Maryland COMAR Study Guide- 10.07.02 – Flashcards

daily rounds by a licensed nurse to determine changes in physical and mental status, which includes medications, labs, clinical data, hydration and nutritional needs, skin integrity, weight changes, appetite, injuries, accidents, incidents

the Minimum Data Set (MDS) without the Resident Assessment Protocol Summary (RAPS)

file an application to renew its license every 2 years at least 60 days before the expiration date of the issued license -submitted on forms provided by the Secretary -along with a nonrefundable 2 year license renewal fee based on the payment schedule

only if the department: -requests that the facility exceed its licensed bed capacity -approves a request from a facility to exceed its licensed bed capacity

a written request that includes the circumstances that prompted the dept to make the request, conditions under which the licensed bed capacity may be exceeded, and number of residents by which the facility's licensed capacity may be exceeded.

If an emergency situation exists, a facility may submit written request that includes circumstances or reasons for the request, identity of any resident involved, beginning and ending dates for which the request is made and documentation of any objection by a resident affected by the request, or by the resident's personal rep -This shall be submitted to the Office of Licensing and Certification Programs -Be for a term not to exceed 30 days

The Administrator

shall be responsible for the control of the operation on a 24 hour basis and shall serve full time, except with the Dept approval, serve less than full time for max of 2 nursing facilities, one of which shall have a licensed capacity of 35 beds or less

-geographical location of the facilities -ownership of the facilities -organizational structure of the facilities -size of the facilities, and -background and experience of the Administrator

the facility at all times shall be under the direct and personal supervision of an experienced, trained, competent employee. when the DON serves as relief, DON shall designate an experienced, qualified RN to direct nursing service

-number of vacant licensed beds in the facility -levels of care of the beds reported vacant -types of patients who will be accepted (private, Medicare, Medicaid, etc)

-prevention and control of infections -fire prevention and patient related safety procedures in emergency situations or conditions -accident prevention -confidentiality of patient information -preservation of patient dignity (Residents Rights) -Psychophysical and psychosocial needs of the aged ill -appropriate orientation to the facility and its policies

-employee social security number -home address -educational background -past employment with documentation that references have been considered by the facility -licensure of personnel employed as registered or practical nurses

-any employee who is licensed, certified, or registered under the Health Occupations Article -any employee whose job duties include assisting residents with activities of daily living

-overview of normal aging causing cognitive impairment and mental illness, risk factors, health conditions, early identification and intervention, procedure for reporting -effective communication -behavioral intervention -making activities meaningful -staff and family interaction -end of life care -managing staff stress

employees who are not licensed, certified, or registered or who do not assist residents with activities of daily living

-they are acutely ill and require medical, surgical, or nursing care beyond the capabilities of the facility -dangerous to themselves or others

-a written physician's order is required for a max of 60 days; if continuation of the device is necessary, a new order shall be written every 60 days -the physician's order shall contain the specific type of protective device to be used -the physician's order shall reflect reason for ordering device -the patient shall be observed periodically by personnel, to insure that patient's health needs are met -patient may not be left in the same postural position for more than 2 consecutive hours

-follow-up as needed with a physician or another health care practitioner at a receiving hospital within 24 hours of the transfer of an acutely ill or unstable resident -provide whatever summary or documentation may be needed at the time of the transfer to enable care continuity at a receiving facility -provide a pertinent medical discharge summary within 30 days of discharge or transfer of the resident

-within 30 days of admission, physician shall visit the resident, assess the resident's needs, and prescribe a regimen of medical care. -after 30 days, a physician, NP, or physician assistant shall visit a resident every 30 days, except that a physician shall visit a resident at least every 120 days

-an alternate schedule may not be ordered for the resident's first 90 days of stay -an alternate schedule may not exceed 60 days between visits. If there is no alternate schedule approved by the physician, visits may not exceed 30 day intervals

in a timely fashion, including all information required of a physician

-a current license as a physician in this state -at least 2 years of experience in the medical care of geriatric or chronically ill and impaired residents -successful completion of a curriculum in physician management or administration from the American Medical Directors Association -privileges at a hospital in this state, participant in an HMO network, or credentialed by a credentialing organization approved by the Dept

-application for an initial license -a change of director of nursing

the license may be revoked unless the administrator and the governing body are able to demonstrate that they have made every effort to obtain a replacement

2-99- 1 full time RN 100-199- 2 full time RNs 200-299- 3 full time RNs 300-399- 4 full time RNs

provide a min of 2 hours of bedside care per licensed bed per day, 7 days per week -includes the care provided by RNs, LPNs, and supportive personnel except that ward clerk's time shall be computed at 50% of the time provided in the nursing unit. -only those hours which the DON spends in bedside care may be counted in the 2 hour min requirement; this time shall be documented

the DON or ADON should make clinical rounds to nursing units, randomly reviewing clinical records, medication orders, patient care plans, staff assignments, and visiting patients

-nursing personnel are aware of the nutritional needs and food and fluid intake of patients -nursing personnel assist promptly in feeding patients -the dietetic service is informed of physician's diet orders and patient's problems -food and fluid intake of patients is observed, and deviations from normal are recorded and reported to charge nurse, physician, and dietetic service

if the supervisor is not a dietitian, the individual shall receive regularly scheduled consultation from a registered dietitian. there shall be a signed agreement between the facility and the consultant specifying hours and frequency of service responsibilities, and registration number if applicable

-shall be planned, prepared, and serves as prescribed by the attending physician -shall be planned by a registered dietitian -preparation and serving shall be supervised by qualified dietetic supervisor -a current diet manual shall be available to medical, nursing, and dietetic staff

-at least three meals or their equivalent shall be served daily -served at regular times with not more than 14 hour intervals between the substantial evening meal and breakfast -substantial evening meal is an offering of three or more menu items at one time, one of which includes a high quality protein such as meat, fish, eggs, or cheese. this meal represents no less than 20% of the day's total nutritional requirements

menus as serves and records of food purchased for consumption by patients shall be filed on the premises for a period of 3o days

at least 1 week in advance

shall occur within 48 hours excluding Saturday and Sunday of the physician's order for the service

within 2 weeks of the referral to rehab services, the rehab team shall provide to the attending physician a written report of the eval, including goals and progress notes shall be written every 2 weeks

at least every 30 days

shall meet at least quarterly to: -establish policies and procedures which shall include at least medications administered to patients shall be ordered in writing by the physician, medications shall be administered by appropriately licensed personnel, the person who prepares meds shall give and record them, meds may not be returned to the container (if patient refuses or mistake occurs, the drug shall be discarded and an annotation entered on the chart), nurses may not package, repackage, bottle, or label in whole or in part any med, , meds accurately and plainly labeled, poisons and meds marked "for external use only" are kept separate from general meds and schedule II drugs

-shall be kept in a separately locked, securely fixed boxes or drawers in the storage area, under TWO locks; the lock on the door of a med room shall be counted as one of the two locks -drug record shall be maintained that includes name of patient, date, time, kind, dosage, and method of administration, name of physician, name of nurse or med aide who administered the med -each facility shall maintain a record and signed Schedule II count at each change of shift -two members of nursing home staff (administrator or nurse) may destroy controlled substances in schedule II-V on the premises of the nursing home- record of the disposal shall be maintained in the facility and copy shall be forwarded to the Division of Drug Control

the pharmacist, or his agent -members of the patient's family or the sponsor for the patient may not deliver meds to the patient or facility

facility shall obtain approval before installing the system by the Office of Health Care Quality.

-services to identify and meet the patient's medically related social and emotional needs -if the designee of facility's staff is not a certified social worker, the facility shall effect an agreement with a qualified social work consultant -written social history within 7 days after admission -social history and recommendations made by social work consultant, if applicable, should be in the records -facilities shall provide space for social work personnel that is accessible to patients, medical, and other staff and privacy for interviews

-ID and summary sheet including patient's name, social security number, armed forces status, citizenship, marital status, age, sex, home address and religion -names, addresses, numbers of referral agencies (hospital admitted from), personal physician, dentist, parents't names or next of kin, or authorized representative -evidence of assessment of the needs of the patient, establishment of an appropriate plan of initial and ongoing treatment, care and services provided -authentication of hospital diagnoses (discharge summary) -consent forms when required -medical and social history, report of physical exam, diagnostic and therapeutic orders, consultation reports, observations and progress notes, reports of medication administration, treatments, and clinical findings -discharge summary including final diagnosis and prognosis -discipline assessment and interdisciplinary care plan

-a period of not less than 5 years from the date of discharge -if a minor, 3 years after the patient becomes of age or 5 years, whichever is longer

hand hygiene, respiratory protection, soiled laundry and linen processing, needles, sharps, special medical waste handling and disposal, appropriate use of antiseptics and disinfectants

the facility shall monitor the Purified Protein Derivative (PPD) status of employees at any time that symptoms suggestive of tuberculosis develop, and periodically, consistent with the tuberculosis control plan

max period of time, not to exceed 24 hours -may not be ordered PRN

-evacuation, transportation, or shelter in place of residents -notification of families and staff regarding the action that will be taken concerning the safety and well being of the residents -staff coverage, organization, and assignment of responsibilities for ongoing shelter in place or evacuation -the continuity of services (operations, planning, and financial and logistical arrangements, procuring essential goods, equipment, and services to sustain operations for at least 72 hours, relocation to alternate facilities or other locations, reasonable efforts to continue care) -tracking system to locate and identify residents in the even of displacement including resident's name, time that the resident was sent to the initial alternative facility or location and name of the initial alternative facility or location -when residents are relocated, the facility shall send brief medical fact sheet that includes name, medical condition or diagnosis, medications, allergies, special diets or dietary restrictions, and family or legal rep contact info

At least annually and updated as necessary

posted conspicuously individual floor plans with designated evacuation routes on each floor

within 24 hours of the commencement of job duties and should be documented in staff's personnel file

at least quarterly on all shifts -document completion of each drill, have all staff sign the document, and maintain documentation for a min of 2 years

semiannually on all shifts -the facility practices evacuating residents or sheltering in place so that each is practiced at least one time a year

36 inches high from floor to the top of the handrail on each side of the corridors in patient areas

elevators shall meet the requirements for elevators in long-term care facilities as set forth in the "Minimum Requirements of Construction and Equipment for Hospital and Medical Facilities"

for the purpose of egress lighting and protection -nursing station, drug distribution station or unit dose storage, a lighted area for emergency telephone use, boiler or mechanical room, kitchen, generator set location and switch gear location, elevator, areas where life support equipment is used, lighting for common area of refuge, and lighting in toilet rooms of common area of refuge

nurses' call system, duplex receptacles installed 50 feet apart in all corridors in patient areas, telephone service (at least one telephone shall be available for incoming and outgoing calls), fire pump, sewerage pump and sump pump, elevator, if required for evacuation, necessary heating equipment to maintain temp of 70 degrees in all common areas of refuge, life support equipment, nonflammable medical gas systems

-an area of not less than 30 sq. feet per bed, exclusive of corridors, shall be designated by the facility as the common area or areas of refuge -the 30 sq. feet per bed shall include a min of 5% of the patient bedrooms with min temp of 70 degrees -heated toilet rooms adjacent to the common areas of refuge shall be provided- this is not reflected in the 30 sq. feet per bed

-the emergency generator set shall come on to full speed and load acceptance within 10 seconds -the emergency generator shall have a capacity of 48 hours of operation from fuel stored onsite -emergency power system shall be tested once a month for a min of 30 minutes under normal emergency facility connected load and recorded in a permanent log book

-patient's room shall be lighted by outside windows and also artificial light adequate for reading and other uses -all entrances, hallways, stairways, inclines, ramps, basements, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service

administrative areas, dining areas, and patient's reading lamps

Patient's rooms

nurse station, stairways, corridors

recreation areas, medicine storage and prep area

-there shall be sufficient lighting at night in selected areas of the facility (hallways, stairs, and designated toilets) for the safety of the patient -there shall be one night light in each bedroom for patients

-all facilities shall be equipped with a properly maintained and operative central heating system capable of maintaining 75 degrees throughout patient's section of the building -appropriate provisions shall be made for emergency auxiliary heat by means of alternate sources of electric power, alternate fuels, or standby equipment -space heaters and portable heaters may not be used

75 degrees at winter design conditions

-all air-supply and air-exhaust systems shall be mechanically operated -all fans serving exhaust systems shall be located at the discharge end of the system -outdoor air intakes shall be located as far as practical but not less than 25 feet from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes -the bottoms of ventilation openings shall be not less than 3 inches above the floor of any room

exhaust hoods in food prep areas shall have an air movement exhaust rate of not less than 50 feet per minute in the direction of the exhaust as measured at the front edge of the cooking surface

shall be provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temps in working stations to 97 degrees effective temp

-all openings to the outside air shall be protected effectively against the entrance of insects by closed doors, closed windows, or other-means -doors and windows shall be screened with wire screen not less than 16 meshes per linear inch

-the facility should provide water in all essential areas in the event of the loss of the normal water supply -the water supply shall be adequate in quantity and delivered under sufficient pressure to satisfactory serve fixtures in the facility -a min of 15 psi is required at top floor fixtures during demand period

-washing, bathing, and other personal use, not more than 120 degrees or less than 100 degrees

-nursing care units may not exceed 60 beds -nurses' station shall be centrally located in relation to beds served and shall provide easy view of corridors outside of rooms -a toilet, within the care unit, for the use of personnel, a hand washing sink equipped with 4 inch wrist blades (handles), goose neck spout, and separate soap dispensers and towel dispensers -medicine storage cabinet with locks -nurses' call system, charting desk and supplies, storage space for misc medical supplies which shall be protected from contamination, sufficient space and equipment for medical records

Cold- any temp not exceeding 46 degrees F Cool- any temp between 46 and 59 degrees F Room Temp- any temp between 59 and 86 degrees F Warm- any temp between 86 and 104 degrees F Excessive Heat- any temp above 104 degrees F

capacity shall be provided for storage of at least two complete changes per bed clean linen shall be stored separately from non-clean items

there shall be separate clean and soiled utility rooms in each nursing unit no more than 120 feet to the most remote patient bedroom. there shall be a separate entrance into each room

shall contain wall and base cabinets with stain resistant counter top, a small sink (goose neck spout and wrist blades) set into the counter, or with drainboards, adequate storage and work counter space for storage and assembly of supplies for nursing procedures provision for storing and transporting clean linen in covered container- clean linen may also be stored in closed linen carts or rooms exclusively provided for this purpose

shall contain work counter with sink, goose neck faucet, and wrist blades, a separate wall-hung sink for hand washing, equipped with wrist blades and soap and towel dispensers; space for waste receptacles and soiled linen receptacles , provision for storing and transporting soiled linen in covered leak proof containers, equipment to clean and sanitize bedpans, urinals, and basins

-a call station providing detachable extension cords to each patient's bed in the patient's rooms -these extension cords shall be readily accessible to patients at all times -a visible signal in the corridor above the corridor door of each patient's bedroom, visible from all parts of the corridor -an audible signal and nurses' call enunciator indicating the room from which the call originates shall be located at the nurses' station -a call system shall be provided in each patient's toilet room, bathroom, and shower stall in locations easily accessible to the patients -the nurses' call system shall be so designed as to require resetting at the station where the call originates

one public drinking fountain shall be provided one each floor, usable from a wheelchair -water stations at each unit is considered a drinking fountain

-patients may not occupy rooms extending below ground level -more than 6 persons may not occupy a multiple occupancy bedroom -beds should be prevented from being located near radiators, registers, or sources of draft -cubicle curtains and tracks shall be provided in multiple occupancy bedrooms between beds to insure privacy -adequate closet space shall be provided in, or convenient to, each bedroom to allow each patient to keep necessary items of clothing; adequate storage space shall be provided for patients' personal possessions, including storage of seasonal clothing -all occupants of any bedroom shall be of the same sex, except in the case of a two-bedroom occupied only by husband & wife -a distance of at least 3 ft shall be maintained between each bed; each bed placed so that all sides of the bed are at least 18 in from walls or heating units -single-bed room- 100 feet min; multiple-bed room- 80 feet min -floor areas of toilet rooms and bathing facilities, closets, and areas occupied by wardrobes, bureaus, or lockers are not included in the calculation of floor space -min horizontal dimension is to be 10 feet to facilitate the placement of beds and to maintain a min clearance of 3 feet at the foot of the bed -window area may not be less than 10 sq ft per bed, half of which is able to be opened; a window opening shall be at least 28in X 28in (to permit entry of firemen, removal of smoke, and emergency evacuation) -the presence of portable air-conditioning units may not block window space - each patient shall be provided with his own bed (at least 36 inches wide), extra pillows, bedside stand with drawer, towel rack, comfortable chair, at least two dresser drawers in a chest of drawers, enclosed space for hanging clothing, wall mirror in each room, and bedside lamp for reading or bedside care

shall be in a separate room for each 12 beds -shall be large enough to accommodate wheelchair and attendant

at least one toilet room on each floor large enough to accommodate wheelchair and attendant -for each 8 beds, at least one toilet enclosed in a separate room or stall -shall be one lavatory for every 4 beds -all lavatories shall have towel dispenser and soap dispenser

disposable pans and urinals shall be cleaned and sanitized when needed or at least weekly

-75 sq ft shall be allotted for treatment area per patient -all electrical equipment shall be calibrated according to manufacturer's directions; a sticker bearing the date of the most current inspection shall be affixed on each piece of equipment

there shall be at least 12 sq ft per bed for 50% of the total licensed beds

the total areas set aside for patients' dining and recreation areas shall be no less than 30 sq ft per bed for the first 100 beds and 27 sq ft per bed for all beds in excess of 100 -the kitchen may not be used as a passageway; it shall be used for no other purpose than activities connected with food service

at least one nourishment pantry convenient to the nursing station shall be provided on each floor in facilities using a centralized food service system -min equipment: fridge, cabinets for dry storage and supplies, work space, sink for purposes other than hand washing, hand washing sink with soap and towel dispenser

-it is recommended that 2 sq ft per patient be provided and that the area be located within easy access to the receiving area and the kitchen -the storeroom shall be cool and well ventilated -all food supplies shall be stored off the floor and away from the wall to allow for cleaning

-feeds residents who do not have difficulty swallowing, choking, recurrent lung aspirations, or tube or parenteral intravenous feedings -a state approved training course for paid feeding assistants shall consist of at least 8 hours of training that includes: feeding techniques, assistance with feeding and hydration, communication and interpersonal skills, appropriate responses to resident behavior, safety and emergency procedures, infection control, resident rights, recognizing changes in a resident's behaviors that are inconsistent with normal behavior -successful completion of a two-part test that includes: written test with a passing score of 80% and demonstration of proper feeding skills performed on a resident under observation