation and training. Patient clinical care staff orientation and training shall include at least the following topics:

  (a) patient rights and responsibilities;

  (b) kidney disease processes;

  (c) hemodialysis process;

  (d) hemodialysis complications;

  (e) dialysis access and management;

  (f) psycho-social implications of dialysis on patient care;

  (g) nutritional requirements;

  (h) universal precautions;

  (i) use of the medical emergency kit;

  (j) use and function of facility equipment;

  (k) emergency procedures;

  (l) AAMI water treatment standards; and

  (m) dialyzer re-use procedures, if offered.

  (5) A registered nurse may delegate the following patient care activities to licensed practical nurses or dialysis technicians:

  (a) cannulation of peripheral vascular access;

  (b) administration of intradermal lidocaine, intravenous heparin and intravenous normal saline; and

  (c) initiation, monitoring and discontinuation of the dialysis process.

  (6) Each ESRD facility must ensure that all personnel are licensed, certified or registered as required by the Utah Department of Commerce.

  (7) Each ESRD facility must ensure that on all shifts, staff are available who are CPR certified, trained in emergency procedures and basic first aid.