N.J. Admin. Code § 8:43J-5.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:43J-5.4 - Development and implementation of interdisciplinary plan of care and discharge planning

(a) A registered professional nurse shall develop a written interdisciplinary plan of care within 15 business days of the date of admission, which shall address, at a minimum:

1. The child's scheduled days of attendance;

2. The specific goals of care;

3. The time frames for achieving the goals and the schedule for evaluation of progress;

4. The interventions needed to accommodate the medical, nursing, psychosocial and educational needs of the child and family;

5. The child's needs and preferences as identified by the child's parent;

6. The orders for treatment, services, medications and diet;

7. The time intervals at which the facility shall review the child's response to treatment; and

8. Specific discharge criteria.

(b) In developing the written interdisciplinary plan of care the registered professional nurse shall base the written interdisciplinary plan of care on the assessments provided by nursing, dietary, child life specialist and social work staff, and, if ordered by the child's primary health care provider, other health professionals.

(c) The interdisciplinary plan of care shall contain measurable objectives with interventions based on the child's care needs and means of achieving each goal and shall address, as appropriate, rehabilitative and/or restorative measures, preventive intervention and training and teaching of personal care.

(d) The interdisciplinary plan of care shall contain discharge planning that takes into account the child's changing clinical and/or financial status as it may affect the child's continued eligibility for PMDC.

1. The facility shall involve, to the fullest extent possible, the child's parent in developing the discharge plan.

(e) The facility's interdisciplinary care team shall review the child's interdisciplinary plan of care at least every 60 days, or more often, if indicated by a change in the child's medical condition.

(f) The implementation of the interdisciplinary plan of care is contingent upon the approval of the child's primary health care provider.

(g) The facility shall give a copy of the interdisciplinary plan of care to the child's parent and shall maintain the parent's signed acknowledgment of receipt thereof in the child's medical record.

N.J. Admin. Code § 8:43J-5.4