216 R.I. Code R. 216-RICR-40-10-17.6 - Patient Care Management
17.6.1
Rights
of Patients
A. Each patient/client of a
home nursing care provider or home care provider has the right to be informed
of his or her rights under R.I. Gen. Laws §
23-17-19.1 and the home
nursing care provider or home care provider must protect and promote the
exercise of these rights.
B. The
home nursing care provider or home care provider must provide the
patient/client with a written notice of the patient/client rights in §
17.6.1(E) of this Part in advance of furnishing care to the patient/client or
during the initial evaluation visit before the initiation of
treatment.
C. A copy of the written
notice of rights signed by the patient/client will be maintained in the
patient/client record by the home nursing care provider or home care provider
and in the patient/client's home. The home nursing care provider or home care
provider must maintain documentation showing that it has complied with the
requirements of this Section.
D.
The provisions of §
17.6 of this Part shall not apply to nursing services
or home health services conducted by and for those who rely exclusively upon
spiritual means through prayer alone in accordance with the creed or tenets of
a recognized church or religious denomination.
E. In addition to the rights stated in R.I.
Gen. Laws §
23-17-19.1:
1. No charge
shall be made for furnishing a health record or part thereof to a patient,
his/her attorney or authorized representative if the record or part thereof is
necessary for the purpose of supporting an appeal under any provision of the
Social Security Act (42 U.S.C. §
301
et seq.) and the
request is accompanied by documentation of the appeal. A provider shall furnish
a health record requested pursuant to this Section within thirty (30) days of
the request.
17.6.2
Confidentiality
A. Disclosure of any health care information
relating to individuals shall be subject to the provisions of the
"Confidentiality of Health Care Communication and Information Act", R.I. Gen.
Laws Chapter 5-37.3, and other relevant statutory and federal
requirements.
17.6.3
Admission and Discharge Policies
A. Providers shall establish policies
pertaining to eligibility for admission to and discharge from home nursing care
provider or home care provider services. Such policies shall be based on the
following criteria:
1. Pre-admission
assessment of patient care needs;
2. Reasonable expectations of the home
nursing care provider's or home care provider's capability to respond to the
medical and nursing needs of the patient;
3. Plan of care;
4. Constraints imposed by limitation of
services, family conditions;
5.
Community or other resources to ensure continuity of patient care;
and
6. Such other criteria as may
be deemed appropriate.
17.6.4
Alzheimer's Operational
Plan
A. Every healthcare facility as
defined in R.I. Gen. Laws §
23-17-2 shall complete and implement an
operational plan for the recognition and management of patients with
Alzheimer's disease or dementia.
1. Such plan
shall include a protocol for the following:
a.
Identifying the signs and symptoms of cognitive impairments, including
Alzheimer's disease;
b. Management
of clients/patients with Alzheimer's disease;
c. Training of clinical and non-clinical
staff; and
d. Advance care planning
and resources for family members.
2. Such plan shall be maintained by the
healthcare facility and made available to the licensing agency upon
request.
17.6.5
Clinical Records
A. Accurate and complete clinical records
maintained in accordance with accepted professional standards shall be kept on
each patient and filed in an accessible location within the home nursing care
provider or home care provider. Such records shall contain no less than the
following information:
1. Identifying data
(name, address, date of birth, gender, date of admission or
readmission);
2. Sources of patient
referral;
3. Name of attending
clinician (including address and telephone number);
4. Original plan of care for services
provided;
a. Personal care
objectives;
b. Homemaker
objectives, as appropriate;
5. Documentation of each patient
contact;
6. Changes in and reviews
of the patient's plan of care, signed by responsible professional;
7. Documentation of an executed advance
directive (if any) and a copy of the advance directive, if provided to the
facility by the patient; and
8.
Discharge summaries.
B.
Home nursing care provider or home care provider personnel involved in the care
of patients shall participate, to the extent possible, in developing care
plans. When practical, designated home nursing care provider or home care
provider personnel shall complete a "Continuity of Care" form as approved by
the Director for each patient who is discharged to another health care
facility, such as a hospital or nursing facility, or other facility licensed
under the provisions of R.I. Gen. Laws Chapter 23-17. Said form shall be
provided to the receiving facility, agency, or provider prior to, upon
transfer, or discharge of the patient. (See the Department's website for the
approved form: health.ri.gov).
C.
Records shall be maintained by the home nursing care provider or home care
provider for a period of at least seven (7) years following the date of
discharge and shall be safeguarded against loss or unauthorized use. This
requirement shall also apply to computerized or electronic records.
1. Records shall be maintained by the home
nursing care provider or home care provider for a minimum of seven (7) years
after a minor patient turns eighteen (18) years of age.
D. Each home nursing care provider or home
care provider shall have written policies and procedures to govern the use and
removal of records and determine the conditions for release of information in
accordance with statutory provisions pertaining to confidentiality.
17.6.6
Nursing Assistant
Services
A. Each home nursing care
provider or home care provider that chooses to provide home nursing care and
home care as provided in this Part shall be subject to the same training
requirements for nursing assistants and the duties of the individuals shall be
the same as those prescribed in Subchapter 05 Part 22 of this Chapter, Nursing
Assistants, Medication Aides, and the Approval of Nursing Assistant and
Medication Aide Training Programs.
B. Supervision of Nursing Assistants
1. Supervision of nursing assistants shall be
directed to the management of patients'/clients' care and services, the
performance of duties, and shall be available at all times during the
established hours of operation of the home nursing care provider or home care
provider and at such other times as they are providing services to
patients/clients.
2. Supervision of
nursing assistants as employees of a home nursing care provider or home care
provider:
3. Nursing assistant
services shall be:
a. Provided in accordance
with a plan of care; and
b.
Monitored/supervised no less than once every three (3) months by a professional
(registered) nurse or other appropriate health care professional who is
licensed in Rhode Island; and
c.
Provided in accordance with Subchapter 05 Part 22 of this Chapter, Nursing
Assistants, Medication Aides, and the Approval of Nursing Assistant and
Medication Aide Training Programs.
d. Such supervision shall include the
following duties:
(1) Conducting the initial
in-home assessment prior to commencement of service, unless documented
extraordinary circumstances prevent such timing. In these cases the initial
in-home assessment must be conducted within forty-eight (48) hours. Subsequent
assessments and direct supervision of the Nursing Assistant (at least one
supervisory session) must be conducted no less than every three (3) months
thereafter or more frequently as the condition of the patient/client may
require;
(2) Involving other
professional disciplines where personal care is provided, as may be deemed
necessary to ensure the provision of quality care;
(3) Developing, reviewing and revising the
plan of care, as the condition of the patient/client may require but no less
than once every three (3) months;
(4) Assigning only delegable duties as set
forth in Subchapter 05 Part 22 of this Chapter, Nursing Assistants, Medication
Aides, and the Approval of Nursing Assistant and Medication Aide Training
Programs for Nursing Assistants;
(5) On-site monitoring the performance of
Nursing Assistants no less than once every three (3) months and maintaining
appropriate records of such monitoring;
(6) Coordinating the management of services
(inter- and intra-agency);
(7)
Monitoring the clinical record for each patient/client which includes
appropriate recording of the plan of care, services rendered, and which is
signed by the person rendering services; and
(8) Such other functions and activities as
may be deemed necessary and appropriate.
17.6.7
Reporting
of Communicable Diseases
A. Each
facility shall report promptly to the Rhode Island Department of Health,
Division of Disease Control, cases of communicable diseases designated as
"reportable diseases" by the Director, when such cases are diagnosed in
accordance with the most current Part 30-05-1 of this Title, Reporting and
Testing of Infectious, Environmental, and Occupational Diseases.
Notes
Amended effective
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