216 R.I. Code R. § 216-RICR-40-10-16.11 - Patient Care Services
16.11.1
Management Responsibility
A. The
rehabilitation hospital center through its Medical Director shall be
responsible to ensure that all health and holistic rehabilitation services and
programs, including services provided per contract or arrangement are rendered
in a safe and effective manner consistent with acceptable standards of
practice, policies of the center and the requirements of this Part.
1. Furthermore, the Medical Director shall be
responsible to ensure that all patients receive adequate medical/surgical
treatment, as may be required for specific conditions, in an appropriate
facility.
B. The center
shall assure the continuity of patient care in the inpatient, day patient and
outpatient settings through written policies, procedures and criteria
pertaining to no less than the following:
1.
Criteria and policies and procedures for admissions to each level of care and
initial assessment of patient care needs;
2. Signed informed consent;
3. Ongoing assessment of patient/family
needs;
4. Development and review of
the plan of care by the interdisciplinary team;
5. Transfer of patients for acute
medical-surgical problems; (see §16.11.1(A) of this Part)
6. The provision of appropriate information
to patient/family at the points of transfer between levels of care;
7. Community or other resources, including
consultation services, to insure continuity of care to meet patient care
needs;
8. Constraints imposed by
limitations of services, patient and home conditions, or other; and
9. Such other criteria as may be deemed
appropriate.
16.11.2
Plan of Care
A. After initial assessment of patient
rehabilitative needs, a written plan of care shall be established by the
interdisciplinary team for each patient admitted to the center and at each
level of care and with the participation of the patient or responsible party.
Such plan shall designate the intensity of services required in relation to the
disability and the individual's response to treatment and shall include
provisions pertaining to:
1. Pertinent
diagnosis and prognosis;
2.
Identification of the intensity of patient care needs
including:
a. The
range of rehabilitation services required;
b. The level of care required;
c. The frequency of therapeutic services
required;
d. Medications;
e. Management of discomfort and pain control;
and
f. Other rehabilitative needs
and prescribed therapies;
3. Such other relevant modalities of care,
training and services as may be appropriate to meet the patient's
rehabilitative needs.
B.
Patient care plans shall be reviewed and updated at periodic intervals as
specified in the plan of care by the multidisciplinary
team.
16.11.3
Levels of Care
A. Inpatient
Care: shall be for the provision of intensive functional rehabilitation
services through the interdisciplinary team, for patients who require
uninterrupted rehabilitation and nursing care services including a range of
intensive rehabilitation services referred to in §16.11.4 of this Part as
related to patient's disability and response to treatment.
B. Day Care: shall be for the provision of
rehabilitation services through the Interdisciplinary Team to patients whose
condition continues to require intensive functional rehabilitation services as
provided in the inpatient setting, but who can accommodate to a less protective
environment such as his or her home, without interrupting the rehabilitation
process.
C. Outpatient: shall refer
to the provision of coordinated and integrated assessment and/or rehabilitation
services with emphasis on continuity of care, education and training to
individuals with disabling impairments requiring less intensive rehabilitation,
supervision and support services.
16.11.4
Rehabilitation Services
A. Physician Services: shall be available
and/or on call on a twenty-four (24) hour basis and be provided by physician(s)
who shall be responsible for the diagnosis and treatment of disabled patients,
and who shall participate with members of the interdisciplinary team in the
development, implementation and assessment of patient care plans.
B. Nursing Services: shall be provided on a
twenty-four (24) hour basis under a licensed professional (registered) nurse in
accordance with R.I. Gen. Laws Chapter 5-34, who has training and experience in
rehabilitation nursing and who shall be responsible to meet the rehabilitative
nursing needs of patients as prescribed in the patient's plan of care and in
accordance with acceptable standards of practice.
1. There shall be a sufficient number of
licensed professional (registered) nurses on duty at all times to plan, assign,
supervise, implement and evaluate nursing care as well as to provide direct
patient care as required.
2. The
number and type of licensed nurses and ancillary nursing personnel shall be
based on evaluation of patient care needs and staff capabilities for each
patient care unit.
3.
Administration of drugs by non-licensed personnel, selected non-licensed
personnel with demonstrated competency, who have satisfactorily completed a
state approved training program in drug administration may administer oral or
topical drugs, if adequate medical and nursing supervision is provided in
accordance with R.I. Gen. Laws Chapter 5-34.
C. Social Services: shall be provided as
prescribed in the plan of care and in accordance with acceptable standards of
practice and center policies. Social Workers hired after January 1, 2019 shall
be qualified on the basis of education, training and experience in accordance
with the provisions of R.I. Gen. Laws Chapter 5-39.1. Staff providing social
services hired before December 31, 2018 shall have at least a bachelor's degree
in social work from a school accredited or approved by the Council on Social
Work Education.
D. Therapeutic
Services: All therapeutic services shall be provided as prescribed by the
interdisciplinary team in the plan of care. Such therapeutic services shall be
provided by appropriate staff or consultants in accordance with the center's
policies and procedures and consistent with prevailing standards of practice.
Furthermore, therapists staff or consultants shall participate in the
development, implementation and assessment of patient care plans.
1. Therapists and assistants (physical,
occupational, speech, audiologist) shall furthermore hold current licensure,
certification or registration as may be required under R.I. Gen. Laws Chapters
5-34, 5-40, and 5-40.1.
E. Psychological Services: shall be provided
by qualified psychologists who are certified in the State of Rhode Island in
accordance with R.I. Gen. Laws Chapter 5-44. Such services shall be provided as
prescribed in the plan of care and the psychologist(s) shall also participate
in the development, implementation and assessment of the patient's plan of
care.
F. Pastoral Care: Clergymen
or members of various denominational organizations or churches shall have
access to patients. Patients shall be notified of the availability of such
services.
G. Prosthetic/Orthotic
Services: shall be rendered as prescribed in the plan of care and provided by
individuals with training and experience in prosthetics and/or orthotic
services, who shall also participate in the development, implementation and
assessment of the plan of care.
H.
Allied Rehabilitation Services: such as pre-vocational, vocational, driver
training shall also be provided in accordance with center policies and through
written agreement with agencies providing vocational training or driver
education.
I. Other Rehabilitation
Services: all other rehabilitation services, including recreation services,
provided by the center shall be provided by individuals with appropriate
qualifications and rendered in accordance with acceptable standards or
practice.
16.11.5
Infection Control
A. The center
shall make provisions through patient care and personnel policies for the
control of infection and for the protection of patients and personnel. Policies
shall pertain to no less than the following:
1. Sanitation and medical asepsis;
2. Disposal of solid waste
materials;
3. Admission and
isolation of patients with known or suspected infections, diseases and other
protective isolation;
4. The
establishment of a center-wide surveillance program which shall include an
infection surveillance officer to conduct all infection surveillance
activities. This shall include a system of periodic reporting, evaluation and
recording of the occurrence of infections among personnel and
patients;
5. The monitoring of
staff personnel to insure the implementation of policies and procedures for the
control of infection control.
B. Reporting of Communicable Diseases: Each
center shall report promptly to the Rhode Island Department of Health, Division
of Disease Control, cases of communicable diseases designated as "reportable
diseases" in accordance with the rules and regulations pertaining to Reporting
and Testing of Infectious, Environmental, and Occupational Diseases (Part
30-05-1 of this Title) when such cases are diagnosed.
1. When outbreaks of food borne illness are
suspected, such occurrences shall be updated immediately to the Rhode Island
Department of Health, Division of Disease Control or to the Division of Food
Protection and Sanitation.
16.11.6
Dietary Services
A. A center shall maintain a dietary service
directed by a full-time person qualified by training and experience in
organization and administration of food service.
B. Each center shall have at least one
Registered Dietitian, licensed by the state and certified by the Commission on
Dietetic Registration, employed on either a full-time, or regular part-time
basis to direct nutritional aspects of patient care and to advise on food
preparation and service.
C.
Adequate space, equipment and supplies shall be provided for the efficient,
safe and sanitary receiving, storage, refrigeration, preparation and service of
food and other related aspects of the food service operation in accordance with
the Rhode Island Food Code (Part 50-10-1 of this Title)
1. Any construction, addition, alteration
affecting food service operations shall be in conformance with the requirements
of R.I. Gen. Laws §
23-1-31.
D. The food service operation shall comply
with applicable standards of the Rhode Island Food Code (Part 50-10-1 of this
Title).
E. Written policies and
procedures shall be established for dietary services, pertaining to but not
limited to the following:
1. Responsibilities
and functions of personnel;
2.
Advising the administrator on all nutritional aspects of patient care, food
service and preparation;
3.
Alterations or modification to diet orders;
4. Food purchasing, storage preparation and
service;
5. Safety and sanitation
relative to personnel and equipment;
6. Ancillary dietary services, including food
storage and preparation in satellite kitchens, and vending
operations;
7. Providing dietary
counseling to patients when necessary; and
8. Ice making in accordance with Good
Manufacturing Practices for Food (Part 50-10-4 of this Title).
F. Any center engaged in
processing or handling or both, of frozen foods shall be subject to standards
of Good Manufacturing Practices for Food (Part 50-10-4 of this
Title).
G. There shall be a diet
manual maintained by the dietary service which shall be reviewed, periodically
revised as necessary and approved by the medical staff. Diets served to
patients shall comply with the principles set forth in the diet
manual.
H. All patient diets shall
be ordered in writing by the physician.
I. A dining room shall be available for those
patients who wish to participate in group dining in accordance with
§16.13.3(A)(5) of this Part.
J. Self-help feeding program shall be
available to those patients who need them to maintain maximum independence in
the activities of daily living.
K.
A center contracting for food service shall require as a part of the contract,
that the contractor comply with the provisions of the rules and regulations of
this Part.
L. All menus shall be
planned at least one week in advance and shall provide for a variety of foods,
adjusted for seasonal changes, and reflecting the dietary preferences of
patients. Menus shall be posted in a conspicuous place in the dietary
department and records of such shall be retained for thirty (30)
days.
16.11.7
Laboratory and Radiology Services
A. Clinical laboratory services shall be in
accordance with the provisions of R.I. Gen. Laws §
23-16.2-3 and the Federal CLIA regulation: 42 C.F.R. § 439. The Center must also
maintain the appropriate CLIA certificate to the level of testing being
performed.
B. A center providing
radiology services must meet the requirements of regulations regarding
Radiation (Subchapter 20 of this Chapter).
1.
Authentication reports of radiological interpretations, consultations shall be
part of the patient's clinical record.
C. Centers contracting with outside resources
for laboratory and/or radiology services shall contract only with:
1. Laboratories which meet the requirements
of the rules and regulations for Clinical Laboratories and Stations (Part
60-05-4 of this Title); and
2.
Radiation facilities which meet the requirements of the rules and regulations
for Radiation (Subchapter 20 of this Chapter).
16.11.8
Pharmacy
A. Each Rehabilitation Hospital Center shall
provide pharmaceutical services either directly within the institution or by
contractual arrangement. In either instance, there shall be evidence of a
current pharmacy license in compliance with R.I. Gen. Laws §
5-19.1-8.
Pharmaceutical services shall be provided in accordance with the rules and
regulations pertaining to Pharmacists, Pharmacies, and Manufacturers,
Wholesalers and Distributors (Subchapter 15 Part 1 of this Chapter).
B. An emergency medication kit, approved by
the pharmaceutical service committee or its equivalent, shall be kept at each
nursing station.
16.11.9
Quality Assurance Program
A. Each
center shall establish and maintain on an ongoing basis a Quality Assurance
Program which involves assessment of all quality assurance activities conducted
in the provision of its health care and rehabilitation program and services at
all levels which shall include no less than:
1. Establishment of standards and criteria
for the assessment of the quality of health and rehabilitation program and
services provided and the appropriateness of the resources utilized;
2. Assessment of rehabilitation
outcomes;
3. Ongoing review of
rehabilitation programs and services by physicians and other health
professionals;
4. A mechanism to
assure the utilization of systematic data collection based on valid samples of
the total patient population to measure performance and patient results, and to
make recommendations to physicians and centers of needed changes;
5. Provisions for combining utilization data
and financial data into management reports which shall be available to the
Director of Health;
6. Arrangements
of routine reporting of results of quality assurance program activities to the
governing body, administration, providers, and the Director of Health;
and
7. Written procedures for
taking appropriate remedial action whenever, as determined under the quality
assurance program, inappropriate or substandard services have been provided or
services which should have been furnished have not been provided.
16.11.10
Equipment
A. Each center shall
have an assortment of styles and sizes of adaptive equipment for patient
evaluation and training in the following areas:
1. Beds - e.g., beds && accessories,
mattresses, waterproof bed protection, enuresis, alarms, self-fitting aids, bed
and cantilever tabled, protective devices for incontinency.
2. Pressure relief -e.g., beds and cushions
designed for pressure relief, sheepskins.
3. Chairs -e.g., geriatric, adjustable and
mobile chairs, self-lift seats, therapeutic training wheelchairs.
4. Communication -e.g., reading aids, writing
and speech aids, deaf aids, remote control apparatus.
5. Eating and Drinking Aids -e.g., non-slip
materials, trays, cutlery.
6.
Electro Diagnostic - EMG
7. Hoists
and Lifting Equipment -e.g., portable, fixed and electric hoists, manual
lifting aids, car hoists, stair climbers.
8. Leisure Activities - e.g., music, sports,
hobbies, crafts, sewing.
9. Sport
&& Physical Recreation -e.g., (facilities for disabled people) clubs
concerned with sports for disabled.
10. Personal Toilet and Personal Care -e.g.,
commodes, hair washing, showers, aids for incontinency.
11. Prosthetics and Orthotics - adjustable
models.
12. Walking Aids and
Wheelchairs
13. Household
equipment/fittings
14.
Clothing/footwear
15. Therapeutic
Devices: nerve muscle stimulators; exercise equipment -e.g., weight/pulleys,
ergometer, treadmill; Modalities: mv/heat/ microwave, traction; Positioning;
Hydrotherapy (whirlpool and therapeutic pool)
16. Other Diagnostic: E.K.G.; Pulmonary
function; Biofeedback && video feedback; audio and visual equipment;
and prevocational, e.g. adjustable heights and accessible work
stations.
Notes
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