Ga. Comp. R. & Regs. R. 111-8-37-.18 - Nursing Services
(1)
The hospice shall have a system to make available nursing services 24-hours a
day, seven days a week to meet the needs of the patients.
(a) A registered nurse must be available at
all times to provide or supervise the provision of nursing care.
(b) On-site nursing services must be made
available within one hour of notification where the terminally ill patient and
the patient with an advanced and progressive disease who has contracted for
nursing services experiences a symptom-management crisis situation.
(c) The hospice must maintain an on-call log
for all calls received after normal business hours, the records of which shall
be kept for a period of two years.
(2) The hospice must designate a director of
nursing who must be a Georgia-licensed registered nurse and who must be
responsible for implementing a system for delivery, supervision, and evaluation
of nursing and personal care services.
(a) The
director of nursing must establish and implement effective policies and
procedures for nursing and personal care services based on generally accepted
standards of nursing practice.
(b)
The director of nursing must ensure that nursing personnel are oriented to
nursing policies and procedures and are qualified and competent for their
assigned duties.
(c) The director
of nursing must ensure the types and numbers of nursing personnel necessary to
provide appropriate nursing care for each patient in the hospice.
(d) The director of nursing must ensure
patient assignments are made that reflect a consideration of patient needs as
well as nursing staff qualifications and competencies.
(3) Nursing staff must administer medications
and other treatments in accordance with the physicians' orders, generally
accepted standards of practice, and any federal and state laws pertaining to
medication administration.
(4) When
a patient who is terminally ill or whose death is anticipated and who is
receiving hospice care from a licensed hospice dies, a physician assistant, a
nurse practitioner, or a registered professional nurse licensed in this state
and employed by the hospice at the time of the apparent death of such person,
may make the determination and pronouncement of the patient's death in the
absence of an attending physician. Such determination or pronouncement shall be
made in writing on a form approved by the Department.
(5)
Personal Care Services.
Personal care services must be available and provided in all components of the
hospice to meet the needs of patients. The hospice may utilize licensed nurses
or qualified personal care aides for the provision of personal care services.
(a) Personal care aides considered qualified
by training and experience to provide services to patients include:
1. Georgia Certified Nursing Aides with
current certification as such; or
2. Individuals who have completed and can
provide validation or documentation of completion of a home health aide
training and competency evaluation program conducted in a Medicare-certified
home health agency; or
3.
Individuals who have successfully completed a personal care aide-training
program, provided by the hospice under the direction of a registered nurse,
which meets the following requirements:
(i)
The personal care aide-training program must be conducted through classroom and
supervised practical training totaling at least 75 hours;
(ii) At least 16 of the 75 hours of training
shall be devoted to supervised practical training;
(iii) The individual being trained must
complete at least 16 hours of classroom training before beginning the
supervised practical training;
(iv)
Supervised practical training must be provided either in a laboratory setting
or in one of the components of the hospice in which the trainee demonstrates
knowledge while performing tasks on an individual or patient under the direct
supervision of a registered nurse or licensed practical nurse; and
(v) The personal care aide-training program
must address each of the following subject areas:
(I) Communications skills;
(II) Observation, reporting, and
documentation of patient status and the care or service furnished;
(III) Reading and recording temperature,
pulse, and respiration;
(IV) Basic
infection control procedures;
(V)
Basic elements of body functioning and changes in body function that must be
reported to an aide's supervisor;
(VI) Maintenance of a clean, safe, and
healthy environment;
(VII)
Recognizing emergencies and knowledge of emergency procedures;
(VIII) The physical, emotional, and
developmental needs of and ways to work with the populations served by the
hospice, including the need for respect for the patient, the patient's privacy,
and the patient's property;
(IX)
Appropriate and safe techniques in personal hygiene and grooming that include:
I. Bed bath;
II. Sponge, tub, or shower bath;
III. Shampooing in the sink, tub, or
bed;
IV. Nail and skin care;
V. Oral hygiene; and
VI. Toileting and
elimination;
(X) Safe
transfer techniques and ambulation;
(XI) Normal range of motion and
positioning;
(XII) Adequate
nutrition and fluid intake, including preparing and assisting with
eating;
(XIII) Any other task that
the hospice may choose to have the personal care aide perform, as authorized by
law; and
(XIV) Patient rights,
including effectuating advance directives and abuse reporting
requirements.
(b) Prior to providing care independently to
patients, a registered nurse must observe personal care aides actually
delivering care to patients and complete an initial competency evaluation for
all personal care tasks assigned to the aide.
(c) Personal care aides must receive at least
12 hours of continuing education annually regarding applicable aspects of
hospice care and services.
(d) A
registered nurse must prepare for each personal care aide written instructions
for patient care that are consistent with the interdisciplinary plan of care
and must make and document supervisory visits to the terminally ill patient's
residence or living facility at least every two weeks to assess the performance
of the personal care aide services.
(e) At least annually, there must be written
evidence for each personal care aide that reflects that the personal care
aide's performance of required job tasks was directly observed by a registered
nurse and such performance was determined to be competent for all job tasks
required to be performed.
Notes
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No prior version found.