10A NCAC 13G .0903      LICENSED HEALTH PROFESSIONAL SUPPORT

(a)  The facility shall assure that an appropriate licensed health professional participates in the on-site review and evaluation of the residents' health status, care plan, and care provided for residents requiring one or more of the following personal care tasks:

(1)           applying and removing ace bandages, TED hose, binders, and braces and splints;

(2)           feeding techniques for residents with swallowing problems;

(3)           bowel or bladder training programs to regain continence;

(4)           enemas, suppositories, break-up and removal of fecal impactions, and vaginal douches;

(5)           positioning and emptying of the urinary catheter bag and cleaning around the urinary catheter;

(6)           chest physiotherapy or postural drainage;

(7)           clean dressing changes, excluding packing wounds and application of prescribed enzymatic debriding agents;

(8)           collecting and testing of fingerstick blood samples;

(9)           care of well-established colostomy or ileostomy. For the purpose of this Rule, "well-established colostomy or ileostomy" means having a healed surgical site without sutures or drainage;

(10)         care for pressure ulcers, up to and including a Stage II pressure ulcer, which is a superficial ulcer presenting as an abrasion, blister, or shallow crater;

(11)         inhalation medication by machine;

(12)         forcing and restricting fluids;

(13)         maintaining accurate intake and output data;

(14)         medication administration through a well-established gastrostomy feeding tube. For the purpose of this Rule, "well-established gastrostomy feeding tube" means having a healed surgical site without sutures or drainage and through which a feeding regimen has been successfully established;

(15)         medication administration through subcutaneous injection in accordance with Rule .1004(q) except for anticoagulant medications;

(16)         oxygen administration and monitoring;

(17)         the care of residents who are physically restrained and the use of care practices as alternatives to restraints;

(18)         oral suctioning;

(19)         care of well-established tracheostomy, not to include endotracheal suctioning. For the purpose of this Rule, "well-established tracheostomy" means the stoma is well-healed and the airway is patent;

(20)         administering and monitoring of tube feedings through a well-established gastrostomy feeding tube in accordance with Subparagraph (a)(14) of this Rule;

(21)         the monitoring of continuous positive air pressure devices (CPAP and BIPAP);

(22)         application of prescribed heat therapy;

(23)         application and removal of prosthetic devices except as used in post-operative treatment for shaping of the extremity;

(24)         ambulation using assistive devices that requires physical assistance;

(25)         range of motion exercises;

(26)         any other prescribed physical or occupational therapy;

(27)         transferring semi-ambulatory or non-ambulatory residents; or

(28)         nurse aide II tasks according to the scope of practice as established in the Nursing Practice Act and rules promulgated under that Act in 21 NCAC 36.

(b)  The appropriate licensed health professional, as required in Paragraph (a) of this Rule, is:

(1)           a registered nurse licensed under G.S. 90, Article 9A, for tasks listed in Subparagraphs (a)(1) through (28) of this Rule;

(2)           an occupational therapist licensed under G.S. 90, Article 18D or physical therapist licensed under G.S. 90-270.90, Article 18E, for tasks listed in Subparagraphs (a)(17) and (a)(22) through (27) of this Rule;

(3)           a respiratory care practitioner licensed under G.S. 90, Article 38, for tasks listed in Subparagraphs (a)(6), (11), (16), (18), (19), and (21) of this Rule; or

(4)           a registered nurse licensed under G.S. 90, Article 9A, for tasks that can be performed by a nurse aide II according to the scope of practice as established in the Nursing Practice Act and rules promulgated under that Act in 21 NCAC 36.

(c)  The facility shall assure that participation by a registered nurse, occupational therapist, respiratory care practitioner, or physical therapist in the on-site review and evaluation of the residents' health status, care plan, and care provided, as required in Paragraph (a) of this Rule, is completed within 30 days after admission or within 30 days from the date a resident develops the need for the task and at least quarterly thereafter, and includes the following:

(1)           performing a physical assessment of the resident as related to the resident's diagnosis or current condition requiring one or more of the tasks specified in Paragraph (a) of this Rule;

(2)           evaluating the resident's progress to care being provided;

(3)           recommending changes in the care of the resident as needed based on the physical assessment and evaluation of the progress of the resident; and

(4)           documenting the activities in Subparagraphs (1) through (3) of this Paragraph.

(d)  The facility shall follow-up and implement recommendations made by the licensed health professional including referral to the physician or appropriate health professional when indicated. The facility shall document follow-up on all recommendations made by the licensed health professional.

History Note:        Authority G.S. 131D-2.16; 131D-4.5; 143B-165;

Temporary Adoption Eff. January 1, 1996;

Eff. May 1, 1997;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. July 1, 2000;

Temporary Amendment Eff. September 1, 2003;

Amended Eff. June 1, 2004;

Readopted Eff. October 1, 2022.