Wis. Admin. Code Department of Health Services DHS 105.19 - Nurses in independent practice
(1) QUALIFICATIONS.
(a) For MA certification to perform skilled
nursing services as a nurse in independent practice providing home health
services under s.
DHS
107.11(6) or private duty nursing
services under s.
DHS
107.12, the nurse shall be:
1. Licensed as a registered nurse pursuant to
s. 441.06, Stats.;
2. Licensed as a practical nurse pursuant to
s. 441.10, Stats.; or
3. A registered nurse providing supervision
of a licensed practical nurse certified under this section.
(b) For MA certification to
perform respiratory care services as a provider in independent practice, the
provider shall be a nurse described in par. (a) or a respiratory therapist. Any
person providing or supervising respiratory care who is not credentialed by the
national board on respiratory care shall know how to perform the services under
s.
DHS
107.113(1) and shall have the skills
necessary to perform those services. Skills required to perform services listed
in s.
DHS 107.113 (1) (e) to
(f) are required on a case-by-case basis, as
appropriate. In no case may a person provide respiratory care before that
person has demonstrated competence in all areas under s.
DHS 107.113 (1) (a) to
(d). A registered nurse who fulfills these
requirements shall coordinate the recipient's care.
(2) PLAN OF CARE. Nursing services and
respiratory care shall be provided in accordance with a written plan of care
which the physician reviews and signs at least every 62 days or when the
recipient's condition changes, whichever occurs first.
(3) SUPERVISION OF A LICENSED PRACTICAL
NURSE. A registered nurse or physician designated by the LPN providing nursing
or respiratory care services shall supervise the LPN as often as necessary
under the requirements of ss. N 6.03 and 6.04 (2) and shall document the
results of supervisory activities. An LPN may provide nursing or respiratory
care services delegated by an RN as delegated nursing acts under ss. N 6.03 and
6.04 and guidelines established by the board of nursing.
(4) DUTIES OF THE NURSE.
(a) The following nursing services may be
performed only by a registered nurse:
1.
Making the initial evaluation visit;
2. Initiating the physician's plan of care
and necessary revisions;
3.
Providing those services that require care of a registered nurse as defined in
ch. N 6;
4. Initiating appropriate
preventive and rehabilitative procedures;
5. Accepting only those delegated medical
acts which the RN is competent to perform based on his or her nursing
education, training or experience; and
6. Regularly reevaluating the patient's
needs.
(b) Nursing
services not requiring a registered nurse may be provided by a licensed
practical nurse under the supervision of a registered nurse. Licensed practical
nurse duties include:
1. Performing nursing
care delegated by an RN under s. N 6.03;
2. Assisting the patient in learning
appropriate self-care techniques; and
3. Meeting the nursing needs of the recipient
according to the written plan of care.
(c) Both RNs and LPNs shall:
1. Arrange for or provide health care
counseling within the scope of nursing practice to the recipient and
recipient's family in meeting needs related to the recipient's
condition;
2. Provide coordination
of care for the recipient, including ensuring that provision is made for all
required hours of care for the recipient;
3. Accept only those delegated medical acts
for which there are written or verbal orders and for which the nurse has
appropriate training or experience;
4. Prepare written clinical notes that
document the care provided within 24 hours of providing service and incorporate
them into the recipient's clinical record within 7 days; and
5. Promptly inform the physician and other
personnel participating in the patient's care of changes in the patient's
condition and needs.
(5) PATIENT RIGHTS. A nurse shall provide a
written statement of the rights of the recipient for whom services are provided
to the recipient or guardian or any interested party prior to the provision of
services. The recipient or guardian shall acknowledge recipient of the
statement in writing. The nurse shall promote and protect the exercise of these
rights and keep written documentation of compliance with this subsection. Each
recipient receiving care shall have the following rights:
(a) To be fully informed of all rules and
regulations affecting the recipient;
(b) To be fully informed of all services to
be provided by the nurse and of related charges, including any charges for
services for which the recipient may be responsible;
(c) To be fully informed of one's own health
condition, unless medically contraindicated, and to be afforded the opportunity
to participate in the planning of services, including referral to a health care
institution or other agency;
(d) To
refuse treatment to the extent permitted by law and to be informed of the
medical consequences of that refusal;
(e) To confidential treatment of personal and
medical records and to approve or refuse their release to any individual,
except in the case of transfer to a health care facility;
(f) To be taught, and have the family or
other persons living with the recipient taught, the treatment required, so that
the recipient can, to the extent possible, help himself or herself, and the
family or other party designated by the recipient can understand and help the
recipient;
(g) To have one's
property treated with respect; and
(h) To complain about care that was provided
or not provided, and to seek resolution of the complaint without fear of
recrimination.
(6)
UNIVERSAL PRECAUTIONS. A nurse shall have the necessary orientation, education
and training in epidemiology, modes of transmission and prevention of HIV and
other blood-borne or body fluid-borne infections and shall follow universal
blood and body-fluid precautions for each recipient for whom services are
provided. The nurse shall employ protective measures recommended by the federal
centers for disease control (CDC), including those pertaining to medical
equipment and supplies, to minimize the risk of infection from HIV and other
blood-borne pathogens.
Note: A copy of the CDC recommended universal precautions may be obtained from the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701.
(7) MEDICAL RECORD. The nurse shall maintain
a medical record for each recipient. The record shall document the nature and
scope of all services provided and shall be systematically organized and
readily accessible to authorized department personnel. The medical record shall
document the recipient's condition, problems, progress and all services
rendered, and shall include:
(a) Recipient
identification information;
(b)
Appropriate hospital information, including discharge information, diagnosis,
current patient status and post-discharge plan of care;
(c) Recipient admission evaluation and
assessment;
(d) All medical orders,
including the written plan of care and all interim physician's
orders;
(e) A consolidated list of
medications, including start and stop dates, dosage, route of administration
and frequency. This list shall be reviewed and updated for each nursing visit,
if necessary;
(f) Progress notes
posted as frequently as necessary to clearly and accurately document the
recipient's status and services provided. In this paragraph, "progress note"
means a written notation, dated and signed by a member of the health team
providing covered services, that summarizes facts about care furnished and the
recipient's response during a given period of time;
(g) Clinical notes written the day service is
provided and incorporated into the clinical record within 7 days after the
visit or recipient contact. In this paragraph, "clinical note" means a notation
of a contact with a recipient that is written and dated by a member of the home
health team providing covered services, and that describes signs and symptoms,
treatment and drugs administered and the patient's reaction, and any changes in
physical or emotional condition;
(h) Written summaries of the recipient's care
provided by the nurse to the physician at least every 62 days; and
(i) Written authorizations from the recipient
or the recipient's guardian when it is necessary for the nurse to procure
medical supplies or equipment needed by the recipient.
(7m) ELECTRONIC VISIT VERIFICATION. The nurse
is required to capture and retain EVV records.
(8) BACK-UP AND EMERGENCY PROCEDURES.
(a) A recipient's nurse shall designate an
alternate nurse to provide services to the recipient in the event the nurse is
temporarily unable to provide services. The recipient shall be informed of the
identity of the alternate nurse before the alternate nurse provides
services.
(b) The nurse shall
document a plan for recipient-specific emergency procedures in the event a
life-threatening situation or fire occurs or there are severe weather warnings.
This plan shall be made available to the recipient and all caregivers prior to
initiation of these procedures.
(c)
The nurse shall take appropriate action and immediately notify the recipient's
physician, guardian, if any, and any other responsible person designated in
writing by the patient or guardian of any significant accident, injury or
adverse change in the recipient's condition.
(9) DISCHARGE OF THE RECIPIENT. A recipient
shall be discharged from services provided by the nurse upon the recipient's
request, upon the decision of the recipient's physician, or if the nurse
documents that continuing to provide services to the recipient presents a
direct threat to the nurse's health or safety and further documents the refusal
of the attending physician to authorize discharge of the recipient with full
knowledge and understanding of the threat to the nurse. The nurse shall
recommend discharge to the physician and recipient if the recipient does not
require services or requires services beyond the nurse's capability. The nurse
provider shall issue a notification of discharge to the recipient or guardian,
if possible at least 2 calendar weeks prior to cessation of skilled nursing
services, and shall, in all circumstances, provide assistance in arranging for
the continuity of all medically necessary care prior to discharge.
(10) DEPARTMENT REVIEW.
(a)
Record review. The
department may periodically review the records described in this section and s.
DHS
106.02(9), subject only to
restrictions of law. All records shall be made immediately available upon the
request of an authorized department representative.
(b)
In-home visits. As part
of the review under par. (a), the department may contact recipients who have
received or are receiving MA services from a nurse provider. The nurse provider
shall provide any identifying information requested by the department. The
department may select the recipients for visits and may visit a recipient with
the approval of the recipient or recipient's guardian. The recipient to be
visited shall be given the opportunity to have any person present whom he or
she chooses during the visit by personnel of the department or other
governmental investigating agency.
(c)
Investigation
complaints. The department may investigate any complaint received by
it concerning the provision of MA services by a nurse provider. Following the
investigation, the department may issue a preliminary final report to the nurse
provider in question, except when doing so would jeopardize any other
investigation by the department or other state or federal agency.
Notes
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No prior version found.