O. Reg. 61/03: GENERAL

 

ONTARIO regulation 61/03

made under the

nursing homes act

Made: March 5, 2003
Filed: March 7, 2003
Printed in The Ontario Gazette: March 22, 2003

Amending Reg. 832 of R.R.O. 1990

(General)

Note: Since the end of 2002, Regulation 832 has been amended by Ontario Regulation 21/03.  Previous amendments are listed in the Table of Regulations published in The Ontario Gazette dated January 18, 2003.

1. (1) The definitions of “nursing care” and “nursing staff” in subsection 1 (1) of Regulation 832 of the Revised Regulations of Ontario, 1990 are revoked and the following substituted:

“nursing care” means skilled nursing and other personal care given by or under the supervision of a registered nurse or a registered practical nurse;

“nursing staff” includes a registered nurse including a registered nurse in the extended class, a registered practical nurse and a health care aide also known as a non-registered nurse’s aide;

(2) The definition of “pharmacist” in subsection 1 (1) of the Regulation is revoked and the following substituted:

“pharmacist” means a member of the Ontario College of Pharmacists;

(3) The definition of “prescription drug” in subsection 1 (1) of the Regulation is revoked and the following substituted:

“prescription drug” means,

(a) a controlled drug mentioned in Schedule G to the Food and Drugs Act (Canada),

(b) a controlled substance as defined in the Controlled Drugs and Substances Act (Canada);

(4) The definition of “registered nursing assistant” in subsection 1 (1) of the Regulation is revoked and the following substituted:

“registered nurse in the extended class” means a member of the College of Nurses of Ontario who is a registered nurse and who holds an extended certificate of registration under the Nursing Act, 1991;

“registered nursing staff” means those members of the nursing staff who are registered nurses including registered nurses in the extended class or registered practical nurses;

2. (1) Clause 47.2 (2) (a) of the Regulation is amended by adding “or a registered nurse in the extended class” after “a physician”.

(2) Clause 47.2 (3) (a) of the Regulation is amended by adding “or a registered nurse in the extended class” after “a physician”.

3. Clause 48 (2) (a) of the Regulation is amended by adding “or a registered nurse in the extended class attending the resident” after “resident’s physician”.

4. The heading preceding section 50 of the Regulation is revoked and the following substituted:

Physicians and Registered Nurses in the Extended Class

5. Section 50 of the Regulation is amended by adding the following subsections:

(5) A licensee of a nursing home may appoint one or more registered nurses in the extended class for the nursing home, and, if the licensee does so, the licensee shall obtain a written statement signed by each of those registered nurses in the extended class stating that he or she will advise the administrator of the home on care matters in the home that are within the competence of a registered nurse in the extended class.

(6) The registered nurse in the extended class appointed under subsection (5) shall comply with the “Standards for Consultation with Physicians by RN(EC)s” including “Collaboration” set out in the publication of the College of Nurses of Ontario entitled “Standards of Practice for Registered Nurses who hold an extended class certificate of registration” as amended from time to time.

(7) A licensee of a nursing home shall notify the Director in writing of the name, address, telephone number and date of appointment of each registered nurse in the extended class appointed under subsection (5) and, wherever there is a change in any of that information, the licensee shall notify the Director in writing of the change.

6. Sections 51 and 52 of the Regulation are revoked and the following substituted:

51. (1) A resident, or the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, may retain a physician to attend the resident and provide the resident with medical care and, if neither of them retains the physician, the administrator shall do so.

(2) A resident, or the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, may retain a registered nurse in the extended class to attend the resident and provide the resident with care.

(3) The registered nurse in the extended class retained under subsection (2) shall comply with the “Standards for Consultation with Physicians by RN(EC)s” including “Collaboration” set out in the publication of the College of Nurses of Ontario entitled “Standards of Practice for Registered Nurses who hold an extended class certificate of registration” as amended from time to time.

(4) A physician or registered nurse in the extended class who is retained under subsection (1) or (2) shall,

(a) visit the resident and review the resident’s medication and diet at least once every three months;

(b) make an annual physical examination of the resident and file with the administrator a written report of the examination and his or her findings on the examination; and

(c) make any additional attendances, in addition to those referred to in clauses (a) and (b), as the resident’s condition requires. 

52. Where a physician or registered nurse in the extended class has been retained to provide a person who is or is to be a resident with care and he or she does not comply with the requirements of section 51, the administrator shall request him or her to comply with the requirements of section 51 and if the physician or registered nurse in the extended class does not do so, the administrator, after consultation with the resident and the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, shall retain another physician and may retain another registered nurse in the extended class to provide the resident with the care.

7. Section 53 of the Regulation is amended by adding the following subsection:

(2) An administrator may arrange for a registered nurse in the extended class to be part of the team that is on call to provide emergency services.

8. (1) Subsection 54 (1) of the Regulation is amended by adding “or a registered nurse in the extended class” after “retain a physician”.

(2) Subsection 54 (2) of the Regulation is amended by adding “or registered nurse in the extended class” after “opinion of the physician”.

9. The Regulation is amended by adding the following section:

54.1 The medical director, a registered nurse in the extended class or the attending physician shall report any incidence of reportable or communicable disease outbreaks to the local medical officer of health in accordance with sections 25 and 26 of the Health Protection and Promotion Act.

10. Clause 55 (5) (c) of the Regulation is amended by striking out “registered nursing assistant” at the end and substituting “registered practical nurse”.

11. Subsection 56 (4) of the Regulation is revoked and the following substituted:

(4) Where a resident’s attending physician or registered nurse in the extended class so requires, a resident’s vital signs shall be observed and recorded regularly by the registered nursing staff and the information shall be reported to the physician or registered nurse in the extended class as he or she directs.

12. Subsection 63 (3) of the Regulation is amended by striking out “registered nursing assistant” and substituting “registered practical nurse”.

13. (1) Subsection 65 (3) of the Regulation is revoked and the following substituted:

(3) Every drug cabinet or storeroom shall be kept locked and the keys shall be under the control of a registered nurse who is on duty or a registered practical nurse on duty or the administrator in the absence of a registered nurse and registered practical nurse.

(2) Subsection 65 (8) of the Regulation is revoked and the following substituted:

(8) No resident shall keep or be permitted to keep a drug on his or her person or in his or her room unless authorized by either a physician or registered nurse in the extended class who is in attendance on the resident, and in accordance with any conditions that are imposed by the physician or the registered nurse in the extended class.

14. (1) Subsection 68 (1) of the Regulation is amended by striking out “pharmacist or physician” and substituting “pharmacist, physician or a registered nurse in the extended class appointed under subsection 50 (5)”.

(2) Subsections 68 (2) and (3) of the Regulation are revoked and the following substituted:

(2) Where a nursing home purchases, keeps or uses a prescription drug referred to in subsection (1), the pharmacist, physician or a registered nurse in the extended class appointed under subsection 50 (5) shall keep or cause to be kept,

(a) a record of the name, strength and quantity of the prescription drug; and

(b) the records required to be kept by the Regulated Health Professions Act, 1991, the Food and Drugs Act (Canada) and the Controlled Drugs and Substances Act (Canada) for the receipt and sale or disposition of the prescription drug.

(3) A prescription drug referred to in subsection (1) shall be stored in a separate locked drug cabinet or storeroom that is accessible only to a pharmacist, physician or member of the registered nursing staff.

15. Subsection 69 (2) of the Regulation is revoked and the following substituted:

(2) Where a resident dies, written approval of the person who has signed the medical certificate of death under the Vital Statistics Act shall be obtained before a drug that was provided for the resident is destroyed or removed.

16. Subsection 70 (3) of the Regulation is amended by striking out “registered nursing assistant” at the end and substituting “registered practical nurse”.

17. Subsections 78 (1), (2) and (3) of the Regulation are revoked and the following substituted:

(1) Where a resident dies in a nursing home, the resident’s death shall be reported immediately to,

(a) a coroner by the person in charge of the nursing home at the time of the resident’s death;

(b) the resident’s physician; and

(c) any registered nurse in the extended class who attended the resident.

(2) Where the attending physician or registered nurse in the extended class is satisfied that the death was from natural causes and the coroner has been informed of the resident’s death, the body of the resident may be moved to a private area in the nursing home.

(3) The attending physician or registered nurse in the extended class shall make a written report indicating the cause and time of death of the resident, and the report shall be retained in the resident’s file.

18. Section 89 of the Regulation is revoked and the following substituted:

89. The medical record of a resident must include a written report of,

(a) the resident’s medical history;

(b) each physical examination of the resident by a physician or a registered nurse in the extended class;

(c) diagnoses of the resident’s condition;

(d) orders for the treatment of the resident, including,

(i) orders for the administration of drugs,

(ii) orders for medication, and

(iii) follow-up notes indicating the resident’s condition at each visit, signed by the physician or registered nurse in the extended class attending the resident;

(e) a written copy of every telephone order for treatment of the resident given by a physician, together with the signature of the registered nurse or registered practical nurse to whom the telephone order was given and the counter-signature of the physician who gave the telephone order;

(f) daily nursing notes that are signed by the nurse in charge of the resident and that record every change in the resident’s condition considered significant in the opinion of the nurse in charge of the resident; and

(g) any records required to be kept under the provisions of the Controlled Drugs and Substances Act (Canada) or Part III of the Food and Drugs Act (Canada).

19. Subsection 127 (1) of the Regulation is revoked and the following substituted:

(1) A licensee of a nursing home shall ensure that each resident’s plan of care is reviewed at least quarterly by at least the following members of the interdisciplinary team providing the resident’s care:

1. The physician providing the resident’s care.

2. The registered nurse in the extended class, if any, providing the resident’s care.

3. The nursing staff providing the resident’s care.

4. The food services supervisor or dietitian responsible for the resident’s needs.