Md. Code Regs. 10.07.05.12 - Services Provided
A. An
agency shall take reasonable measures to ensure that all individuals who are
referred to provide services to clients do so in accordance with Maryland laws
and regulations, including but not limited to the Health Occupations Article,
Annotated Code of Maryland.
B.
Provision of Services.
(1) A registered nurse
shall assess each new client who requires skilled services and assistance with
the activities of daily living.
(2)
The registered nurse shall also:
(a)
Participate in developing the client's plan of care and in assigning
appropriate personnel;
(b)
Determine whether the client requires the services of a certified nursing
assistant, or whether services may be provided by an individual who is not
certified; and
(c) Participate in
training and retraining the individuals who will provide the care, when
indicated.
C.
Plan of Care.
(1) A client's plan of care
shall be based on assessments of the client's health, function, and
psychosocial condition.
(2) An
assessment of a client shall be completed:
(a)
When the client is requesting or requiring services regulated by this
chapter;
(b) Before the client
receives services from the agency unless:
(i)
The client does not request skilled care or skilled services; and
(ii) There is no reason to believe that the
client requires skilled care or skilled services, such as discharge
instructions requiring skilled care;
(c) Within 48 hours of when the client begins
services when the client requires, including but not limited to:
(i) Wound and catheter care;
(ii) Treatment of stage three or stage four
skin ulcers;
(iii) Ventilator
services;
(iv) Skilled monitoring,
testing, and aggressive adjustment of medications and treatments where there is
the presence of, or risk for, a fluctuating acute condition;
(v) Monitoring of a chronic medical condition
that is not readily controllable through available medications and
treatments;
(vi) Infusion
therapy;
(vii) Specialized
intravenous therapies or nutrition support;
(viii) Monitoring for being at high risk for
health or safety complications which cannot be adequately managed; or
(ix) A different level of care after
notification of a significant change of condition;
(d) At the request of the client or the
client representative;
(e) At least
annually; and
(f) Except in the
following circumstances:
(i) Weather-related
emergencies;
(ii) Natural
disasters; or
(iii) Federal, state,
or local declaration of an emergency.
(3) When a registered nurse determines in the
nurse's clinical judgment that the client does not require an assessment within
48 hours of a significant change of condition as provided in §C(2)(c) of
this regulation, the registered nurse shall:
(a) Document the determination in the
client's record; and
(b) Ensure
that an assessment of the client is conducted within 7 calendar days.
(4) The agency shall ensure that
the care plan developed for the client at a minimum addresses:
(a) The services to be provided to the
client, which are based on the assessment of the client;
(b) When and how often the services are to be
provided;
(c) How and by whom the
services are to be provided;
(d)
Long-range and short-range goals for the client; and
(e) Physical needs, including safety measures
to protect against injury.
(5) Client care plans shall be reviewed by a
registered nurse or another health care practitioner who is authorized to do so
under Health Occupations Article, Annotated Code of Maryland, when
appropriate.
D. Informed
Consent.
(1) An adult client who is competent
to make decisions or a client representative with legal authority to make
health care decisions may consent to make changes to the agency's recommended
plan of care.
(2) A cognitively
capable adult client, but not a client representative with legal authority to
make health care decisions, may waive the licensee's recommendation of
certified care services to be provided in the adult client's home to assist
with treatments of a routine nature, or with the self-administration of
medications.
(3) A cognitively
capable adult client may waive the licensee's recommended skilled
care.
(4) Consents.
(a) The consent given under §D(1)-(3) of
this regulation may be granted only after a discussion of the risks and
benefits with the client or, if appropriate, the client representative with
legal authority to make health care decisions. This discussion shall be
reflected in an informed consent form.
(b) The informed consent form shall be:
(i) Signed and dated by the client, or the
client representative with legal authority over health care decisions;
and
(ii) Documented in the client's
records.
(c) A form
confirming a waiver of skilled services shall be signed by a cognitively
capable adult client and maintained in the client's record.
(5) Client medications shall be
administered in accordance with §F of this regulation.
E. Nursing Supervision.
(1) For clients who require skilled services
or assistance with the activities of daily living, an agency shall have a
registered nurse to provide oversight for:
(a)
Implementation of the care plan;
(b) Delegation;
(c) Supervision; and
(d) Training.
(2) The registered nurse shall provide
periodic, on-site supervision of care:
(a) At
least every 45 days if the staff administers medications to the
client;
(b) At least every 3 months
if the staff assists the client with self-administration of
medications;
(c) At least every 4
months if the staff does not administer medications or assist the client with
medication self-administration; or
(d) At a greater frequency established by the
registered nurse due to the client's medical condition or clinical
status.
(3) The agency
shall maintain accurate documentation of the supervision that is provided by
the registered nurse.
F.
Medication Administration. If agency employees, independent contractors, or
contractual employees administer medications, the agency shall:
(1) Provide for administration of drugs and
treatments by licensed or certified staff consistent with Maryland law and the
client's plan of care, unless the client has executed an informed consent form
under §D of this regulation;
(2) Provide for drugs and treatments to be
administered only as ordered by the physician; and
(3) Document in the client's clinical record:
(a) Medications administered or
taken;
(b) Medication errors;
and
(c) Adverse drug reactions and
corrective action.
G. On-Call Services. The agency shall:
(1) Establish a procedure by which current
clients or their representatives may contact a representative of the agency by
communication device at any time, 24 hours a day and 7 days a week;
(2) Recognize and respond to emergency
inquiries in a manner that is consistent with medical and nursing
standards;
(3) Ensure that the
inquiry is directed to an individual for response as required by medical and
nursing standards;
(4) Ensure that
the individual responds to an inquiry not later than 1 hour after the inquiry
is received by the agency or sooner as necessitated by medical
standards;
(5) Maintain a log of
inquiries that includes the identity of the response personnel, content of the
inquiry, and the time of each inquiry; and
(6) Provide clients or the client
representatives with written procedures and the phone number for on-call
service.
Notes
Regulation .12E amended as an emergency provision effective June 1, 2012 (39:13 Md. R. 784); amended permanently effective September 3, 2012 (39:17 Md. R. 1148)
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