3917.1 Skilled nursing services shall be provided by a registered nurse, or by a licensed practical nurse under the supervision of a registered nurse, and in accordance with the patient's plan of care.

3917.2 Duties of the nurse shall include, at a minimum, the following:

1. (a) Initial assessment and evaluation;
2. (b) Coordination of care and referrals;
3. (c) Ensuring that patient needs are met in accordance with the plan of care;
4. (d) Implementing preventive and rehabilitative nursing procedures;
5. (e) For registered nurses, supervision of nursing services delivered by licensed practical nurses, including on-site supervision at least once every sixty-two (62) calendar days;
6. (f) Supervision of services delivered by home health and personal care aides and household support staff, as appropriate;
7. (g) Recording progress notes at least once every thirty (30) calendar days and summary notes at least once every sixty-two (62) calendar days;
8. (h) Reporting changes in the patient's condition to the patient's physician;
9. (i) Patient instruction, and evaluation of patient instruction; and
10. (j) Discharge planning.

3917.3 Except as described further in this subsection, wound care and tube feeding shall be provided only by a registered nurse or by a licensed practical nurse. Simple wound care and gastrostomy tube feeding may be provided by a home health aide or personal care aide, provided that the aide receives adequate training prior to performing the service and provided that the service is monitored continuously, with on-site supervision by a licensed nurse at least every two (2) weeks.

SOURCE: Final Rulemaking published at 51 DCR 2876 (March 19, 2004).