Chapter DHS 132

DHS 132.63(2)(b)2. 2. 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 Note Note: For inservice training requirements, see s. DHS 132.44 (2) (b).

DHS 132.63(4) (4) Menus.

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.

DHS 132.63(4)(a)6. 6. A variety of protein foods, fruits, vegetables, dairy products, breads, and cereals shall be provided.

DHS 132.63(4)(b) (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) (5) Meal service.

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.

DHS 132.63(5)(g) (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.

DHS 132.63(7) (7) Sanitation. 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° F. (4°C.).

DHS 132.63 Note Note: See ch. DHS 145 for the requirements for reporting incidents of suspected disease transmitted by food.

DHS 132.63 History 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.

DHS 132.64 DHS 132.64 Rehabilitative services.

DHS 132.64(1) (1) 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.

DHS 132.64(2) (2) Service plans and restrictions.

DHS 132.64(2)(b) (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.

DHS 132.64(2)(c) (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.

DHS 132.64(3) (3) Specialized services — qualifications.

DHS 132.64(3)(a) (a) Physical therapy. Physical therapy shall be given or supervised only by a physical therapist.

DHS 132.64(3)(b) (b) Speech and hearing therapy. Speech and hearing therapy shall be given or supervised only by a therapist who:

DHS 132.64(3)(b)1. 1. Meets the standards for a certificate of clinical competence granted by the American speech and hearing association; or

DHS 132.64(3)(b)2. 2. Meets the educational standards, and is in the process of acquiring the supervised experience required for the certification of subd. 1.

DHS 132.64(3)(c) (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.

DHS 132.64(3)(d) (d) Equipment. Equipment necessary for the provision of therapies required by the residents shall be available and used as needed.

DHS 132.64 Note Note: For record requirement, see s. DHS 132.45.

DHS 132.64 History 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.

DHS 132.65 DHS 132.65 Pharmaceutical services.

DHS 132.65(1) (1) Definitions. As used in this section:

DHS 132.65(1)(a) (a) “Medication” has the same meaning as the term “drug” defined in s. 450.06, Stats.

DHS 132.65(1)(b) (b) “Prescription medication” has the same meaning as the term“prescription drug” defined in s. 450.07, Stats.

DHS 132.65(1)(c) (c) “Schedule II drug” means any medication listed in s. 961.16, Stats.

DHS 132.65(2) (2) Services.

DHS 132.65(2)(a) (a) Each facility shall provide for obtaining medications for the residents directly from licensed pharmacies.

DHS 132.65(2)(b) (b) 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.

DHS 132.65(4) (4) Emergency medication kit.

DHS 132.65(4)(a) (a) A facility may have one or more emergency medication kits. All emergency medication kits shall be under the control of a pharmacist.

DHS 132.65(4)(b) (b) The emergency kit shall be sealed and stored in a locked area.

DHS 132.65(5) (5) Contingency supply of medications.

DHS 132.65(5)(a) (a) Maintenance. 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.

DHS 132.65(5)(b) (b) Storage. Contingency drugs shall be stored at a nursing unit, except that those medications requiring refrigeration shall be stored in a refrigerator.

DHS 132.65(5)(c) (c) Single units. Contingency medications shall be stored in single unit containers, a unit being a single capsule, tablet, ampule, tubex, or suppository.

DHS 132.65(5)(d) (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.

DHS 132.65(5)(e) (e) Control. 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.

DHS 132.65(6) (6) Requirements for all medication systems.

DHS 132.65(6)(b) (b) Storing and labeling medications. Unless exempted under par. (f), all medications shall be handled in accordance with the following provisions:

DHS 132.65(6)(b)1. 1. ‘Storage.’ 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° F. (29° C.).

DHS 132.65(6)(b)2. 2. ‘Transfer between containers.’ Medications shall be stored in their original containers, and not transferred between containers, except by a physician or pharmacist.

DHS 132.65(6)(b)3. 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, Stats.

DHS 132.65(6)(b)4. 4. ‘Separation of medications.’ Medications packaged for individual residents shall be kept physically separated.

DHS 132.65(6)(b)5. 5. ‘Refrigeration.’ Medications requiring refrigeration shall be kept in a separate covered container and locked, unless the refrigeration is available in a locked drug room.

DHS 132.65(6)(b)6. 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.

DHS 132.65(6)(b)7. 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.

DHS 132.65(6)(b)8. 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) (c) Destruction of medications.

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.

DHS 132.65(6)(c)2. 2. ‘Procedure.’ 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) (d) Control of medications.

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.

DHS 132.65(6)(d)2. 2. ‘Signatures.’ When the medication is received by the facility, the person completing the control record shall sign the record indicating the amount received.

DHS 132.65(6)(d)3. 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.

DHS 132.65(6)(e) (e) Proof-of-use record.

DHS 132.65(6)(e)1. 1. 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.

DHS 132.65(6)(e)2. 2. 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.

DHS 132.65(6)(f) (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.

DHS 132.65(7) (7) Additional requirements for unit dose systems.

DHS 132.65(7)(a) (a) Scope. When a unit dose drug delivery system is used, the requirements of this subsection shall apply in addition to those of sub. (6).

DHS 132.65(7)(b) (b) General procedures.

DHS 132.65(7)(b)1. 1. The individual medication shall be labeled with the drug name, strength, expiration date, and lot or control number.

DHS 132.65(7)(b)2. 2. A resident’s medication tray or drawer shall be labeled with the resident’s name and room number.

DHS 132.65(7)(b)3. 3. 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.

DHS 132.65(7)(b)4. 4. 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.

DHS 132.65(7)(b)5. 5. If not delivered from the pharmacy to the facility by the pharmacist, the pharmacist’s agent shall transport unit dose drugs in locked containers.

DHS 132.65(7)(b)6. 6. The individual medication shall remain in the identifiable unit dose package until directly administered to the resident. Transferring between containers is prohibited.

DHS 132.65(7)(b)7. 7. Unit dose carts or cassettes shall be kept in a locked area when not in use.

DHS 132.65 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (3) (b), am. (6) (a), (b) 6. and (c), Register, January, 1987, No. 373, eff. 2-1-87; am. (3) (b) 2., (6) (b) 8. and (c) 1. and 3., Register, February, 1989, No. 398, eff. 3-1-89; correction in (1) (c) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; correction made to (6) (d) 1. under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; CR 04-053: am. (2) and (5) (d), r. (3) (a), renum. and am. (3) (b) 1. and 2., r. (6) (c) 3. Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (3) and (6) (a) and (f) 1. and 2., renum. (6) (f) 2. to be (6) (f), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.67 DHS 132.67 Dental services.

DHS 132.67(1) (1) Advisory dentist. The facility shall retain an advisory dentist to participate in the staff development program for nursing and other appropriate personnel and to recommend oral hygiene policies and practices for the care of residents.

DHS 132.67(3) (3) Dental examination of residents. Every resident shall have a dental examination by a licensed dentist within 6 months after admission unless a dental examination has been performed within 6 months before admission. Subsequent dental health care shall be provided or arranged for the resident as needed.

DHS 132.67 Note Note: For record requirements, see s. DHS 132.45; for dentists’ orders, see s. DHS 132.60 (5); for staff development programs about dental practices, see s. DHS 132.44 (2).

DHS 132.67 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (3), Register, January, 1987, No. 373, eff. 2-1-87; CR 06-053: r. (2) and (4), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.68 DHS 132.68 Social services.

DHS 132.68(1) (1) Provision of services. Each facility shall provide for social services in conformance with this section.

DHS 132.68(2) (2) Staff. Social worker. Each facility shall employ or retain a person full-time or part-time to coordinate the social services, to review the social needs of residents, and to make referrals.

DHS 132.68(3) (3) Admission history. The facility shall prepare a social history of each resident.

DHS 132.68(4) (4) Care planning. A social services component of the plan of care, including potential for discharge, if appropriate, shall be developed and included in the plan of care required by s. DHS 132.60 (8) (a).

DHS 132.68(5) (5) Services. Social services staff shall provide the following:

DHS 132.68(5)(a) (a) Referrals. If necessary, referrals for guardianship proceedings, or to appropriate agencies in cases of financial, psychiatric, rehabilitative or social problems which the facility cannot serve;

DHS 132.68(5)(b) (b) Adjustment assistance. Assistance with adjustment to the facility, and continuing assistance to and communication with the resident, guardian, family, or other responsible persons;

DHS 132.68(5)(c) (c) Discharge planning. Assistance to other facility staff and the resident in discharge planning at the time of admission and prior to removal under this chapter; and