Revisions to HFS 132, Wisconsin
Adm. Code, effective November 1, 2004
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BQA 05-001 (PDF, 159 KB)
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DATE: January 7, 2005 DSL-BQA-05-001
TO: Nursing Homes NH 01
FROM: Cris Ros-Dukler, Director, Bureau of Quality Assurance
On November 1, 2004, changes to HFS 132, Wisconsin Administrative Code,
went into effect.
These changes, developed by members of the nursing home associations,
nursing home administrators, and representatives from the Board of Aging
and Long Term Care and the Bureau of Quality Assurance (BQA), represent
the first substantial changes to chapter HFS 132 in more than ten years.
A current copy of chapter HFS 132 can be obtained on the Internet at: www.legis.state.wi.us/rsb/code/hfs/hfs132.pdf.
This memo highlights the major changes that were made to chapter HFS
132.
- HFS 132.31(1)(k) was amended concerning the use of physical and
chemical restraints. Instead of solely requiring the order of a
physician, restraints may be used only when required to treat the
resident’s medical symptoms. This mirrors the federal requirement
found at 42 CFR 483.13(a) [F221].
- HFS 132.45(4)(g)2 was amended to allow the use of electronic
signatures, provided the electronic representation is used only by the
person who makes the entry, and provided the facility possesses a
signed statement from that person certifying that s/he is the only
person using that electronic signature.
- A new section, HFS 132.46 Quality assurance and assessment, was
added to chapter HFS 132. These regulations require all nursing homes
to have a Quality Assurance and Assessment Committee comprised of the
Director of Nurses, the medical director or a designated physician,
and at least three other members of facility staff. This committee
must meet at least quarterly to identify, develop, and implement
appropriate plans of action to correct any identified quality
deficiencies within the facility. Facilities are not required to
disclose the notes of this committee to BQA except to determine
compliance with this section. These requirements mirror the federal
nursing home regulations found at 42 CRF 483.75(o) [F520 – F522].
The development of these regulations prompted the deletion of the
regulations previously found at HFS 132.65(3)(a) concerning the
Pharmaceutical Services Committee.
- HFS 132.42(3)(a), concerning physical health certifications for new
employees, and HFS 132.52(2)(c), concerning physical health
certifications of new residents, were amended to permit physician
assistants and advanced practice nurse prescribers to screen the
individuals for apparent clinical diseases. HFS 132.60(5)(a)1 and 2,
concerning medication, treatment, and rehabilitative therapy orders,
was amended to clarify the process for oral and written orders issued
by authorized prescribers.
- A new subdivision, HFS 132.60(1)(c)5, was added concerning pain
management. This codified the expectations for pain management based
on accepted professional standards of practice. Nursing homes are
required to:
- assess and treat each resident suspected of or experiencing pain so
that they may be as pain free as possible;
- conduct an initial pain assessment and conduct regular and periodic
reassessments of pain;
- evaluate the effectiveness of the measures being taken to relieve
pain; and
- consider and implement, as appropriate, nonpharmacological
interventions to control pain.
- HFS 132.83(4) was amended. Facilities whose medical records are
solely electronically based must have emergency back-up power for the
facility’s electronic record system.
- HFS 132.83(7)(a)2 was amended. Instead of 110o, hot water
temperature at fixtures used by residents may be in the range of 110
– 115o.
- HFS 132.84(3) was amended. While each resident living area is
required to have a staff work station, the requirement for a nurse
station that is centrally located within the living area has been
deleted.
We have attached a complete
copy of the changes (PDF, 93 KB) that were
made to HFS 132, Wisconsin Administrative Code.
If you have questions, please contact the Regional
Field Operations Director whose region serves your nursing home.
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