{"ref":"DC-HH-CS-02","title":"Skilled Nursing, Psychiatric Nursing, and Monitoring Services","category":"Clinical tasks","summary":"Sets out who may provide skilled nursing, the duties every Agency nurse carries out, on-site supervision of licensed practical nurses at least every 62 calendar days, progress notes every 30 and summary notes every 62 calendar days, the limits on wound care and tube feeding by aides, and the extra requirements for psychiatric nursing, monitoring services, and ventilator-dependent patients.","inShort":["Skilled nursing is given by a registered nurse, or by a licensed practical nurse supervised by a registered nurse, following the plan of care.","A registered nurse visits each LPN on site, during patient care, at least every 62 calendar days.","Nurses write a progress note at least every 30 days and a summary note at least every 62 days. Finish visit notes by the end of the next business day.","Report changes in the patient’s condition to the physician. Call 911 first in an emergency; call the physician the same day for a significant change.","Only nurses do wound care and tube feeding, unless the nurse assigns simple wound care or g-tube feeding to a trained aide and checks on site at least every two weeks."],"primaryCitation":"22-B DCMR §3917","citations":["22-B DCMR §3907.1","22-B DCMR §3907.9","22-B DCMR §3911.2","22-B DCMR §3912.6","22-B DCMR §3916.1","22-B DCMR §3916.3","22-B DCMR §3917.1","22-B DCMR §3917.2","22-B DCMR §3917.3","22-B DCMR §3918.1","22-B DCMR §3918.2","22-B DCMR §3919.1","22-B DCMR §3919.2","22-B DCMR §3924.1","22-B DCMR §3999.1","17 DCMR §9313"],"federalCitations":["42 CFR §484.75","42 CFR §484.115(e)","42 CFR §484.115(k)","42 CFR §484.60(c)(1)"],"surveyorAsks":["Show me the progress notes and summary notes for this skilled nursing patient for the last 62 days.","Who supervises your licensed practical nurses? Show me the last on-site supervisory visit for this LPN."],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22-B DCMR §3917.1)","5. Who Provides Skilled Nursing","6. Duties of the Nurse","7. Supervision of Licensed Practical Nurses","8. Nursing Documentation","9. Reporting Changes to the Physician","10. Patient and Caregiver Instruction","11. Wound Care and Tube Feeding","12. Psychiatric Nursing","13. Monitoring Services","14. Ventilator-Dependent Patients","15. Responsibilities","16. Records and Compliance Monitoring","17. Staff Training","18. References","19. Related Policies and Forms","20. Approval","21. Revision History"],"version":"1.0","sample":false,"pack":"dc-hha","state":"Washington, DC","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}