Md. Code Regs. 10.07.01.31 - Hospital Palliative Care Programs
A. Acute general hospitals and special
hospitals-chronic care with 50 or more beds shall establish an active hospital
wide palliative care program that provides consultation services to patients
suffering from pain and symptoms due to serious illnesses or
conditions.
B. The hospital shall.
(1) Promote the palliative care
program;
(2) Provide information
and referrals to patients and families when appropriate regarding the
availability of palliative care services; and
(3) Inform patients of the patient's right to
request a palliative care consultation.
C. Staffing.
(1) The hospital shall designate a qualified
interdisciplinary care team with training in palliative care to staff the
palliative care program.
(2) The
hospital shall ensure that:
(a) A qualified
health care professional coordinates the activities of the palliative care
program with the palliative care patient's interdisciplinary care
team;
(b) Staff is appropriately
trained, credentialed, or certified in the staff's area of expertise;
(c) Staff receives continuing training and
education; and
(d) Written policies
and procedures for the hospital palliative care program are established,
implemented, maintained, and updated periodically.
D. Palliative Care Education and
Training. The hospital shall provide and document training to medical and other
clinical staff as determined by the hospital regarding:
(1) Services provided by the palliative care
program;
(2) Domains of palliative
care; and
(3) Legal requirements
for:
(a) Health care decisions; and
(b) MOLST as referenced in COMAR
10.01.21.
E.
Interdisciplinary Plan of Care.
(1) The
hospital shall incorporate the recommendations of the palliative care program
into the palliative care patient's interdisciplinary care plan.
(2) The hospital shall review the
interdisciplinary plan of care and revise it as necessary to meet the needs of
the palliative care patient.
(3)
The palliative care program shall conduct care conferences as appropriate to
review the plan of care with:
(a) The
palliative care patient;
(b) The
palliative care patient's family;
(c) The health care professionals;
and
(d) Other interdisciplinary
team members.
(4)
Contents. The hospital shall ensure that the palliative care patient's plan of
care includes at a minimum:
(f)
(g) Preferred site of death and after-death
arrangements, as appropriate;
(g)
(h) Grief and
bereavement plan, as appropriate;
(h)
(i) Assessment of
cultural needs;
(i)
(j) Assessment of legal needs; and
(j)
(k)
Assessment of discharge needs.
(a) Initial
assessments conducted by the interdisciplinary palliative care team;
(b) Psychological needs assessment;
(c) Treatment goals;
(d) Choice of treatment options;
(e) Preferred care setting;
(f) Availability of hospice
services;
(5) Collaboration. The hospital shall
document and provide palliative care services in collaboration with:
(a) The attending physician; and
(b) Any other health care provider managing
the patient's care.
(6)
Continuity of Care. The hospital shall coordinate services to ensure continuity
of care for the palliative care patient. The hospital shall:
(a) Transfer the pertinent parts of the
medical record, medical orders, and plan of care with the palliative care
patient upon transfer to post-acute care;
(b) Ensure that MOLST forms are completed in
accordance with COMAR 10.01.21;
(c)
Convert a palliative care patient's treatment goals into medical orders, as
appropriate; and
(d) Have reporting
mechanisms to keep all staff informed and updated about care changes and
treatment goals.
F. Palliative Care Services.
(1) The hospital or palliative care program
shall counsel the palliative care patient or the patient's authorized decision
maker regarding:
(a) Health options;
(b) Pain management options;
(c) Prognosis;
(d) Risks and benefits of
treatment;
(e) Availability of
grief and bereavement services, as appropriate;
(f) Psychological services;
(g) Availability of spiritual care counseling
through the hospital or outpatient providers; and
(h) Hospice services, as
appropriate.
(2)
Referrals.
(a) As appropriate and upon request
by the patient or authorized decision maker, the hospital may make timely
referrals.
(b) The hospital shall
document any referrals made to:
(i) Inpatient
or outpatient bereavement providers;
(ii) Psychological services for the
palliative care patient and the patient's family;
(iii) Inpatient or outpatient spiritual care
services; and
(iv)
Hospice.
(3)
Pain and Symptom Management. The hospital shall:
(a) Conduct and document pain and symptom
assessments using available standardized scales to appropriately manage a
palliative care patient's symptoms;
(b) Provide adequate and appropriate dosage
of analgesics and sedatives to meet the needs of the palliative care patient;
and
(c) Educate the patient and the
patient's family about the use of opioids during end-of-life care.
(4) Other Services. The hospital
shall provide culturally and linguistically appropriate education and support
about how to safely care for the patient at home or in an alternate residential
setting as appropriate.
(5)
Imminent Death. The palliative care program shall document and counsel the
patient, the authorized decision maker, the patient's family, and the
interdisciplinary care team about the active dying phase and imminent death as
appropriate.
(6) MOLST. The
hospital shall comply with the procedures and requirements of the Medical
Orders for Life-Sustaining Treatment Form, which is incorporated by reference
at COMAR 10.07.21.
(7) Interpreter
Services. The hospital shall ensure interpreter services are available and
accessible to the palliative care program.
G. Advance Directives.
(1) The hospital shall recognize the
authority of:
(a) An advance directive
established in compliance with Health-General Article, ยง5-602, Annotated
Code of Maryland; and
(b) An
authorized decision maker.
(2) The hospital shall ensure that any
provided advance directive and authorized decision maker designation are in the
patient's medical record, including the electronic medical record.
(3) The hospital shall promote advance care
planning and the completion of advance directives through community outreach
activities.
H. Ethics
Committee. The hospital shall allow staff, patients, and the patient's family
in the palliative care program access to an ethics committee to address ethical
conflicts at the end of life.
I.
Quality Improvement. The palliative care program shall take part in the
hospital's quality improvement and performance improvement activities to the
extent required by State and federal statute.
J. Departmental Oversight. The Department
shall have access to all data maintained through the hospital's palliative care
program to determine the hospital's compliance with State and federal
regulations.
Notes
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