Ala. Admin. Code r. 420-5-11-.03

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-5-11-.03 - Patient Care

(1)Admission Policy.

(a) Patient Admission. All patients shall be admitted to the services of the facility on orders from a physician.

(b) Restrictions. Patients shall not be accepted without reasonable assurance that existing programs will improve the patient's condition. Each potential patient shall be thoroughly evaluated to determine if needs are consistent with available services.

(c) Grievance Procedure. A grievance procedure shall be established and adequately explained to each patient. A brochure or manual shall be provided to the patient which outlines the programs, rules and responsibilities.

(2)Medical Direction.

(a) Physician Direction. The physician retains overall responsibility for the general medical direction of the patient and is periodically apprised of the patient's condition and progress.

(b) Emergency Physician Coverage. Provision shall be made for physician coverage of medical emergencies.

(3)Rehabilitation Services.

(a) Scope of Service. The facility shall provide or arrange for services essential to the implementation of its program. These services shall be of such quality and so applied that they constitute an effective program which achieves the rehabilitation objective for the individual patient.

(b) Program Requirements. Each specialized rehabilitative service offered has an adequate program designed in accordance to the discipline's professional practices.

(c) Facilities and Equipment. The organization has the equipment and facilities required to provide the range of services necessary in the treatment of the types of disabilities accepted for service.

(d) Personnel Qualifications. Services are provided by or under the supervision of a qualified therapist. The number of qualified therapists and qualified therapy assistants shall be adequate for the volume and diversity of service offered. A qualified therapist in each service offered shall be on the premises or be readily available during the operating hours of the organization.

(e) Supportive Personnel. If personnel are available to assist qualified therapists by performing services incidental to the therapy that do not require professional knowledge and skill, such personnel are instructed in appropriate patient care policies by qualified therapists who retain responsibility for the treatment prescribed by the attending physician.

(f) Therapy Assistants. A qualified therapist is present, or is readily available to offer needed supervision to the therapy assistant when therapy services are provided on or off the organization's premises. When a qualified therapist is not on the premises during all hours of operation, patients are scheduled in such a manner as to ensure the therapist's presence when specific skills are needed (e.g., the evaluation and reevaluation), and to provide appropriate and needed supervision to the therapy assistant when providing service. When therapy services are provided off the premises of the organization by a qualified therapist assistant, such services are provided under the supervision of a qualified therapist who makes an on-site supervisory visit at least once every 30 days.

(g) Qualification of Staff. The agency's social or vocational adjustment services are rendered, as applicable, by qualified psychologists, qualified social workers, or qualified vocational specialists. Social or vocational adjustment services may be performed by a qualified psychologist or qualified social worker. Vocational adjustment services may be furnished by a qualified vocational specialist.

(h) Arrangements for Social or Vocational Services. Adjustment services may be provided by means of a written contract with others which provide for retention by the agency of responsibility for, and control and supervision of such services. The terms of the contract shall:

1. Provide that the regimen of social or vocational adjustment services to be furnished is developed in consultation between appropriate professional staff members and the patient's attending physician.

2. Specify the geographical areas in which the services are to be furnished.

3. Provide that such services are furnished by personnel meeting professional qualifications.

4. Provide that personnel under contract will participate as needed in conferences required to coordinate patient care.

5. Provide for the preparation of treatment records and notes, and for the prompt incorporation of such into the clinical records of the agency.

6. Specify the period of time the contract is to be in effect and the manner of termination of renewal.

(i) Arrangements for Specialized Rehabilitative Therapists.

1. When an organization provides specialized rehabilitative therapists under an arrangement with others, such services are to be furnished in accordance with the terms of a written contract, which provides for retention by the organization of professional and administrative responsibility for, and control and supervision of such services.

2. Contract provision. The terms of the contract:

(i) Provide that the specialized rehabilitative therapy services are to be furnished in accordance with the plan of care established by the physician responsible for the patient's care and may not be altered in type, amount, frequency, or duration by the therapists (except in the case of an adverse reaction to a specific treatment).

(ii) Specify the geographic area in which the services are to be furnished.

(iii) Provide the personnel and service contracted for, meet the same requirement as those which would be applicable if the personnel and services were furnished directly by the agency.

(iv) Provide that, as needed, the therapists will participate in conferences required to coordinate the care of an individual patient.

(v) Provide for the preparation of treatment records, with progress notes and observations, and for the prompt incorporation of such into clinical records of the agency.

(vi) Specify the financial arrangements which provide that the contracting outside resource may not bill the patient.

(vii) Specify the period of time the contract is to be in effect and the manner of termination or renewal.

(4)Pharmaceutical Services.

(a) Applicability. The provisions of this section shall apply to all rehabilitation centers.

(b) Administering Drugs and Medicines. Drugs and medicines shall not be administered to individual patients nor to anyone within or outside the facility unless ordered by a physician duly licensed to prescribe drugs. Such orders shall be in writing and signed personally by the physician who prescribes the drug or medicine.

(c) Medicine Storage. Medicines and drugs maintained for daily administration shall be properly stored and safeguarded in enclosures of sufficient size which are not accessible to unauthorized persons. Only authorized personnel shall have access to storage enclosures.

(d) Medicine Preparation Area. Medicines and drugs shall be prepared for administration in an area which contains a counter and a sink. Where possible, this area shall be located in such a manner to prevent contamination of medicines being prepared for administration.

(e) Narcotic Permit. Each rehabilitation center shall procure a controlled drug permit from DEA if a stock of controlled drugs is to be maintained. The permit shall be displayed in a prominent location.

(f) Records. Records shall be kept of all stock supplies of controlled substances giving an accounting of all items received and/or administered.

(g) Medication Orders. All oral or telephone orders for medications shall be received by a licensed nurse or a physician, shall be reduced to writing on the physician's order sheet with an indication as to the prescribing physician and who wrote the order. Telephone or oral orders shall be signed by the prescribing physician within 48 hours. Patients requiring medications outside of the facility shall be given a written prescription where that medication can be obtained from a licensed pharmacy, except in cases where the rehabilitation center has a licensed pharmacy as a part of the center.

(h) Pharmacy. If the facility has a pharmacy, it shall be of sufficient size to permit orderly storage and accurate identification of all drugs and medicines, and avoid overcrowding of preparation and handling areas. The pharmacy shall comply with all state and federal regulations governing the operation of a pharmacy. In addition, the pharmacy shall also:

1. Be adequately lighted with artificial illumination.

2. Be provided with proper safeguards.

3. Be provided with a counter and sink.

4. Be provided with shelving.

5. Have a refrigerator.

6. Be provided with prescription files.

7. Be provided with books and equipment in accordance with requirements of the Alabama State Board of Pharmacy for compounding and dispensing of drugs.

(i) Poisonous Substances. All poisonous substances must be plainly labeled and kept in a cabinet or closet separate from medicines and drugs to be prepared for administration.

(j) Emergency Kit or Emergency Drugs. Each rehabilitation center, upon the advice and written approval of the facility's physician, must maintain an emergency kit or stock supply of drugs and medicines for the use of the physician in treating the emergency needs of his patient. This kit or medicine shall be stored in such a manner as to limit its access to authorized personnel, but in such a manner as to allow quick retrieval.

(k) Drug Reference Sources. Each rehabilitation center shall maintain reference sources for identifying and describing drugs and medicines.

(5)Infection Control.

(a) Infection Control Committee. A committee shall be established to write and monitor policies and procedures for investigation, controlling, and preventing infections.

(b) Infection Control Committee Membership. The committee shall have representation of the professional staff, housekeeping, laundry, and maintenance and shall meet at least quarterly.

(c) Linens. Linens used by patients who have or are suspected of having a communicable disease shall be processed in a manner to prevent the spread of infection. Precautions shall be taken in storing and transporting soiled and clean linens in order to prevent contamination of clean linen.

(d) Location and Space Requirements. Each rehabilitation center shall have laundering facilities, unless proper commercial laundries are used. The laundry shall have adequate rooms and/or spaces for sorting, processing and storage of soiled material.

(e) There shall be policies and procedures for cleaning and disinfecting equipment such as hydrotherapy tanks and pools, hydrocullators, paraffin bath and other equipment.

(f) There shall be policies and procedures for the proper handling, cleaning and disposal of all infectious material and waste products. Space shall be provided for the sanitary storage and disposal of waste by incineration, containerization, removal or by a combination of these techniques.

(g) There shall be policies and procedures for aseptic techniques in the handling of patients to be followed by all personnel.

L. O'Neal Green, Rick Harris

Ala. Admin. Code r. 420-5-11-.03

Original rules effective January 1, 1981. Repealed and New Rule: Filed December 17, 2003; effective January 21, 2004.

Statutory Authority:Code of Ala. 1975, §§ 22-2-2(6), 22-21-20, etseq.