N.Y. Comp. Codes R. & Regs. Tit. 10 § 415.12 - Quality of care
Each resident shall receive and the facility shall provide the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care subject to the resident's right of self-determination.
(a) Activities
of daily living. Based on the comprehensive assessment of a resident, the
facility shall ensure that:
(1) a resident's
abilities in activities of daily living do not diminish unless circumstances of
the individual's clinical condition demonstrate that diminution was
unavoidable. This includes the resident's ability to:
(i) bathe, dress and groom;
(ii) transfer and ambulate;
(iii) toilet;
(iv) eat; and
(v) use speech, language or other functional
communication systems;
(2) a resident is given the appropriate
treatment and services to maintain or improve his or her abilities specified in
paragraph (1) of this subdivision; and
(3) a resident who is unable to carry out
activities of daily living receives the necessary services to maintain good
nutrition, grooming, and personal and oral hygiene.
(b) Vision and hearing. To ensure that
residents receive proper treatment and assistive devices to maintain vision and
hearing abilities, the facility shall, if necessary, assist the resident:
(1) in making appointments;
(2) by arranging for transportation to and
from the office of a medical practitioner specializing in the treatment of
vision or hearing impairment or the office of a professional specializing in
the provision of vision or hearing assistive devices if such services are not
provided on-site; and
(3) by
promoting the safekeeping, maintenance, and use of vision or hearing assistive
devices which the resident needs.
(c) Pressure sores. Based on the
comprehensive assessment of a resident, the facility shall ensure that:
(1) a resident who enters the facility
without pressure sores does not develop pressure sores unless the individual's
clinical condition demonstrates that they were unavoidable despite every
reasonable effort to prevent them; and
(2) a resident having pressure sores receives
necessary treatment and services to promote healing, prevent infection and
prevent new sores from developing.
(d) Urinary incontinence. Based on the
resident's comprehensive assessment, the facility shall ensure that:
(1) a resident who is incontinent of bladder
receives the appropriate treatment and services to prevent urinary tract
infections and to restore as much normal bladder function as possible;
and
(2) a resident who enters the
facility without an indwelling catheter is not catheterized unless the
resident's clinical condition demonstrates that catheterization was
necessary.
(e) Range of
motion. Based on the comprehensive assessment of a resident, the facility shall
ensure that:
(1) a resident who enters the
facility without a limited range of motion does not experience reduction in
range of motion unless the resident's clinical condition demonstrates that a
reduction in range of motion is unavoidable; and
(2) a resident with a limited range of motion
receives appropriate treatment and services to increase range of motion and/or
to prevent further decrease in range of motion.
(f) Mental and psychosocial functioning.
Based on the comprehensive assessment of a resident, the facility shall ensure
that:
(1) a resident who displays mental or
psychosocial adjustment difficulty receives appropriate treatment and services
to correct the assessed problem; and
(2) a resident whose assessment did not
reveal a psychosocial adjustment difficulty does not display a pattern of
decreased social interaction and/or increased withdrawn, angry, or depressive
behaviors, unless the resident's clinical condition demonstrates that such a
pattern was unavoidable.
(g) Enteral feeding tubes.
(1) Based on the comprehensive assessment of
a resident, the facility shall ensure that a resident who has been able to eat
alone or with assistance is not fed by an enteral feeding tube unless the
resident's clinical condition demonstrates that use of such a tube was
unavoidable.
(2) A resident who is
fed by an enteral feeding tube shall receive the appropriate treatment and
services to prevent aspiration pneumonia, diarrhea, significant regurgitation,
vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and
to restore, if possible, normal feeding function.
(3) Following consideration of possible
alternatives for short-term nutritional therapy, nasogastric tubes and feeding
formulations may be used for feeding purposes when determined clinically
appropriate by the attending physician and interdisciplinary care team which
includes a health care professional with training in diagnosis and management
of swallowing disorders. Nasogastric tube feedings shall be used to promote a
therapeutic program to maintain adequate nutrition and hydration and include a
plan to help the resident develop or regain eating skills.
(4) Residents receiving nasogastric tube
feedings shall be reassessed at a minimum by the registered professional nurse,
social worker, and dietitian as needed, but no less than once every six weeks,
for the ability to return to normal feeding function. If the nasogastric
feeding is continued, the reasons for continuation shall be documented in the
resident's clinical record. If nasogastric feedings are to be continued longer
than 95 days, permanent enteral feeding procedures such as surgical gastrostomy
or jejunostomy shall be considered.
(5) Nasogastric tube feeding formulations
shall be given in accordance with the manufacturer's instructions or at a rate
appropriate to the physical size of the resident and the amount of fluid and
nutrients necessary to meet the assessed caloric and fluid needs of the
resident.
(6) To minimize resident
discomfort, nasogastric tubes used for resident feeding purposes shall:
(i) be the smallest gauge appropriate for the
patient and shall not exceed 3.96 millimeters (#12 French) in outside diameter
unless medically indicated;
(ii) be
made of a soft, flexible material such as medical grade polyurethane or
silicone; and
(iii) be specifically
manufactured for nasogastric feeding purposes.
(7) The facility shall develop and follow
policies and procedures for nasogastric tube feedings which are written in
accordance with prevailing standards of professional practice and in
consultation with the medical, nursing, dietary and pharmacy services of the
facility. Medical practitioners shall be informed of such policies and
procedures governing the use of nasogastric tubes for resident feeding. The
policies and procedures shall address as a minimum:
(i) types and sizes of nasogastric tubes and
the various types of feeding formulations available at the facility;
(ii) the need to assess each resident's
clinical and nutritional status to determine the size of the nasogastric tube
and type of feeding appropriate for that individual;
(iii) standard techniques for inserting a
nasogastric tube and confirming the correct placement of the tube;
(iv) procedures for administering nasogastric
feedings including positioning the resident and the need for resident
observation and monitoring before, during and following the feeding;
and
(v) infection control policies
related to tube feedings.
(h) Accidents. The facility shall ensure
that:
(1) the resident environment remains as
free of accident hazards as is possible; and
(2) each resident receives adequate
supervision and assistive devices to prevent accidents.
(i) Nutrition. Based on a resident's
comprehensive assessment, the facility shall ensure that a resident:
(1) maintains acceptable parameters of
nutritional status, such as body weight and protein levels, unless the
resident's clinical condition demonstrates that this is not possible;
and
(2) receives a therapeutic diet
when there is a nutritional problem.
(j) Hydration. The facility shall provide
each resident with sufficient fluid intake to maintain proper hydration and
health.
(k) Special needs. The
facility shall ensure that residents receive proper treatment and care for the
following special services:
(1)
injections;
(2) parenteral and
enteral fluids;
(3) colostomy,
ureterostomy or ileostomy care;
(4)
tracheostomy care;
(5) tracheal
suctioning;
(6) respiratory
care;
(7) podiatric care;
and
(8) prostheses.
(l) Drug therapy.
(1) Unnecessary drugs. Each resident's drug
regimen shall include only those medications prescribed to treat a specific
documented illness or condition and not otherwise contraindicated for a given
resident. The drug regimen shall be monitored for evidence of both adverse
actions and therapeutic effect. Dose changes or discontinuation of the drug
must be made if the drug is ineffective and/or is causing disabling or harmful
side effects and/or the condition for which it was prescribed has
resolved.
(2) Psychotropic drugs.
Based on a comprehensive assessment of a resident and consistent with the
provisions of subdivision (a) of section
415.4 of this Part, the facility
shall ensure that:
(i) the use of
psychotropic drugs shall:
(a) meet all
conditions of paragraph (1) of this subdivision;
(b) be ordered by a physician who, in
accordance with generally accepted standards of care and services, specifies
the problem for which the drug is prescribed;
(c) be used, except in emergencies, only as
an integral part of a resident's comprehensive care plan and only after
alternative methods for treating the condition or symptoms have been tried and
have failed; and
(d) be
discontinued if harmful effects of the medication outweigh the beneficial
effects of the drug.
(ii) residents who use psychotropic drugs
receive gradual dose reductions and behavioral interventions, unless clinically
contraindicated, in an effort to discontinue these drugs and assist the
resident to attain and maintain optimum physical and emotional
functioning.
(m) Medication errors. The facility shall
ensure that:
(1) it is free of medication
error rates of five percent or greater; and
(2) residents are free of any significant
medication errors.
Notes
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No prior version found.