Wisconsin Legislature: DHS 134.60(6)(b)2.

1. Medications may be administered only by a nurse, a practitioner or a person who has completed training in a drug administration course approved by the department. Facility staff shall immediately record the administration of medications in the resident’s record.

2. Facilities shall develop policies and procedures designed to provide safe and accurate acquisition, receipt, dispensing and administration of medications and these policies and procedures shall be followed by personnel assigned to prepare and administer medications and to record their administration. Except when a single unit dose drug delivery system is used, the same person shall prepare and administer the resident’s medications.

3. If for any reason a medication is not administered as ordered in a unit dose drug delivery system, an unadministered dose slip with an explanation of the omission shall be placed in the resident’s medication container and a notation shall be made in the resident’s record.

4. Self-administration of medications by a resident shall be permitted if the interdisciplinary team determines that self-administration is appropriate and if the resident’s physician or dentist, as appropriate, authorizes it.

5. Medication errors and suspected or apparent drug reactions shall be reported to the physician or registered nurse in charge or on call as soon as discovered and an entry shall be made in the resident’s record. Appropriate action or interventions shall be taken.

Note: See s. DHS 134.67, pharmaceutical services, for additional requirements.

(e) Habilitative or rehabilitative therapies. Any habilitative or rehabilitative therapy ordered by a physician or dentist shall be administered by a therapist or QIDP. Any treatments and changes in treatments shall be documented in the resident’s record.

(5) Physical restraints.

(a) Definitions. In this subsection:

1. “Mechanical support” means any article, device or garment used only to achieve proper body position or balance of the resident or in specific medical or surgical treatment, including a geri chair, posey belt, jacket, bedside rail or protective head gear.

2. “Physical restraint” means any article, device or garment used primarily to modify resident behavior by interfering with the free movement of the resident or normal functioning of a portion of the body, and which the resident is unable to remove easily, or confinement in a locked room, but does not include mechanical supports. A totally enclosed crib or barred enclosure is a physical restraint.

(b) Use of restraints.

1. Except as provided in subd. 2., a physical restraint may be applied only as an integral part of the resident’s behavior management program on the written order of a physician. The order shall indicate the resident’s name, the reason for the restraint and the period during which the restraint is to be applied. An order for a physical restraint not used as an integral part of a behavior management program may not be in effect longer than 12 hours.

2. In an emergency, a physical restraint may be temporarily applied without an order of a physician if necessary to protect the resident or another person from injury or to prevent physical harm to the resident or another person resulting from the destruction of property, provided that the physician is notified within one hour following application of the restraint and authorizes its continued use and that:

a. For the initial emergency authorization, the physician specifies the type of restraint to be used, reasons for the restraint and time limit or change in behavior that will determine when the restraints are removed;

b. A follow-up contact is made with the physician if an emergency restraint is continued for more than 12 hours; and

c. Written authorization for the emergency use of restraints is obtained from the physician within 48 hours following the initial physician contact.

3. A physical restraint may only be used when less restrictive measures are ineffective and provided that a habilitation plan is developed and implemented to reduce the individual’s dependency on the physical restraints.

4. A physical restraint may not be used as punishment, for the convenience of the staff or as a substitute for an active treatment program or any particular treatment.

5. A physical restraint used as a time-out device, as defined in sub. (6), shall be applied only during a behavior management program and only in the presence of staff trained to implement the program.

a. Staff trained in the use of restraints shall check physically restrained residents at least every 30 minutes.

b. Residents in physical restraints shall have their positions changed, personal needs met, and an opportunity for motion and exercise for a period of at least 10 minutes during every 2 hour period of physical restraint.

7. If the mobility of a resident is required to be restrained and can be appropriately restrained either by a locked unit or another physical restraint, a locked unit shall be used and s. DHS 134.33 shall apply.

8. Any use of restraints shall be noted, dated and signed in the resident’s record. A record shall be kept of the periodic checking on the resident in restraints required by subd. 6.

(6) Behavior management programs.

(a) Definition. In this subsection and in sub. (5), “time-out” means a procedure to improve a resident’s behavior by removing positive reinforcement when the behavior is undesirable.

(b) Plans. A written plan shall be developed for each resident participating in a behavior management program, including a resident placed in a physical restraint to modify behavior or for whom drugs are used to manage behavior. The plan shall be incorporated into the resident’s IPP and shall include:

1. The behavioral objectives of the program;

2. The methods to be used;

3. The schedule for the use of each method;

4. The persons responsible for the program;

5. The data to be collected to assess progress toward the desired objectives; and

6. The methods for documenting the resident’s progress and determining the effectiveness of the program.

(c) Review and approval. The department shall review for approval every plan for a behavior management program before the program is started for the following:

1. Any unlocked time-out that exceeds one hour;

2. Any procedure considered unusual or intrusive, such as a procedure that would be considered painful or humiliating by most persons or a procedure involving the confinement of an ambulatory person by means of a physical restraint or specialized clothing; or

3. Any procedure that restricts or denies a resident right under subch. II.

(d) Consent. A behavior management program may be conducted only with the written consent of the resident, the parents of a minor resident or the resident’s guardian.

(e) Duration. Time-out involving removal from a situation may not be used for longer than one hour and then only during the behavior management program and only in the presence of staff trained to implement the program.

(7) Conduct and control.

(a) The facility shall have written policies and procedures for resident conduct and control that are available in each living unit and to parents and guardians.

(b) When appropriate, residents shall be allowed to participate in formulating policies and procedures for resident conduct and control.

(d) No resident may discipline another resident unless this is done as part of an organized self-government program conducted in accordance with written policy and is an integral part of an overall treatment program supervised by a licensed psychologist or physician.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; CR 04-053: r. (4) (a) 2. and 3. and (c), am. (4) (d) 2. and (5) (b) 1. Register October 2004 No. 586, eff. 11-1-04; correction in (4) (a) 1. made under s. 13.93 (2m) (b) 7., Stats., Register October 2007 No. 622; 2019 Wis. Act 1: am. (1) (a) 2., (2) (a) 1., 2., 3., 6. to 9., (3) (a) 2., (4) (e) Register May 2019 No. 761, eff. 6-1-19; CR 20-068: am. (2) (a) 1. Register December 2021 No. 792, eff. 1-1-22.

DHS 134.61 Nursing services.

(1) Required services. All facilities shall provide residents with nursing services in accordance with the needs of the residents. These services shall include:

(a) The development, review, and updating of an IPP as part of the interdisciplinary team process;

(b) The development, with a physician, of a medical care plan of treatment for a resident when the physician has determined that the resident requires such a plan;

(c) In facilities with residents who have been determined by the physician not to require a medical care plan, arrangements for a nurse to conduct health surveillance of each resident on a quarterly basis;

(d) Based on the nurse’s recorded findings, action by the nurse, including referral to a physician when necessary, to address the health problems of a resident; and

(e) Implementation with other members of the interdisciplinary team of appropriate protective and preventive health measures, including training residents and staff as needed in appropriate personal health and hygiene measures.

(2) Nursing administration.

(a) Health services supervision.

1. A facility shall have a health services supervisor to supervise the facility’s health services full-time on one shift a day, 7 days a week, for residents for whom a physician has ordered a medical care plan.

2. The health services supervisor required under subd. 1. shall be:

a. A registered nurse; or

b. A licensed practical nurse with consultation at regular intervals from a registered nurse under contract to the facility.

(3) Training.

(a) A registered nurse shall participate as appropriate in the planning and implementation of training programs for facility personnel.

(b) The facility shall train resident care personnel in:

1. Detecting signs of illness or dysfunction that warrant medical or nursing intervention;

2. Basic skills required to meet the health needs and problems of the residents; and

3. First aid for accidents and illnesses.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

DHS 134.62 Professional program services.

(1) Provision of services. All facilities shall have or arrange for professional program services staff to implement the active treatment program defined in a resident’s individual program plan (IPP). Professional program staff shall work directly with the resident and with other staff who work with the resident in carrying out the goals and objectives stated in the resident’s IPP.

(2) Qualifications of professional program staff.

(a) Psychology staff. Psychological services shall be provided by a psychologist licensed under ch. 455, Stats.

(b) Physical therapy staff. Physical therapy services shall be given or supervised by a registered physical therapist licensed under ss. 448.05 and 448.07, Stats.

(c) Speech pathology and audiology staff. Speech and hearing therapy shall be given or supervised by a speech pathologist or audiologist who:

1. Meets the standards for a certificate of clinical competence granted by the American speech and hearing association; or

2. Meets the educational requirements and is in the process of acquiring the supervised experience required for certification under subd. 1.

(d) Occupational therapy staff. Occupational therapy shall be given or supervised by a therapist who meets the standards for registration as an occupational therapist of the American occupational therapy association.

(e) Recreation staff. Recreation shall be led or supervised by an individual who has a bachelor’s degree in recreation or in a related specialty such as art, dance, music, physical education or recreation therapy.

(f) Other professional program staff. Professional program services other than those under pars. (a) to (e) shall be provided by individuals who have at least a bachelor’s degree in a human services field such as sociology, special education or rehabilitation counseling.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

DHS 134.64 Dietetic services.

(1) Services. Facilities shall provide or contract for dietetic services which meet the requirements of this section. Services shall include:

(a) Planning menus that provide nutritionally adequate diets to all residents;

(b) Initiating food orders;

(d) Storing and handling food;

(e) Preparing and serving food;

(f) Maintaining safe and sanitary conditions;

(g) Orienting, training and supervising staff; and

(h) Controlling food costs.

Note: For standards on safe and sanitary conditions, see s. DHS 190.09.