Advice Support Tool

Theme: Nursing

Sub-Theme(s): including:

Direct nursing support and
Registered Nurse (RN) Delegation and Supervision of Care (DSOC) model of support.

NOTE — as per OG DRHS — ‘A disability-related health support is a support you may need to help you manage a health condition directly because of your disability. Or, to help you to manage your health or health condition if your disability means you can’t do this on your own.’

References: [include any relevant referenced documents]

NDIS Act 2013 Section 34 1. (a) - (f) and 2.
NDIS Support for Participant Rules 2013
OG_DisabilityRelatedHealthSupports.docx
SOP_DisabilityRelatedHealthSupports.docx
- PG_RespiratorySupports.docx
- OG_WoundAndPressureCareSupports.docx
- OG_PodiatryAndFootCareSupports.docx
- OG_NutritionSupportIncludingMealPreparation.docx
- OG_EpilepsySupports.docx
- OG_DysphagiaSupports.docx
- OG_DiabetesManagementSupports.docx
- OG_ContinenceSupports.docx

Note: All criteria need to be met for the supports to be funded through the NDIS.

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
34.1(a) Enabling the participant’s goals and objectives (supports will assist the participant to pursue the goals and objectives in their plan)	Yes	The participant may not have a specific goal regarding nursing support, however, consider how the management of disability related health issues may underpin and assist the participant to pursue their stated goals. s47E(d) - certain operations of agencies
34.1(b) Assist the participant’s social and economic participation	Yes	The nursing support itself may not specifically be utilized to assist with social and economic participation however consider s47E(d) - certain operations of agencies

Criteria for reasonable and necessary supports

Is criteria met?

Considerations (including evidence used)

(supports will assist the participant to undertake activities to facilitate their social and economic participation)

There are rare times when it is reasonable and necessary to include direct nursing support whilst they are accessing the community. s47E(d) - certain operations of agencies

It is important to consider the High Intensity Support Skills Descriptors - December 2022 (ndiscommission.gov.au), as various supports can be delegated to and provided by a High Intensity Disability Support Worker (HI DSW) rather than a trained nurse — where the HI DSW receives periodic oversight and supervision from a RN.

Additionally, tasks delegated by a RN using RN DSOC may occur in various environments and may be required to assist with social participation. For example, if the participant s47E(d) - certain operations of agencies

34.1(c) Value for money (supports represents value for money, ie the costs of support are reasonable, both in terms of the benefits achieved and the cost of alternative support) Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) — (f); Are there comparable support options which would achieve the same outcome at a substantially lower cost? What alternative supports were considered?

Is there a nursing report? This may be from a hospital-based or independent nurse. This will outline if s47E(d) - certain operations of agencies RN DSOC provides an appropriate comparable support model of care within the community setting and achieves the same outcome in meeting the participant’s DRHS needs in the community as direct RN supports — providing better value for money. SOP_DisabilityRelatedHealthSupports.docx. All requests must be scrutinized to determine if a trained nurse or standard/HI DSW is appropriate - High Intensity Support Skills Descriptors - December 2022 (ndiscommission.gov.au)

There are some Clinical tasks that cannot be delegated to a standard/HI DSW and only a trained nurse can complete these tasks however, it s47E(d) - certain operations of agencies

Criteria for reasonable and necessary supports

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
Is there evidence that the support will substantially improve the life stage outcomes and be of long-term benefit to the participant?	When a trained nurse is required, a RN is funded in the plan unless a Clinical Nurse (CN/CNC) is specifically required. As the participant’s diagnoses may result in lifelong disability-related health support needs, the need for nursing supports may also be lifelong; however, typically the level of need may wax and wane over time—do not assume that because a level of nursing support was included in one plan that it should be duplicated in the next. The nursing report should outline redacted.

As per COAG - NDIS-Principles-to-Determine-Responsibilities-NDIS-and-Other-Service (1).pdf Health remains responsible for all health-related needs that are not directly linked to the disability, including palliative care. Nursing reports will often include a request for DRHS consumables such as wound dressings, ventilation consumables etc. Please refer to other Advice Support Tools for specific information on DRHS consumables prescribed by nurses.

Hospital discharges may require DSW to be trained whilst the participant is still in hospital s47E(d) - certain operations of agencies. | Is there evidence that funding support is likely to increase independence and reduce funded support costs in the long-term? Is there evidence the quoted support cost is comparable to expected cost of same kind of supports?

Is there evidence the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports?

34.1(d) Support is effective or beneficial for the participant (supports will be, or are likely to be, effective for desired effect and | Yes | There will be some DRHS tasks that only a trained nurse or trained informal support can complete. However, a RN DSOC is regarded as current best practice within community settings and the High Intensity Support Skills Descriptors - December 2022 (ndiscommission.gov.au) provides redacted.

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Criteria for reasonable and necessary supports

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
beneficial for the participant, having regard to current good practice)
Consider NDIS Support for Participant Rules 2013 Part 3.2 and 3.3
What are the expected benefits of the support provision?
How will effectiveness of achieved outcome be measured?
When will effectiveness of achieved outcome be achieved?
Are there other supports required to achieve or maximise the reported support outcomes for participant?		supplementary guidance that clearly outlines the skills and knowledge that HI DSW should possess when delivering complex DRHS supports. Using a RN DSOC provides support to the DSW — with periodic oversight and supervision.
RN DSOC provides for assessments, support plan development and reviews, training and supervision — therefore this ensures that DSW have appropriate support plans to follow enabling them to provide optimum and consistent support.

NOTE The NDIS does not fund training of support workers to undertake competency based training to obtain the initial skill set required to support NDIS participants. It would be expected that a support worker providing support to a participant will have completed an appropriate qualification or will have been deemed competent to perform the prescribed duties, tasks and interventions required by a participant. It is the service provider’s responsibility to ensure that support workers have the knowledge, skills and experience to perform their role and to cover any costs related to general training and accreditation of support workers. The NDIS funds training of support workers to ensure the particular needs of the participant are met redacted.

The level of RN hours funded in a RN DSOC is dependent on the identified ‘support type’ skill areas as per Disability-related health supports | NDIS these are: Dysphagia supports. Nutrition supports. Diabetes Management supports. Continence supports. Wound and pressure care supports. Podiatry supports. |

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
Epilepsy supports.
The hours are calculated using the table in SOP_DisabilityRelatedHealthSupports.docx
and additional information can be found on page 2 DRHS_Blurbs_.docx
At the end of the planning period, NDIS expects that a nursing report will be provided in readiness for the next plan reassessment, and this will include the use of recognized tools to measure the outcome of RN and HI DSW supports. This may include wound assessment, continence report, medication administration compliance reporting etc.
34.1(e) Support coordinates with but does not replace informal support (funding or provision of supports takes account of what it is reasonable to expect families, carers, informal networks and the community to provide)
Consider NDIS Support for Participant Rules 2013 Part 3.4	☐ Yes
☐ No	A trained nurse is only funded when required to complete clinical tasks that cannot be completed by informal supports or standard/HI DSW or to provide RN DSOC.
Consideration is given to redacted: s47E - certain operations of agencies
34.1(f) Support is most appropriately funded by the NDIS (supports are not more appropriately funded or provided through other general service systems or universal service obligations)
Consider NDIS Support for Participant Rules 2013 Schedule 1.	☐ Yes
☐ No	If the participant is an inpatient (hospital) it is deemed the responsibility of the health system to provide all nursing supports during the hospital stay. Discharge planning may request nursing to be funded in the community. Evidence will be provided by the hospital nursing or medical staff.
This includes the responsibilities outlined in COAG - NDIS-Principles-to-Determine-Responsibilities-NDIS-and-Other-Service (1).pdf
CHL do I need to mention mental health nurses?

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
Where the participant resides in an Aged Care Facility the Aged Care Quality of Care Principles (2014 legislation - Quality of Care Principles 2014 (legislation.gov.au)) Part 3 Care and services — to be provided for all care recipients who need them — fees may apply, 3.8 includes the provision of Nursing Services.
For participants that receive health treatments at home e.g. dialysis or infusions and typically the patient would be expected to complete these tasks without nursing support or the treatment is started by a health system nurse
Support will not cause harm
(Supports will not be funded if it is likely to cause harm to the participant or pose a risk to others, or the support would be contrary to a law of a jurisdiction)
Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.3	☐ Yes
☐ No	and these should not be delegated by a RN.
Providers of nursing support services are to provide nurses that possess the relevant competencies, skills and experience that will meet the participant’s individual needs.
As per ANMF Guideline - Delegation by registered nurses ‘The registered nurse delegating care to an assistant in nursing or any other unregistered person is responsible for determining that the delegation is appropriate, and that the outcome is evaluated and recorded’ and ‘Employers are responsible for ensuring agency or workplace policies, protocols and practices in relation to delegation are in line with state and territory legislation, industrial instruments, and the NMBA Decision-making framework for nursing and midwifery’. Providers of standard/HI DSW are to ensure that support workers possess the relevant competencies, skills and experience and are familiar with the participant’s individual needs and support plans prior to commencing support.

Version Control

Version #	Status	Date	Modified by	Brief Description of Modification
V1.0	Cleared	29/08/2023	NIB743	Production of initial V1.0
V1.0	Cleared	05/09/2023	JIF775	Transferred to Key Advisor Advice Resources repository

Note: Document uncontrolled in hard copy