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.
9.6.3
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.