All services are performed by licensed Registered Nurses within the RN scope of practice and require physician or nurse practitioner orders when applicable.

Telehealth Nursing Support

Telehealth nursing services are provided by licensed Registered Nurses during designated hours to support continuity of care, reinforce the plan of care, and promote patient safety. Services include, but are not limited to:

• RN follow-up nursing assessments related to the established plan of care

• Medication review, education, and reinforcement of prescribed regimens

• Caregiver education and coaching consistent with physician orders

• Symptom monitoring and nursing triage within RN scope of practice

• Reinforcement of physician and provider orders

• Patient and caregiver education related to medical equipment, safety, and infection prevention

• Identification of changes in condition and timely communication with the supervising provider, as indicated

Telehealth nursing services are supportive in nature and do not replace emergency medical services or in-person medical care. In the event of an emergency, patients and caregivers are instructed to call 911 or seek immediate medical attention.

Home Care Nursing Services:

Services are provided by licensed Registered Nurses within the scope of practice defined by the New Jersey Nurse Practice Act and applicable Department of Health regulations. Services include, but are not limited to, the following, as ordered by a physician or authorized provider and outlined in the individualized plan of care:

Neurological / Mental Status Assessment

• Ongoing assessment of level of consciousness, responsiveness, and neurological status

• Monitoring of orientation, behavior, cognition, and changes in mental status

• Pain assessment using standardized, age-appropriate, and clinically validated scales

• Observation and documentation of changes in neurological condition

• Implementation of seizure precautions and safety measures as ordered

• Identification of safety risks and timely provider notification for significant changes

Head, Eyes, Ears, Nose, and Throat (HEENT)

• Assessment of pupils, oral cavity, mucous membranes, and overall HEENT status

• Oral hygiene and mouth care per provider order

• Monitoring of swallowing function and aspiration risk

• Tracheostomy site assessment and monitoring when applicable

Respiratory System (High-Acuity Focus)

• Assessment of respiratory rate, effort, breath sounds, oxygen saturation, and work of breathing

• Tracheostomy care and airway maintenance per physician or NP order

• Ventilator monitoring, including:

- Verification of prescribed ventilator settings

- Alarm function checks

- Equipment safety assessments

• Oxygen therapy administration and monitoring as ordered

• Nebulizer treatments and prescribed respiratory therapies

• Airway suctioning and secretion management

• Humidification system management

• Continuous monitoring for signs of respiratory distress

• Prompt intervention and provider notification for clinical variances

• Documentation of patient response and outcomes

Cardiovascular System

• Monitoring of heart rate, blood pressure, and vital signs

• Peripheral circulation and pulse assessment

• Assessment for edema and fluid imbalance

• Observation for signs of cardiovascular instability

• Implementation of provider-ordered interventions and escalation when indicated

Gastrointestinal, Enteral Access, and Ostomy Care

• Gastrostomy (G-tube) and Jejunostomy (J-tube) site assessment and care

• Monitoring for infection, leakage, skin irritation, or tube displacement

• Administration of enteral nutrition and feeding pump management as ordered

• Colostomy and fecal ostomy assessment and care, including:

- Stoma assessment

- Appliance integrity

- Peristomal skin protection

• Urostomy assessment and care, including:

- Stoma condition

- Urinary output characteristics

- Appliance management

• Monitoring and documentation of output, skin integrity, and tolerance

• Patient and caregiver education related to enteral feeding and ostomy care, as appropriate

Genitourinary System

• Monitoring of urinary output and characteristics

• Urinary catheter insertion, care, and maintenance per provider order

• Perineal care and hygiene

• Observation for signs and symptoms of urinary tract infection

Integumentary System

• Comprehensive skin integrity assessment

• Wound assessment and dressing changes per provider order

• Pressure injury prevention interventions

• Monitoring for signs of infection, impaired healing, or skin breakdown

Musculoskeletal / Functional Status

• Assessment of mobility, strength, and functional ability

• Assistance with positioning, transfers, and ambulation as ordered

• Range-of-motion exercises per individualized plan of care

• Fall-risk identification and implementation of safety interventions

Medication Management

• Administration of medications via prescribed routes (oral, enteral, inhaled, injectable)

• Medication reconciliation and verification against provider orders

• Monitoring for therapeutic response and adverse reactions

• PRN medication administration with required reassessment and documentation

• Patient and caregiver education related to medications, as appropriate

Infection Prevention and Control

• Implementation of infection prevention and control practices consistent with NJDOH standards

• Hand hygiene and standard precautions

• Cleaning and disinfection of equipment and supplies

• Monitoring for signs and symptoms of infection

• Education of patients and caregivers on infection prevention strategies

All skilled nursing services are provided, supervised, and evaluated by licensed Registered Nurses, delivered strictly within RN scope of practice, and performed only pursuant to physician or nurse practitioner orders, in compliance with N.J.A.C. 8:42, N.J.A.C. 13:37, and applicable federal regulations.

SERVICES (INSURANCE-CREDENTIALING SAFE)

Skiled Nursing Services (RN-Led, In-Home Care)

RN-Led Care Coordination Services

BYS ProCare provides comprehensive, RN-led care coordination services in accordance with the individualized plan of care and applicable New Jersey Department of Health regulations. Services include, but are not limited to:

• Communication and coordination with the patient’s physician, specialists, therapists, and other members of the interdisciplinary care team

• Reinforcement and clarification of physician orders and the established plan of care

• Medication reconciliation and coordination with pharmacies, as clinically indicated

• Monitoring for changes in patient condition and timely notification of the ordering provider

• Assistance with appointment coordination and referral follow-up

• Durable medical equipment (DME) and medical supply coordination

• Support with healthcare system navigation and administrative coordination

All care coordination activities are performed by or under the supervision of a Registered Nurse and documented in accordance with NJAC 8:42.

Family & Caregiver Education

BYS ProCare provides structured family and caregiver education as an integral component of skilled nursing services. Education includes, but is not limited to:

• Instruction on the patient’s treatment plan

• Medication education

• Medical equipment training

• Infection prevention

• Recognition of changes in condition

• Patient safety and emergency preparedness

Education is documented in the clinical record and does not replace emergency medical care.

BYS ProCare provides skilled overnight nursing services when medically necessary and ordered by an authorized provider. but are not limited to:

• Continuous clinical monitoring

• Respiratory and airway management

• Medication administration

• Safety surveillance and emergency preparedness

• Ongoing assessment and provider notification

• Caregiver relief

Overnight services do not replace emergency medical services, In case of a medical emergency, call 911.

Overnight Nursing Care

24/7 ON-CALL CARE COORDINATION & TELEHEALTH SUPPORT

RN-led care coordination and telehealth nursing support are available on an on-call basis. Not intended for emergency medical situations, in case of a medical emergency, call 911.