OAR 411-380-0050: Direct Nursing Service Requirements

(1) DIRECT NURSING SERVICES CRITERIA. The Department uses the Direct Nursing Services Criteria at the following times: (a) For initial eligibility of direct nursing services. (b) As part of annual ISP planning, but no longer than 12 months from the last assessment. (c) After any significant change of condition, such as hospitalization, emergency visits, or significant changes in the health status of the individual, reported by the case management entity or provider. (2) NURSING SERVICE PLAN. Each individual must have a written Nursing Service Plan that meets the standards in OAR chapter 851, division 045. (a) An RN must develop a Nursing Service Plan within seven days of the initiation of direct nursing services and submit the Nursing Service Plan to the case management entity and Department for review. (b) The RN must review, update, and resubmit the Nursing Service Plan to the case management entity and the Department in the following instances: (A) Every six months. (B) Within seven working days of a change of RN. (C) With any request for authorization of an increase in hours of service. (D) After any significant change of condition, such as hospitalization, emergency visits, or significant change in the health status of the individual. (c) The RN must share the Nursing Service Plan with the individual and if applicable, the legal representative, designated representative, foster care provider, or agency providers. (3) Direct nursing services must be documented as part of the ISP. The maximum number of eligible hours based on the Direct Nursing Services Criteria must be authorized in the ISP. (4) Direct nursing services may not duplicate or occur at the same time as hourly attendant care services, except when the delivery of attendant care is provided by a personal support worker or provider agency as defined in OAR 411-317-0000, and the individual: (a) Has been assessed needing Department approved 2:1 attendant care supports based on the results of a functional needs assessment; (b) Is attending employment or day service activities; (c) Needs 2:1 staffing in the community; or (d) Has authorized direct nursing services with a nursing ratio other than 1:1 as described in section (7) of this rule. (5) Direct nursing services must be delivered on a shift staffing basis. Shifts are from a minimum of four hours to a maximum of 16 hours. (6) Direct nursing services include, but are not limited to the following: (a) Continuous assessment and reassessment of the medical condition, as part of each shift. (b) Skilled nursing tasks. (c) Nursing interventions. (d) Implementation of treatment and therapies. (e) Data collection, including ventilator, medication, or seizure logs. (f) Documentation, including shift notes and flow sheets. (g) Written and oral communication with individuals, physicians and other health professionals, other caregivers, case management entities, ISP teams, foster care providers, and agency providers. (h) Assuring current physician orders are in place or coordinating this responsibility with the residential provider. (i) Other nursing responsibilities under OAR 851-045-0040 approved by the Department. (7) NURSING RATIOS. (a) Direct nursing services must be provided exclusively unless direct nursing services are authorized for an individual with a nursing ratio other than 1:1 as described in subsection (b) of this section. (b) Individuals in licensed adult foster homes and 24-hour residential and day service activity settings determined eligible at acuity levels - 1 through 6 based on the Direct Nursing Services Criteria in OAR 411-380-0030(3) may have a nursing ratio no higher than 1:4 or one nurse for four individuals per shift. (c) The nursing ratio is determined by the nurse using their professional judgement at the beginning of each shift within the allotted hours: (A) After reviewing any previous shift documentation; and (B) After an initial assessment of the medical condition of each individual. (d) The decision to have an alternative nursing ratio must be documented as described in OAR 411-380-0080.