Section 460. Health care services

A. The facility shall ensure, either directly or indirectly, that the health care service needs of residents are met. The ways in which the needs may be met include, but are not limited to:

1. Staff of the facility providing health care services;

2. Persons employed by a resident providing health care services; or

3. The facility assisting residents in making appropriate arrangements for health care services.

a. When a resident is unable to participate in making appropriate arrangements, the resident's family, legal representative, designated contact person, cooperating social agency or personal physician shall be notified of the need.

b. When mental health care is needed or desired by a resident, this assistance shall include securing the services of the local community services board, state or federal mental health clinic or similar facility or agent in the private sector.

B. A resident's need for skilled nursing treatments within the facility shall be met by the facility's employment of a licensed nurse or contractual agreement with a licensed nurse, or by a home health agency or by a private duty licensed nurse.

C. Services shall be provided to prevent clinically avoidable complications, including, but not limited to:

1. Pressure ulcer development or worsening of an ulcer;

2. Contracture;

3. Loss of continence;

4. Dehydration; and

5. Malnutrition.

D. When care for gastric tubes is provided to the resident by unlicensed direct care facility staff as allowed in 22VAC40-72-340 J (ii), the following criteria shall be met:

1. The care shall be provided by a direct care staff member who has successfully completed general and resident-specific training requirements and competencies in tube care from the delegating registered nurse, which has been documented by the nurse, and includes the following:

a. Type and amount of feeding and method of administration;

b. Necessary equipment and supplies;

c. Methods for determining that the resident's tube remains properly placed and unobstructed;

d. Acceptable parameters for residual contents—when to administer feedings and when to hold;

e. When, how often and with what amounts of water direct care staff are to flush tube;

f. How tube is to be clamped and secured;

g. How site is to be cleansed and dressed including frequency;

h. What information is to be documented; and

i. What information is to be reported and how soon (e.g., tube out or displaced, drainage around tube, signs of infection, nausea, vomiting, diarrhea, etc.).

2. Whenever administering a tube feeding, the direct care staff member is responsible for all of the following:

a. Confirming physician or other presciber order for type and amount of feeding and method of administration;

b. Confirming written instructions from RN;

c. Gathering necessary equipment and supplies;

d. Identifying resident;

e. Explaining procedure to resident;

f. Confirming that feeding tube is in place and unobstructed;

g. Elevating head of bed or positioning resident comfortably in chair;

h. Washing hands;

i. Preparing feeding according to physician or other prescriber order and written instructions from RN;

j. Checking residual to confirm amount falls within parameters specified by RN;

k. Administering feeding by gravity flow or other method as approved by physician or other prescriber and instructed by RN;

l. Flushing feeding tube with the amount of water specified by the RN;

m. Clamping and securing tube;

n. Cleansing and covering site as instructed;

o. Documenting feeding;

p. Confirming patient comfort, e.g., leaving head of bed elevated or patient positioned comfortably in chair for 30 to 60 minutes; and

q. Documenting resident's tolerance of feeding and any other observations related to the condition and care of the site.

3. Prior to independently administering any tube feedings, the direct care staff person shall successfully demonstrate competency without prompting and without assistance in all of the procedures specified in subdivision 2 of this subsection. The delegating RN shall observe and document a minimum of two successful demonstrations before authorizing in writing the direct care staff member to perform the tube feeding independently. The authorization only applies for more than one resident when the delegating RN has verified and documented that the same type of feeding tube, feeding, and method of administration are used for each resident.

4. Written protocols that encompass the basic policies and procedures for the performance of gastric tube feedings shall be available to any direct care staff member responsible for tube feedings.

5. Contact information for the delegating RN shall be readily available to all staff responsible for tube feedings when an RN or LPN is not present in the facility.

6. The facility shall have a written back-up plan to ensure that a person who is qualified as specified in this subsection is available if the direct care staff member who usually provides the care is absent.

E. When the resident suffers serious accident, injury, illness, or medical condition, or there is reason to suspect that such has occurred, medical attention from a licensed health care professional shall be secured immediately. The circumstances involved and the medical attention received shall be documented in the resident's record. The date and times of occurrence, as well as the personnel involved shall be included in the documentation.

1. The resident's physician (if not already involved), next of kin, legal representative, designated contact person, case manager, and any responsible social agency, as appropriate, shall be notified as soon as possible but at least within 24 hours of the situation and action taken.

2. A notation shall be made in the resident's record of such notice, including the date, time, caller and person notified.

F. If a resident refuses medical attention, the facility shall notify the resident's physician immediately, and next of kin, legal representative, designated contact person, case manager, and any responsible social agency, as appropriate, as soon as possible but at least within 24 hours. A notation shall be made in the resident's record of such refusal and notification, including the date, time, caller and person notified.

G. If a resident refuses medical attention, the facility shall assess whether it can continue to meet the resident's needs.

Historical Notes

Derived from Volume 23, Issue 06, eff. December 28, 2006.

Statutory Authority

§§ 63.2-217 and 63.2-1732 of the Code of Virginia.