10 Colo. Code Regs. § 2505-10-8.614

Current through Register Vol. 47, No. 16, August 25, 2024

Section 10 CCR 2505-10-8.614 - [Repealed effective 9/14/2024] GASTROSTOMY SERVICES

Gastrostomy services shall not be provided by any person who is not otherwise authorized by law to administer gastrostomy services except under the supervision of a licensed nurse or physician pursuant to the requirements of these rules.

A. An individual who is not authorized by law to administer gastrostomy services may administer gastrostomy services to an individual requiring gastrostomy services only if a licensed nurse or physician first:

1. Develops a written individualized protocol for the individual receiving gastrostomy services which is based on the individual's physician orders, meets the requirements of section 8.614.E, and is updated each time that the physician's orders change for that individual's gastrostomy services;

2. Oversees training given to the unlicensed person and documents such training, as provided in section 8.614.G, and directly observes the unlicensed person performing the gastrostomy services until such time as the unlicensed person reaches proficiency, which is defined as such person performing all aspects of the individualized protocol referred to above, at least three consecutive observations without error, and,

3. Performs gastrostomy services for each individual receiving such services at least once prior to the time that the unlicensed person provides any such services for that individual.

B. For staff who are performing gastrostomy services for several individuals with similar protocols, the licensed nurse or physician overseeing their training may document their proficiency with less than three (3) observations for each individual receiving services. The alternative method for establishing proficiency of each staff shall be documented.

C. A licensed nurse or physician shall monitor each unlicensed person who is performing gastrostomy services for an individual requiring such services pursuant to section 8.614.A, to ensure that such unlicensed person is properly implementing the orders of the physician and the individualized protocol referred to in section 8.614.A, on a quarterly basis during the first year and semi-annually thereafter, unless more frequent monitoring is required by the individualized protocol. Such monitoring shall be documented in the record of the individual receiving gastrostomy services.

D. When changes are made in the physician's order for gastrostomy services and/or in the individual's protocol, the licensed nurse or physician overseeing the training shall determine the extent of training required to ensure that the unlicensed person(s) authorized to provide such services pursuant to section 8.614.A, continues to be proficient in performing all aspects of gastrostomy services.

E. An individualized protocol shall be maintained in the record of the individual receiving gastrostomy services for whom it is prepared and shall include at least the following:

1. The proper procedures for preparing, storing and administering gastrostomy services;

2. The proper care and maintenance of the gastrostomy site, needed materials and equipment;

3. The identification of possible problems associated with gastrostomy services; and,

4. A list of health professionals to contact in case of problems, including the physician of the individual receiving gastrostomy services and the licensed nurse(s) and/or physician(s) who are responsible for monitoring the unlicensed person(s) performing gastrostomy services pursuant to section 8.614.C.

F. A licensed physician shall review and approve the individualized protocol for each individual receiving gastrostomy services through a nasogastric tube.

G. The licensed nurse or physician who oversees the training given to an unlicensed person to perform gastrostomy services for the individual pursuant to section 8.614.A shall document in the record of such individual the following:

1. The date or dates on which the training occurred;

2. The fact that, in the opinion of such licensed nurse or physician, the unlicensed individual has reached proficiency in performing all aspects of the individualized protocol referred to in section 8.614.A.1; and,

3. The legible signature and title of such licensed nurse or physician.

H. Notwithstanding anything contained in these regulations to the contrary, any person administering medication(s) through gastrostomy tubes shall be subject to the requirements of section 25-1.5-303, C.R.S.

I. The program approved service agency shall assure that there is documentation in the record of each individual receiving gastrostomy services for each gastrostomy service provided to him or her, the following, at a minimum:

1. A written record of each nutrient or fluid administered;

2. The beginning and ending time of the nutrient or fluid intake;

3. The amount of nutrient or fluid intake;

4. The condition of the skin surrounding the gastrostomy site;

5. Any problem(s) encountered and action(s) taken; and,

6. The date and signature of the person performing the procedure.

10 CCR 2505-10-8.614

47 CR 16, August 25, 2024, effective 9/14/2024