N.H. Admin. Code § He-P 811.16

Current through Register No. 45, November 7, 2024

Section He-P 811.16 - Client Management

(a) At the time of admission, personnel of the ESRDDC shall:

(1) Have a written order from a licensed practitioner for the client's treatment at the ESRDDC;

(2) Provide, both orally and in writing, to the client or the client's legal representative and obtain written confirmation acknowledging receipt and understanding of the following policies:

a. The facility's policy on client rights and responsibilities which, at a minimum, shall contain the patient's bill of rights under RSA 151:21;

b. The facility's policies and procedures on the reuse of dialysis supplies, including hemodialyzers, if applicable;

c. The facility's complaint procedure; and

d. Information about advanced directives such as:

1.Living wills, pursuant to RSA 137-H;

2.Durable powers of attorney for healthcare, pursuant to RSA 137-J; and

3.DNR order;

(3) Collect and record identification data that includes:

a. Client's name, home address, and home telephone number;

b. Client's date of birth;

c. Name, address, and telephone number of an emergency contact;

d. Name, address, and telephone number of the client's primary care provider;

e. Client's insurance information; and

f. Copies of all executed legal directives such as durable power of attorney, legal guardian, or living will;

(4) Obtain documentation of informed consent for:

a. All treatments prescribed by the licensed practitioner; and

b. The reuse of dialysis supplies, including hemodialyzers, if applicable;

(5) Obtain consent for release of information as applicable;

(6) Obtain a medical history and physical examination that has been completed by a licensed practitioner; and

(7) Conduct a nursing assessment completed by:

a. A registered nurse; or

b. An LPN, but a review and signature by a registered nurse shall be required in accordance with the nurse practice act RSA 326-B.

(b) The licensee shall ensure that medical care and services are provided as follows:

(1) Each client shall be under the care of a licensed practitioner at all times;

(2) Each ESRDDC shall have a least one dialysis station in which a person with an infectious disease may be dialyzed;

(3) The reuse of dialysis supplies, including hemodialyzers, shall be permitted only when the client or guardian has:

a. Been informed of the center's policies and procedures regarding the reuse of dialysis supplies; and

b. Provided written consent for the staff use of reused dialysis supplies;

(4) An individualized care plan shall be developed by an interdisciplinary team, composed of the client, the licensed practitioner, a registered nurse, a social worker, and a dietician, and based on the results of:

a. The client's medical history and physical examination; and

b. The interdisciplinary assessment as determined by the client's needs;

(5) The individualized care plan shall:

a. Identify the treatment, including modality and dialysis settings, for the client;

b. Be reviewed and updated as indicated by the client's response to treatment; and

c. Contain documentation that the client or their guardian participated in the development of the care plan;

(6) The client shall be provided education in the following areas:

a. Purpose and procedures for the different types of dialysis treatments;

b. Outcomes associated with end stage renal disease, or chronic kidney disease; and

c. The center's emergency procedures, including both medical and non-medical procedures;

(7) Each client shall receive a rehabilitative assessment, as applicable;

(8) The center's staff shall notify the department within one business day of any reportable incidents or a significant change of status and document such notification;

(9) The personnel of the ESRDDC shall follow the orders of the licensed practitioner;

(10) Written notes shall be documented in the client's record for:

a. All care and services provided at the ESRDDC that shall include the:

1.Date and time of the care or service;

2.Description of the care or service;

3.Progress notes; and

4.Signature and title of the person providing the care or service;

b. Notification of the licensed practitioner of:

1.Any significant change in the status of the client; or

2.Any side effects, adverse reactions, or ineffective results of any medications prescribed for the client; and

c. Any significant changes or reportable incidents involving the client, which shall include the:

1. Date and time of the incident or occurrence;

2. Description of the incident or occurrence, including identification of injuries, if applicable;

3. If medical intervention was required:

(i) Date and time the emergency contact person or guardian was notified; and

(ii) Date and time the licensed practitioner was notified;

4.Action taken including follow-up; and

5.Signature and title of the person reporting the incident or occurrence;

(11) The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX;

(12) If the ESRDDC offers a home dialysis program, it shall:

a. Have written policies and procedures for training clients and their caregivers;

b. Provide oversight and monitoring of the home dialysis procedure;

c. Provide consultations with a social worker, registered dietitian, or other professionals, as necessary;

d. Ensure either directly or indirectly that adequate supplies and equipment are available;

e. Provide annual testing of home water supplies for dialysis use as required by the AAMI's "American National Standard for Dialysate for Hemodialysis" (RD 52:2009 edition), available as noted in Appendix A;

f. Maintain written documentation of all care and services provided by the staff of the ESRDDC; and

g. Not be required to have a separate home health care provider license, pursuant to He-P 809; and

(13) ESRDDC trained caregivers operating under the direction of the ESRDDC who assist with home dialysis shall not be required to hold a separate home health care provider license, pursuant to He-P 809.

(c) The licensee shall transfer a client whose needs exceed those authorized by the current licensing classification or cannot be met by the programs and services offered at or arranged by the ESRDDC.

(d) If unforeseen complications arise that cannot be stabilized at the ESRDDC, the facility shall:

(1) Transfer the client to an acute care hospital;

(2) Call 911 for transport; and

(3) Have copies of medical information regarding the treatment received at the center transferred with the client.

(e) Documentation for any client discharged or transferred from the facility shall include:

(1) The date and time of discharge or transfer;

(2) The physical, mental, and medical condition of the client;

(3) Destination of client;

(4) Name of responsible person accompanying the client;

(5) Discharge planning and referrals;

(6) Discharge summary;

(7) Physician signed order for discharge or transfer; and

(8) In the event of death, the funeral director's receipt.

(f) Transfers and discharges shall be done in accordance with RSA 151:21 and RSA 151:26.

N.H. Admin. Code § He-P 811.16

#9963, eff 7-28-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12827, Effective 7/20/2019, Expires 1/16/2020.

Amended by Volume XL Number 7, Filed February 13, 2020, Proposed by # 12985, Effective 1/29/2020, Expires 1/29/2030.