481-69.27 Nurse Review

The rules in 481-67.27 require nurse reviews to be completed in certain circumstances. Those circumstances include the following:

• If a tenant is not receiving any personal or health related services but a significant change is noted.
• If the tenant receives personal or health-related services at least:
  • Every 90 days
  • After a significant change in their condition.

The nurse review is a note that the health care professional completes in the tenant’s record. Reminder a health care professional is defined as a physician, physician assistant, registered nurse, licensed practical nurse via nurse delegation, or advanced registered nurse practitioner licensed in Iowa by the respective licensing board or eligible to practice in Iowa through compact licensure agreements. The nurse review note must include at least the following:

• Adverse reactions to the medications prescribed to them.
• Make appropriate referrals
• Ensure prescription medication orders are current and administered consistently with those orders
• Assess and document the health status of each tenant

Each note must be written showing the date, time, and signature of the completing health care professional.

If you’re completing a note via nurse delegation, the program RN must ensure the LPN is trained and demonstrate competencies related to nurse reviews prior to completion. Additionally, as part of the nurse delegation practice, the RN should monitor ongoing completion of the nurse reviews to ensure they are completed in accordance with the delegation training and competencies.

Assisted living providers should periodically assess compliance with the nurse review rules by completing tenant record reviews and ensuring all required elements are accurately documented in the nurse review note. It may be worthwhile to document somehow that the nurse review is a “nurse review note” to make it very clear to the surveyor reviewing the record. This may also help with a tenant record review.