SECTION 317:30-5-392. Description of Skilled Nursing services

  Types of Skilled Nursing Services in the waiver programs offered by the Oklahoma Department of Human Services' Developmental Disabilities Services Division (DDSD) are:

(1)   Extended Duty Skilled Nursing Care. Extended Duty Skilled Nursing Care allows a licensed nurse to provide direct services in a community setting up to 24 hours per day.

(A)   Extended Duty Skilled Nursing Care must be:

(i)   provided only to those service recipients who have health-related issues that require skilled treatment or other intervention by a licensed nurse more frequently than every two hours;

(ii)   ordered by a licensed medical physician, osteopathic physician, physician assistant, or advanced practice nurse;

(iii)   justified in amount by the review done in accordance with OAC 340:100-5-26; and

(iv)   documented in the service recipient's Plan of Care.

(B)   When Extended Duty Skilled Nursing Care is medically indicated in accordance with subparagraph (A) of this paragraph, Extended Duty Skilled Nursing Care includes:

(i)   skilled nursing care and interventions rendered directly to the service recipient by the nurse;

(ii)   monitoring, evaluation, and documentation of the service recipient's physical or mental status;

(iii)   administration of medication or treatments or both as ordered by the licensed medical physician, osteopathic physician, physician assistant or advanced practice nurse;

(iv)   documentation of medication or treatment administration, skilled nursing interventions, service recipients's responses to medication or treatment, and any adverse reactions, or other significant changes;

(v)   implementation of all tasks and objectives of the written nursing plan of care; and

(vi)   performance of training and general care to the service recipient during periods in which skilled nursing tasks and interventions are not being performed.

(2)   Intermittent Skilled Nursing Care. Intermittent Skilled Nursing Care involves performance of intermittent skilled tasks or interventions that only a licensed nurse can perform according to Section 1020 of Title 57 of the Oklahoma Statutes and OAC 340:100-5-26.3.

(A)   Intermittent Skilled Nursing Care must be:

(i)   ordered by a licensed medical physician, osteopathic physician, physician assistant or advanced practice nurse;

(ii)   justified in amount by the review done in accordance with OAC 340:100-5-26; and

(iii)   documented in the service recipient's Plan of Care.

(B)   Intermittent Skilled Nursing Care includes:

(i)   skilled nursing care and interventions rendered directly to the service recipient, as ordered by the licensed medical physician, osteopathic physician, physician assistant, or advanced practice nurse;

(ii)   health-related assessments;

(iii)   administration of medication or treatments ordered by the licensed medical physician, osteopathic physician, physician assistant, or advanced practice nurse;

(iv)   documentation of medication or treatment administration, the service recipient's response to medication or treatment, and any adverse reaction or other significant changes; and

(v)   implementation of all tasks and objectives of the nursing plan of care.

(3)   Individualized Skilled Nurse Training and Evaluation. Individualized Skilled Nurse Training and Evaluation provides individualized evaluation and oversight of health care needs by a licensed nurse and specific, individualized health training by a licensed nurse to the service recipient or the service recipient's family or paid caregivers in accordance with Section 1020 of Title 56 of the Oklahoma Statutes and OAC 340:100-5-26.3.

(A)   The licensed nurse assesses the service recipient's training needs prior to initiating competency-based training and develops a nursing plan of care that outlines the methods, goals, and objectives of the training to be performed. The nurse exercises prudent judgment in making the final decision as to what may be trained and delegated to community service workers, as provided by Section 1020 of Title 56 of the Oklahoma Statutes.

(B)   Services include:

(i)   individualized nurse training or evaluation or both provided directly to the service recipient, family or paid caregiver(s), as identified in the individual plan and the nursing plan of care;

(ii)   evaluation and documentation of the competency of individuals trained through return demonstration, written test, verbalization of understanding, or other means suitable to the type of training performed;

(iii)   professional monitoring and supervision to the community service worker in accordance with the applicable licensing requirements and evaluation of:

(I)   the stability of the condition of the service recipient;

(II)   the training and capability of the person receiving training;

(III)   the nature of the task being trained; and

(IV)   the proximity and availability of the licensed nurse to the person when the task is being performed; and

(iv)   attendance at required meetings as specified in the individual plan.

[Source: Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 16 Ok Reg 3283, eff 6-1-99 (emergency); Amended at 17 Ok Reg 1204, eff 5-11-00; Amended at 24 Ok Reg 80, eff 8-2-06 (emergency); Amended at 24 Ok Reg 926, eff 5-11-07]