(a) A licensed nurse must practice within the constraints
of applicable state laws and regulations governing their practice,
including the Nurse Practice Act, and must follow the guidelines contained
in the facility's written policies and procedures.
(b) A nurse must enter, or approve and sign, nurses'
notes in the following instances:
(1) at least monthly; and
(2) at the time of any physical complaints, accidents,
incidents, and change in condition or diagnosis, and progress. All
of these situations must be promptly recorded as exceptions and included
in the clinical record.
(c) If permitted by written policies of the nursing
facility, an RN or a physician's assistant may determine and pronounce
a resident dead unless a resident is being supported by artificial
means that preclude a determination that the resident's spontaneous
respiratory and circulatory functions have ceased. The facility's
nursing staff and the medical staff or consultant must have jointly
developed and approved the policies. The policies must include the
following requirements:
(1) The apparent death of a resident must be reported
immediately to the attending physician, relatives, and any guardian
or legal representatives.
(2) The body of a deceased resident must not be removed
from the facility without a physician's or registered nurse's authorization.
Telephone authorization is acceptable, if not in conflict with local
regulations. Authorization by a justice of the peace, acting as a
coroner, is sufficient when the attending or consulting physician
or registered nurse is not available.
(3) A death that involves trauma, or unusual or suspicious
circumstances, must be reported immediately, in accordance with local
regulations, and to HHSC Complaint and Incident Intake, in accordance
with §19.602(g)(2) of this chapter (relating to Incidents of
Abuse, Neglect, and Exploitation Reportable to the Texas Health and
Human Services Commission and Law Enforcement Agencies by Facilities).
Deaths must also be reported to HHSC monthly, in accordance with §19.606
of this chapter (relating to Reporting of Resident Death Information).
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Source Note: The provisions of this §554.1010 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective August 31, 2015, 40 TexReg 5461; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |