216 R.I. Code R. § 216-RICR-40-10-9.6 - Emergency Care Services

9.6.1 Management Services

A. Each FECF shall provide emergency care service with professional and ancillary staff to ensure that all persons treated are released or transferred within a reasonable and appropriate length of time. No patient shall be held overnight.

B. Policies and procedures pertaining to the provision of emergency medical care services and supported by appropriate manuals and reference material shall be established by the Medical Director and approved by the governing body. Such policies and procedures shall pertain to no less than the following:

1. The responsibility of the medical staff for emergency patient care;

2. Medical circumstances under which definitive care cannot be provided and procedures for referral;

3. Procedures that may and may not be performed in the FECF;

4. Procurement, storage and administration of drugs and medications in accordance with R.I. Gen. Laws Chapters 21-28 and 21-31;

5. Disposal of hypodermic needles, syringes and instruments in accordance with the requirements of the Rules and Regulations for Governing Hypodermic Needles, Syringes and Other Such Instruments;

6. Handling of persons who are emotionally ill, under the influence of drugs or alcohol, dead on arrival, or other categories of special care;

7. Procedures for early transfer of severely ill or injured to hospital;

8. Written instructions to be given to the patient to assure continuity of care;

9. Notification of patient's personal physician and transmission of relevant reports per written consent of patient;

10. Disclosure of patient information in accordance with federal and state law;

11. Location and storage of supplies and special equipment; and

12. Pursuant to R.I. Gen. Laws § 23-17-26 the provision of prompt emergency medical care for every person in an emergency without discrimination on account of economic status or source of payment and without delaying treatment for the purpose of prior discussion of source of payment unless such delay can be imposed without material risk to the health of the person.

9.6.2 Supportive Services

A. Each FECF shall provide on the premises during hours of operation, the following:

1. Clinical laboratory services must be provided on the premises of the FECF subject to the provisions of R.I. Gen. Laws § 23-16.2-3; and

2. Diagnostic radiology services which meet the requirements of §9.5.4(D) of this Part and Rules and Regulations for the Control of Radiation.

a. Mammography

(1) All aspects of mammography services shall be managed in accordance with the provisions of the Rules and Regulations Related to Quality Assurance Standards for Mammography of the Rhode Island Department of Health.

9.6.3 Medical Records

A. A medical record shall be maintained on every patient provided emergency care.

B. For each visit to the emergency facility the medical record shall contain documentation relating to the following:

1. Patient identification (name, address, age and sex);

2. Time and means of arrival;

3. Pertinent medical history of the illness or injury and physical findings;

4. Emergency care given before arrival;

5. Diagnostic and therapeutic orders;

6. Reports of procedures, tests and findings;

7. Diagnostic impression;

8. Conclusion at termination of evaluation/treatment, including final disposition of patient's condition on discharge or transfer and any instructions given for follow-up care;

9. A patient's leaving against medical advice; and

10. Origin of incoming patient and destination of patient at discharge.

C. All medical records either original or accurate reproductions shall be preserved for a minimum of five (5) years, except that records of minors shall be kept for at least five (5) years after such minor shall have reached the age of 18 years.

9.6.4 Medical Equipment and Supplies

A. No less than the following special supplies and equipment shall be available and located within the emergency service area:

1. Oxygen;

2. Electrocardiograph;

3. Cardiac monitor and defibrillator with battery pack;

4. Pacemaker insertion set-up; external pacemaker

5. Central venous catheter set-up;

6. Gastric lavage equipment;

7. Suction device;

8. Intravenous fluids and administration devices;

9. Endotracheal intubation, and tracheostomy trays; and

10. Emergency obstetrical pack.

B. Medical equipment and supplies for the reception, appraisal, examination, treatment and observation of patients shall be determined by the amount, type and extensiveness of services provided.

C. The emergency drug cart(s) and adjunctive emergency equipment shall be checked by an appropriate, designated individual as per written procedures after each use to assure that all items required for immediate availability are actually contained in the cart and are in usable condition.

9.6.5 Discharge Planning: Substance Use Disorder, Opioid Use Disorder, and Chronic Addiction

A. Evaluation

1. The FECF must administer a standardized evaluation to all patients with an indication of substance use disorder, opioid use disorder, or chronic addiction. If the patient declines evaluation this must be documented in the medical record. If the patient is determined after an evaluation to have a substance use disorder or opioid use disorder then appropriate medical services will be offered to the patient. Services offered to the patient shall include, but are not limited to clinically appropriate inpatient and outpatient services.

2. FECFs shall have a written policy for evaluation available upon request, inspection, or related to investigation of complaint.

B. Laboratory Screening

For every patient presenting to the FECF with an opioid overdose, the FECF must order a laboratory screening to determine what substance(s) caused the overdose. If the patient refuses the laboratory screening, the FECF is still in compliance as long as the test was ordered. If the patient declines screening this must be documented in the medical record.

C. Education

1. The FECF must educate all patients who are prescribed opioids on the risks and benefits of prescribed opioids as well as safe storage and disposal in accordance with the section titled "Patient Education/Consent" in Rules and Regulations for Pain Management, Opioid Use and the Registration of Distributors of Controlled Substances in Rhode Island.

2. When patients present with indications of illicit drug use (including but not limited to the use of illegal substances or the use of diverted prescription drugs), the FECF must educate such patients on illicit drug use, including evidence-based harm reduction strategies such as proper syringe disposal and how to obtain non-prescription syringes.

3. If the Department issues a health advisory (either statewide or for the particular geographic area in which the FECF is contained) regarding an increase in overdoses or overdose deaths, the FECF is required to educate illicit drug use and diverted overdose patients with evidence-based harm reduction strategies.

D. Naloxone

1. The FECF must have a written policy that outlines when a prescriber should dispense or prescribe naloxone to patients. This policy must include a list of conditions that would prompt the dispensing or prescribing of naloxone. A sample list of conditions is found in the Department's guidance document "Levels of Care for Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder."

2. For patients meeting the conditions set out in the FECF's policy, a prescriber must dispense or prescribe naloxone.

3. For those patients who are dispensed or prescribed naloxone, education regarding how to administer naloxone shall be provided to patients prior to discharge.

4. FECFs shall have a written policy for naloxone available upon request, inspection or related to investigation of complaint.

E. Peer Recovery

1. The FECF shall offer all patients the opportunity to speak with a peer recovery support specialist, if those patients:

a. are diagnosed with substance use disorder or opioid use disorder using then evaluation protocol required by §9.6.5(A) of this Part, or

b. are treated for an opioid overdose.

2. To fulfill the above requirement, at a minimum the FECF must inform the patient that the FECF will contact a peer recovery support specialist on the patient's behalf.

3. FECFs shall have a written policy for peer recovery available upon request, inspection or related to investigation of complaint.

F. Treatment Services

1. The FECF shall provide information to patients about appropriate inpatient and outpatient services, including but not limited to medication assisted treatment and biopsychosocial treatment, if those patients:

a. are diagnosed with substance use disorder or opioid use disorder using then evaluation protocol required by §9.6.5(A) of this Part, or

b. are treated for an opioid overdose.

2. FECFs must make a good faith effort to assist the patient in obtaining an appointment with a qualified licensed professional. To fulfill the above requirement, at a minimum the FECF must present a list of names, addresses, and phone numbers of appropriate inpatient and outpatient services. This list shall include information about medication-assisted treatment. If the patient declines to receive information or assistance about treatment services this must be documented in the medical record.

3. FECFs shall have a written policy for treatment services available upon request, inspection or related to investigation of complaint.

G. Notification of Emergency Contact

1. Prior to discharge and with patient consent, the FECF will attempt to notify the patient's emergency contacts and peer recovery support specialist (if any of these individuals have been identified) pursuant to R.I. Gen. Laws § 23-17.26-3(iii). If the patient declines notification of an emergency contact or recovery coach, the treating provider will document this refusal in the medical record.

2. FECFs shall have a written policy for notification of emergency contact available upon request, inspection, or related to investigation of complaint.

H. Right to Refuse Treatment

Pursuant to R.I. Gen. Laws § 23-17-19.1(4), a patient has the right to refuse any screening, treatment, or service described in §§9.6.5(A) through (G) of this Part.

I. Overdose Reporting

FECFs shall comply with the reporting requirements found in Rules and Regulations Pertaining to Opioid Overdose Prevention and Reporting.

Notes

216 R.I. Code R. § 216-RICR-40-10-9.6