6 Colo. Code Regs. § 1011-1 Chapter 08 Part 17

Current through Register Vol. 47, No. 11, June 10, 2024

Part 17 - Gastrostomy Services

17.1 Gastrostomy services shall not be administered by an unlicensed individual unless that individual is trained and supervised by a licensed physician, nurse, or other practitioner.

17.2 The facility shall ensure that a physician, licensed nurse, or other practitioner has developed a written, individualized gastrostomy service protocol for each resident requiring such service, and that the protocol is updated each time the orders change for that resident's gastrostomy services. Each protocol shall include, but not be limited to:

(A) The proper procedures for preparing, storing, and administering nutritional supplements through a gastrostomy tube, including, but not limited to:

(1) The type of gastrostomy tube used by the resident;

(2) A list of all equipment and materials required for the procedure;

(3) The position of the resident during and after feeding;

(4) Procedures for cleaning the gastrostomy site and surrounding skin;

(5) Procedures for cleaning the gastrostomy equipment; and

(6) Instructions for documenting the procedure.

(B) The routine care and maintenance of the external gastrostomy site.

(C) The identification of possible problems associated with gastrostomy services and the extent to which an unlicensed individual may address the problem, including, but not limited to:

(1) Notification to licensed staff and/or providers regarding changes in the gastrostomy site;

(2) Signs of infection;

(3) Procedures to follow when the resident experiences coughing, nausea, or vomiting;

(4) Leakage around the stoma; and

(5) Procedures to follow when a gastrostomy tube has been dislodged or pulled out.

(a) Unlicensed individuals may not reinsert a gastrostomy tube, except that an unlicensed individual may take actions as directed/delegated by a licensed provider in an emergent situation if the resident is at risk of stoma site closure.

(D) The names and contact numbers of the resident's physician, licensed nurse, or other practitioner who is responsible for monitoring the unlicensed person(s) performing gastrostomy services and intervening, if problems are identified.

17.3 The facility shall ensure that a physician, licensed nurse, or other practitioner provides training to any unlicensed individual who may provide gastrostomy services. Documentation of the training shall be kept in the resident's record and shall include:

(A) The date or dates of when the training occurred;

(B) Indication that the unlicensed individual has reached proficiency which is defined as performing all aspects of the resident's protocol without error three (3) consecutive times; and

(C) The signature of the physician, licensed nurse, or other authorized, licensed practitioner that provided the training and observed the three (3) trials.

17.4 The facility shall ensure that a physician, licensed nurse, or other practitioner performs the gastrostomy services for each resident receiving gastrostomy services at least once prior to the unlicensed person providing the services.

17.5 For unlicensed persons performing gastrostomy services for several residents with similar protocols, the physician, licensed nurse, or other practitioner overseeing their training may document their proficiency with less than three (3) observations for each resident receiving services. The alternative method for establishing the proficiency of each staff member shall be documented.

17.6 The facility shall ensure that the physician, licensed nurse, or other practitioner observes and documents the unlicensed staff performing gastrostomy services for each resident at least quarterly for the first year and semi-annually thereafter, unless more frequent monitoring is appropriate. Such monitoring shall be documented in the record of the individual receiving gastrostomy services.

17.7 When changes are made to the written order for gastrostomy services and/or in the resident's protocol, the facility shall ensure that the physician, licensed nurse, or other practitioner that provides the training determines the extent of training that the unlicensed person will need to remain proficient in performing all aspects of the gastrostomy services. If changes in protocols occur, the facility shall document training and competency of unlicensed staff on the new protocol.

17.8 The facility shall ensure that the primary care practitioner or ordering physician annually reviews and approves the protocol for each resident receiving gastrostomy services.

17.9 For each resident, the facility shall ensure the following documentation for each gastrostomy service provided to the resident is included in the resident's record:

(A) A written record of each nutrient and fluid administered;

(B) The beginning and ending time of nutrient or fluid intake;

(C) The amount of nutrient or fluid intake;

(D) The condition of the skin surrounding the gastrostomy site;

(E) Any problem(s) encountered and action(s) taken; and

(F) The date and signature of the person performing the procedure.

6 CCR 1011-1 Chapter 08 Part 17