N.J. Admin. Code § 8:135-1.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:135-1.1 - Introduction and purpose

(a) The levels of supervision system (system) is designed to provide a timely, uniform process which affords each patient the structure and intensity of supervision appropriate to the patient's condition during the course of hospitalization.

1. The structure provided through the system takes the form of an individualized set of clinical interventions, schedule of activities, and conditions under which patients exercise their personal autonomy and liberty.

2. Level determination is based primarily upon the patient's clinical condition and related behaviors.

3. The system is not a treatment modality or a mechanism to earn privileges; rather, it is a tool to be used to make a clinical determination as to the degree of structure and supervision necessary for each patient to successfully participate in treatment and rehabilitation programs, while maintaining a safe and secure therapeutic environment for patients and staff alike.

4. Appropriate structure and supervision facilitates each patient's successful participation in treatment and rehabilitation programs, which are designed to improve functioning, promote positive social adjustment while hospitalized, reduce risk of violence to self or others, and move patients to the least restrictive setting as quickly as possible.

5. The system is separate from and in addition to the clinical interventions of special precautions (for example, choking, suicide, arson, and escape precautions) and special levels of observations (two-to-one supervision, one-to-one supervision, constant visual observation, periodic visual observation, face checks, and head counts).

(b) The system shall be interpreted and implemented in a manner that facilitates the effective treatment of each patient while maintaining the least restrictive setting necessary to accomplish individual goals identified in the treatment plan.

1. Under no circumstances shall this policy be interpreted and implemented in any manner that abridges liberties specified in the "Patients' Bill of Rights" (N.J.S.A. 30:4-24.2 et seq.).

(c) The treatment team shall determine the appropriate level for each patient upon admission and review the assigned level at any time during the course of a patient's hospitalization, but, minimally, at the patient's scheduled treatment planning review.

1. Level determinations shall be made in accordance with the parameters set forth herein.

2. Treatment teams shall use these parameters to motivate patients to exercise increased responsibility, accountability, and independence while correspondingly decreasing the structure and intensity of staff supervision.

i. These incremental steps are part of a continuum by which a patient progresses through the system toward the goal of discharge with appropriate community support.

3. The treatment team shall document in a patient's clinical record its justification for the level that the treatment team determines to be necessary.

(d) The purpose of the system is:

1. To establish clear guidelines that define parameters of structure and supervision necessary to maintain the safety of patients, hospital staff and the community at large during patient physical movement to and from program sites, related patient treatment services, and leisure time activities.

2. To ensure that all patients receive such considerations in an equitable, consistent and justifiable fashion based on individual clinical considerations.

3. To establish a system that maximizes continuity of care for patients whenever transfer from unit to unit, or hospital section to hospital section becomes appropriate and necessary.

4. To facilitate patient groupings that are optimal for positive social interaction and support progress towards discharge.

N.J. Admin. Code § 8:135-1.1

Amended by R.1993 d.58, effective 2/1/1993.
See: 24 N.J.R. 4232(a), 25 N.J.R. 583(b).
At (c), changed "assign" to "determine" regarding Interdisciplinary Treatment Team and appropriate level of patient.
Amended by R.2003 d.236, effective 7/7/2003.
See: 34 N.J.R. 4290(a), 35 N.J.R. 2903(a).
Rewrote the section.

Amended and recodified from 10:36-1.1 by 55 N.J.R. 2258(b), effective 11/9/2023