Section 325.20707. Nursing care and services.

Rule 707. (1) A patient in a home shall receive preventive, supportive, maintenance, habilitative, and rehabilitative nursing care directed to the physiologic and psychosocial needs and well-being of that patient.

(2)   Patient observations by nursing personnel shall be accurately recorded in the clinical record in accordance with established and written procedures.

(3)   Treatments administered to a patient shall be modified according to the patient response consistent with the orders of the attending physician and nursing assessment. All modifications shall be documented in the patient's clinical record.

(4)   Nursing care and services shall include, at a minimum,  all  of  the following:

(a)   Care of the skin, mouth, teeth, hands, and feet and shampooing and grooming of the hair.

(b)    Oral hygiene shall be provided at least daily and more often as required. Special mouth care shall be regularly provided to the acutely ill patient in accordance with individual need or as ordered by the physician.

(c)    A patient's hair shall be combed or brushed daily. A patient's hair shall be shampooed on a routine basis at least weekly and more often as required, unless the attending physician writes an order to the contrary.

(d)  A patient shall be offered the opportunity and facilities for, and assistance with, shaving, if necessary, as often as is required for comfort and appearance, unless the patient requests otherwise or the physician writes an order to the contrary. Daily shaving shall be made available on request or for comfort and appearance as needed.

(e)     A complete tub or  shower   bath  shall  be  taken,  under   staff supervision, by, or administered to, an ambulatory patient at least once a week, unless the physician writes an order to the contrary.

(f)      A bedfast patient shall be assisted with  bathing  or   bathed completely at least twice a week and shall be partially bathed daily and as required due to secretions, excretions, or odors.

(g)   A patient shall be provided the opportunity for, and, as necessary, assisted with, personal care, including toileting, oral  hygiene,  and washing of hands and face before the breakfast meal. A patient's hands shall be washed before and, as required, after all meals and snacks.

(h)    A patient's clothing or bedding shall be changed promptly when it becomes wet or soiled.

(i)   A patient shall receive skin care as required according to written procedures to prevent dryness, irritation, itching, or decubitus.

(j)   A patient shall receive care as required according to written procedures to prevent complications of inactivity or prolonged periods of

being bedfast.

(k)    An inactive or bedfast patient shall be positioned according to written procedures so that major body parts are in natural alignment. Such position shall be changed appropriately at regular and specified intervals. Supportive devices shall be employed as indicated to maintain posture, support weakened body parts, or relieve undue pressure.

(l)   A patient shall have, during each day, planned periods of rest, exercise, and diversional activities consistent with the patient's health status and desires.

(m)   A patient shall be weighed and have his or her temperature, pulse, respirations, and blood pressure taken and recorded on admission and at least monthly thereafter or more frequently if ordered by a physician. The patient's measured or estimated height shall be recorded on admission.

(n)   Provisions shall be made for the marking, laundering, ironing, and mending of the clothing of each patient. The clothing of each patient shall be stored individually. A system of inventory for patient clothing shall be implemented and maintained to prevent and control loss  or  theft insofar as possible.

(o)   A patient who is out of bed in the daytime shall be dressed in comfortable clothing, unless contraindicated by the patient's medical condition or preference and justification thereof is documented in the patient's clinical record. Ambulatory patients shall wear appropriate footwear. Nonambulatory patients shall   at  least  wear appropriate protective foot coverings.

History: 1981 AACS; 1983 AACS.