La. Admin. Code tit. 48 § I-8443

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Current through Register Vol. 50, No. 11, November 20, 2024

Section I-8443 - Personnel Qualifications and Responsibilities

A. Chief Executive Officer or Administrator

1. Qualifications are as cited in the CFR and designated in writing by the governing body.

2. Responsibilities include:

a. enforcement of local, federal and state requirements;

b. overall management of the facility;

c. annual documented review and appropriate actions taken on all policies, procedures, facility rules, goals, grievances, budget, internal and external evaluations (including all survey findings);

d. implementation and enforcement of codes of conduct to ensure professional, ethical and legal operations; and

e. implementation and enforcement of facility practices that ensure that employees have the necessary administrative support to provide therapeutic milieu for patients (including adequate staff, supplies, and other support).

B. Clinical Nursing Supervisor

1. Qualifications

a. currently licensed as a registered nurse in the state of Louisiana;

b. eighteen months or more of clinical experience as a registered nurse; and

c. six months or more of clinical experience which must include: nursing care of a patient with permanent kidney failure or who is undergoing kidney transplantation, including training in and experience with the dialysis process.

2. Responsibilities include:

a. supervising the clinical nursing functions of the facility;

b. performing the liaison duties between others, including facility staff, physicians and patients;

c. supervising the training and performance of the technicians and non-medical staff in order to ensure safe care;

d. functioning as a patient advocate; and

e. accepting responsibility and accountability for the assessment, planning, intervention, teaching, supervision, and evaluation of care to ensure that the patient receives safe and effective dialysis treatment according to the prescribed treatment plan and in accordance with LAC 46:XLVII.3901-3913.

C. Charge Nurse

1. Qualifications

a. currently licensed as registered nurse in the state of Louisiana;

b. six months or more of clinical experience as a registered nurse; and

c. three months or more of the clinical experience must include nursing care of a patient with permanent kidney failure or who is undergoing kidney transplantation, including training in and experience with the dialysis process.

2. Responsibilities include:

a. accepting responsibility and accountability for the assessment, planning, intervention, teaching, supervision, and evaluation of care to ensure that the patient will receive safe and effective dialysis treatment according to the prescribed treatment plan and in accordance with LAC 46:XLVII.3901-3913;

b. performing initial verification and biannual validation of cannulating skills of dialysis technicians and LPN's;

c. providing supervision and assistance as needed to RN's, LPN's and dialysis technicians; and

d. being on site and available in the treatment area to provide patient care during all dialysis treatments, but may leave the immediate area for meals and breaks. However, during these periods of absence the facility must insure that all necessary care can be delivered by the licensed person on duty.

D. Registered Nurse

1. Qualifications. Possession of a current valid license or be an RN applicant with a temporary permit to practice in Louisiana.

2. Responsibilities include:

b. conducting admission nursing assessments with each visit prior to delegating any task other than collection of data (vital signs only);

c. reassessing patients as needed to determine a change in the patient's status or at the patient's request;

d. participating in the team review of a patient's progress;

e. recommending changes in treatment based on the patient's current needs;

f. providing oversight and direction to dialysis technicians and LPN's; and

g. participating in continuous quality improvement activities.

3. Registered nurses may perform the duties of the nursing positions cited above for which they are qualified and designated.

E. Dietitian/Nutritionist

1. Qualifications. Possession of a currently valid license with the Louisiana Board of Dietitians/Nutritionists.

2. Responsibilities include:

a. those duties defined in R.S. 37:3081-3094;

b. providing in-service and staff training, consultation to professionals and paraprofessionals, and direct supervision as needed to improve the overall quality of care being provided;

c. conducting individual and/or group didactic and counseling interaction with patients as needed to achieve compliance with dietary restrictions;

d. documenting direct communication with other dietitians who may be involved in the patient's care, such as dietitians at the nursing home, assisted living, etc;

e. providing continuous learning opportunities for patients and/or care givers, including regionally appropriate recipes when possible; and

f. providing adequate knowledge to staff to reinforce patient education.

F. Social Worker

1. Qualifications. Currently licensed by the Louisiana State Board of Social Work Examiners as a Licensed Clinical Social Worker or certified by the board as either a graduate social worker (GSW) or provisional graduate social worker (provisional GSW).

2. Responsibilities include those duties defined in R.S. 37:2701-2723 including, but not limited to:

a. Assessment-identification and evaluation of an individual's strengths, weaknesses, problems, and needs for the development of the treatment plan.

b. Case Management-function in which services, agencies, resources, or people are brought together within a planned framework of action directed toward the achievement of established goals. It may involve liaison activities and collateral contracts with other facilities.

c. Patient Education-function in which information is provided to individuals and groups concerning the disease process and treatment, positive lifestyle changes, and available services and resources. Facility orientation may be included with information given regarding rules governing patient conduct and infractions that can lead to disciplinary action or discharge from the facility, availability of services, costs, and patient's rights.

d. Counseling (Individual/Group)-services to provide appropriate support to the patient and/or family to assist individuals, families, or groups in achieving objectives through:

i. exploration of a problem and its ramifications;

ii. examination of attitudes and feelings;

iii. consideration of alternative solutions; and

iv. decision making and problem solving.

e. Referral-assisting patient and/or family to optimally utilize the available support systems and community resources.

f. Treatment Planning-function in which all disciplines and the patient:

i. identify and rank problems needing resolution;

ii. establish agreed upon immediate objectives and long-term goals; and

iii. decide on a treatment process, frequency, and the resources to be utilized.

G. Medical Director. Every facility shall have a designated medical director.

1. Qualifications

a. the medical director shall have a current, valid license to practice medicine in Louisiana;

b. be board certified in Internal Medicine or Pediatrics, or board eligible, or board certified in Nephrology;

c. have completed an accredited Nephrology training program;

d. have at least 12 months of experience or training in the care of patients at ESRD facilities; and

EXCEPTION: In emergency situations, such as, isolated rural areas, natural disasters, or the death of the qualified director, DHH may approve the interim appointment (for a limited time period) of a licensed physician who does not meet the above criteria.

2. Responsibilities include:

a. providing services as required by the facility to meet the standards;

b. providing oversight to ensure that the facility's policies/procedures and staff conform with the current standards of medical practice;

c. performing liaison duties between others, including facility staff, physicians, and patients;

d. ensuring that each patient at the facility receives medical care and supervision appropriate to his/her needs; and

e. ensuring that each patient is under the care of a physician.

H. Physician Services.

1. Each patient shall be under the care of a physician on the medical staff.

2. At a minimum, each patient receiving dialysis in the facility shall be seen by a physician, physician's assistant, or advanced practice nurse at least once every 30 days; home patients shall be seen at least every three months. There shall be evidence of monthly assessment for new and recurrent problems and review of dialysis adequacy.

3. At a minimum, each patient, whether receiving dialysis in the facility or at home, shall be seen by a physician once every twelve months.

4. If advanced practice nurses or physicians assistants are utilized:

a. there shall be evidence of communication with the treating physician whenever the advanced practice registered nurse or physicians assistant changes treatment orders;

b. the advanced practice nurse or physicians assistant may not replace the physician in participating in patient care planning or in quality management activities; and

c. the treating physician shall be notified and direct the care of patient medical emergencies.

I. Patient Care Technician (PCT) or Dialysis Technician

1. Qualifications include basic general education (high school or equivalent) and dialysis training as specified in § 8441 C

2. Responsibilities include:

a. performing patient care duties only under the direct and on-site supervision of qualified registered nurses;

b. performing only those patient care duties that are approved by facility management and included in the policy and procedure manual; and

c. performing only those patient care duties for which they have been trained and are documented as competent to perform.

J. Reuse Technician

1. Qualifications. Basic general education (high school or equivalent), facility orientation program, and completion of education and training to include the following:

a. health and safety training, including universal precautions;

b. principles of reprocessing, including dangers to the patient;

c. procedures of reprocessing, including pre-cleaning, processing, storage, transporting, and delivery;

d. maintenance and safe use of equipment, supplies, and machines;

e. general principles of hemodialysis and in-depth information on dialyzer processing; and

f. competency certification on a biannual basis by a designated facility employee.

2. Responsibilities. The reuse technician is responsible for the transport, cleaning, processing, and storage of dialyzers to limit the possibility of cross contamination, and to avoid improper care of multiple use dialyzers.

3. Any technician or professional staff who performs reprocessing shall have documented training in the procedure.

La. Admin. Code tit. 48, § I-8443

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 28:2198 (October 2002), amended LR 30:433 (March 2004).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2117.4.