A facility with 75 to 99 residents in need of skilled nursing care shall have, in addition to the director of nursing services, at least one registered nurse on duty as charge nurse during every daytime tour of duty. In addition, the facility shall have at least one registered nurse on duty as charge nurse every day on at least one other non-daytime tour of duty.
A facility with 100 or more residents in need of skilled nursing care shall have, in addition to the director of nursing services, at least one registered nurse on duty as charge nurse at all times.
An intermediate care facility shall have a charge nurse during every daytime tour of duty, who may be the director of nursing.
The charge nurse, if a registered nurse, shall supervise the nursing care of all assigned residents, and delegate the duty to provide for the direct care of specific residents, including administration of medications, to nursing personnel based upon individual resident needs, the facility's physical arrangement, and the staff capability.
The charge nurse, if a licensed practical nurse, shall manage and direct the nursing and other activities of other licensed practical nurses and less skilled assistants and shall arrange for the provision of direct care to specific residents, including administration of medications, by nursing personnel based upon individual resident needs, the facility's physical arrangement, and the staff capability. A licensed practical nurse who serves as a charge nurse shall be under the supervision and direction of a registered nurse who is either in the facility or on call.
In addition to the requirements of sub. (2)
, there shall be adequate nursing service personnel assigned to care for the specific needs of each resident on each tour of duty. Those personnel shall be briefed on the condition and appropriate care of each resident.
DHS 132.62 History
Cr. Register, July, 1982, No. 319
, eff. 8-1-82; am. (2) (b) 2. and (c), r. (2) (d), Register, January, 1987, No 373
, eff. 2-1-87; am. (3) (a), Register, February, 1989, No. 398
, eff. 3-1-89; CR 04-053
: am. (2) (a) 1. and r. and recr. (3) (a) Register October 2004 No. 586
, eff. 11-1-04; CR 06-053
: r. (1) (b), (2) (a) 2. b., (b) 2. and (c), (3) (a) and (c) to (h), renum. (1) (a) to be (1), cons., renum. and am. (2) (a) 2. (intro.) and a. to be (2) (a) 2., cons., renum. and am. (3) (intro.) and (b) to be (3), Register August 2007 No. 620
, eff. 9-1-07.
The facility shall provide each resident a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.
DHS 132.63(2)(a)(a) Dietitian.
The nursing home shall employ or retain on a consultant basis a dietitian to plan, direct and ensure implementation of dietary service functions.
The nursing home shall designate a person to serve as the director of food services. A qualified director of food services is a person responsible for implementation of dietary service functions in the nursing home and who meets any of the following requirements:
Has completed at least a course of study in food service management approved by the dietary managers association or an equivalent program.
Holds an associate degree as a dietetic technician from a program approved by the American dietetics association.
If the director of food services is not a dietitian, the director of food services shall consult with a qualified dietitian on a frequent and regularly scheduled basis.
DHS 132.63(4)(a)(a) General.
The facility shall make reasonable adjustments to accommodate each resident's preferences, habits, customs, appetite, and physical condition.
A variety of protein foods, fruits, vegetables, dairy products, breads, and cereals shall be provided.
(b) Therapeutic diets.
Therapeutic diets shall be prescribed by the attending physician. The attending physician may delegate to a licensed or certified dietitian the prescribing of a resident's diet, including a therapeutic diet, to the extent allowed by law. Therapeutic diets shall be served consistent with such orders.
DHS 132.63(5)(c)(c) Table service.
The facility shall provide table service in dining rooms for all residents who can and want to eat at a table, including residents in wheelchairs.
(g) Drinking water.
When a resident is confined to bed, a covered pitcher of drinking water and a glass shall be provided on a bedside stand. The water shall be changed frequently during the day, and pitchers and glasses shall be sanitized daily. Single-service disposable pitchers and glasses may be used. Common drinking utensils shall not be used.
All readily perishable food and drink, except when being prepared or served, shall be kept in a refrigerator which shall have a temperature maintained at or below 40°
DHS 132.63 Note
See ch. DHS 145
for the requirements for reporting incidents of suspected disease transmitted by food.
DHS 132.63 History
Cr. Register, July, 1982, No. 319
, eff. 8-1-82; am. (2) (a), (4) (a) 3., (5) (d) and (f) and (7) (a) 4., Register, January, 1987, No. 373
, eff. 2-1-87; r. and recr. (5) (c), Register, February, 1989, No. 398
, eff. 3-1-89; CR 04-053
: am. (1), r. and recr. (2), r. (6) (c) and (7) (a) 4. Register October 2004 No. 586
, eff. 11-1-04; CR 06-053
: r. (2) (c), (3) (4) (a) 1. to 3., and 5., (b) 2. and 3., (5) (a), (b), (d) to (f), (6), (7) (a), (b) 1. and (c), and (8), renum. (4) (a) 4., (b) 1., and (7) (b) 2. to be (4) (a) and (b), (7), Register August 2007 No. 620
, eff. 9-1-07; 2017 Wis. Act 101
: am. (4) (b) Register December 2017 No. 744
, eff. 1-1-18.
Provision of services.
Each facility shall either provide or arrange for, under written agreement, specialized rehabilitative services as needed by residents to improve and maintain functioning.
(b) Report to physician.
Within 2 weeks of the initiation of rehabilitative treatment, a report of the resident's progress shall be made to the physician.
(c) Review of plan.
Rehabilitative services shall be re-evaluated at least quarterly by the physician and therapists, and the plan of care updated as necessary.
(a) Physical therapy.
Physical therapy shall be given or supervised only by a physical therapist.
(b) Speech and hearing therapy.
Speech and hearing therapy shall be given or supervised only by a therapist who:
Meets the standards for a certificate of clinical competence granted by the American speech and hearing association; or
Meets the educational standards, and is in the process of acquiring the supervised experience required for the certification of subd. 1.
(c) Occupational therapy.
Occupational therapy shall be given or supervised only by a therapist who meets the standards for registration as an occupational therapist of the American occupational therapy association.
Equipment necessary for the provision of therapies required by the residents shall be available and used as needed.
DHS 132.64 Note
For record requirement, see s. DHS 132.45
DHS 132.64 History
Cr. Register, July, 1982, No. 319
, eff. 8-1-82; CR 06-053
: r. (2) (a), Register August 2007 No. 620
, eff. 9-1-07.
“Prescription medication" has the same meaning as the term“prescription drug" defined in s. 450.07
Each facility shall provide for obtaining medications for the residents directly from licensed pharmacies.
The facility shall establish, maintain, and implement such policies and procedures as are necessary to comply with this section and assure that resident needs are met.
A facility may have one or more emergency medication kits. All emergency medication kits shall be under the control of a pharmacist.
The emergency kit shall be sealed and stored in a locked area.
A facility may have a contingency supply of medications not to exceed 10 units of any medication. Any contingency supply of medications must be under the control of a pharmacist.
Contingency drugs shall be stored at a nursing unit, except that those medications requiring refrigeration shall be stored in a refrigerator.
(c) Single units.
Contingency medications shall be stored in single unit containers, a unit being a single capsule, tablet, ampule, tubex, or suppository.
(d) Committee authorization.
The quality assessment and assurance committee shall determine which medications and strengths of medications are to be stocked in the contingency storage unit and the procedures for use and re-stocking of the medications.
Unless controlled by a “proof-of-use" system, as provided by sub. (6) (e)
, a copy of the pharmacy communication order shall be placed in the contingency storage unit when any medication is removed.
(b) Storing and labeling medications.
Unless exempted under par. (f)
, all medications shall be handled in accordance with the following provisions:
Medications shall be stored near nurse's stations, in locked cabinets, closets or rooms, conveniently located, well lighted, and kept at a temperature of no more than 85°
2. `Transfer between containers.'
Medications shall be stored in their original containers, and not transferred between containers, except by a physician or pharmacist.
3. `Controlled substances.'
Separately locked and securely fastened boxes or drawers, or permanently affixed compartments, within the locked medication area shall be provided for storage of schedule II drugs, subject to 21 USC ch. 13
, and Wisconsin's uniform controlled substance act, ch. 961
4. `Separation of medications.'
Medications packaged for individual residents shall be kept physically separated.
Medications requiring refrigeration shall be kept in a separate covered container and locked, unless the refrigeration is available in a locked drug room.
6. `External use of medications.'
Poisons and medications for external use only shall be kept in a locked cabinet and separate from other medications, except that time-released transdermal drug delivery systems, including nitroglycerin ointments, may be kept with internal medications.
7. `Accessibility to drugs.'
Medications shall be accessible only to the registered nurse or designee. In facilities where no registered nurse is required, the medications shall be accessible only to the administrator or designee. The key shall be in the possession of the person who is on duty and assigned to administer the medications.
8. `Labeling medications.'
Prescription medications shall be labeled with the expiration date and as required by s. 450.11 (4)
, Stats. Non-prescription medications shall be labeled with the name of the medication, directions for use, the expiration date and the name of the resident taking the medication.
DHS 132.65(6)(c)1.1. `Time limit.'
Unless otherwise ordered by a physician, a resident's medication not returned to the pharmacy for credit shall be destroyed within 72 hours of a physician's order discontinuing its use, the resident's discharge, the resident's death or passage of its expiration date. No resident's medication may be held in the facility for more than 30 days unless an order is written every 30 days to hold the medication.
Records shall be kept of all medication returned for credit. Any medication not returned for credit shall be destroyed in the facility and a record of the destruction shall be witnessed, signed and dated by 2 or more personnel licensed or registered in the health field.
DHS 132.65(6)(d)1.1. `Receipt of medications.'
The administrator or a physician, nurse, pharmacist, or the designee of any of these may be an agent of the resident for the receipt of medications.
When the medication is received by the facility, the person completing the control record shall sign the record indicating the amount received.
3. `Discontinuance of schedule II drugs.'
The use of schedule II drugs shall be discontinued after 72 hours unless the original order specifies a greater period of time not to exceed 60 days.
For schedule II drugs, a proof-of-use record shall be maintained which lists, on separate proof-of-use sheets for each type and strength of schedule II drug, the date and time administered, resident's name, physician's name, dose, signature of the person administering dose, and balance.
Proof-of-use records shall be audited daily by the registered nurse or designee, except that in facilities in which a registered nurse is not required, the administrator or designee shall perform the audit of proof-of-use records daily.
(f) Resident control and use of medications.
Medications which, if ingested or brought into contact with the nasal or eye mucosa, would produce toxic or irritant effects shall be stored and used only in accordance with the health, safety, and welfare of all residents.
When a unit dose drug delivery system is used, the requirements of this subsection shall apply in addition to those of sub. (6)
The individual medication shall be labeled with the drug name, strength, expiration date, and lot or control number.
A resident's medication tray or drawer shall be labeled with the resident's name and room number.
Each medication shall be dispensed separately in single unit dose packaging exactly as ordered by the physician, and in a manner to ensure the stability of the medication.
An individual resident's supply of drugs shall be placed in a separate, individually labeled container and transferred to the nursing station and placed in a locked cabinet or cart. This supply shall not exceed 4 days for any one resident.
If not delivered from the pharmacy to the facility by the pharmacist, the pharmacist's agent shall transport unit dose drugs in locked containers.