Ga. Comp. R. & Regs. R. 111-8-22-.11 - Patient Care Services
(1) Nursing Services.
(a) Nursing services shall be provided in
accordance with current standards of practice as defined by Georgia
law.
(b) The facility shall employ
a full-time registered nurse to be the nurse responsible for nursing services,
and to supervise the provision of patient care by licensed practical nurses and
unlicensed personnel.
(c) A
licensed registered nurse shall be present in the treatment area when patient
treatments are in progress.
(d) The
facility shall ensure the following patient care activities are assigned to and
performed by appropriately licensed nurses:
1.
Conducting nursing assessments on admission and when indicated by an observed
or reported change in the patients' health status;
2. Provision of nursing input for the team
review of a patient's progress;
3.
Recommending to the team changes in treatment suggested by the patient's
needs;
4. Administration of
medications, including the introduction of intravenous saline;
5. Initiation and discontinuation of
hemodialysis via a central catheter, and manipulation of a central catheter or
change of dressing for a central catheter;
6. Administration of blood or blood
products;
7. The facilitation of
communication between the patient, the patient's family, and other members of
the treatment team; and
8.
Provision of oversight and supervision for dialysis technician trainees,
dialysis technicians, and other unlicensed personnel involved in patient care
activities, including the recording of treatment observations and interventions
in progress notes, as qualified for such oversight and supervision by the rules
contained in this chapter.
(e) Dialysis treatments for pediatric
patients under fourteen years of age or under 35 kilograms in weight shall be
performed by a licensed registered nurse with experience in pediatric dialysis.
(2) Nutrition Services.
The facility shall provide nutrition services to the patients and the patients'
families and caregivers, which are designed to maximize the patient's
nutritional status. Services shall be provided by a qualified dietitian, as
defined by these rules, and shall include at a minimum:
(a) Basic nutritional education must be
initiated within two weeks of admission by the nursing or dietary staff. A
comprehensive nutritional assessment report with recommendations for patient
education will be completed within thirty days of admission and at least
annually thereafter;
(b)
Participation as a member of the interdisciplinary treatment team in the
development of each patient's plan(s) of care and review of that
plan;
(c) Availability of a
qualified dietitian to provide counseling and assistance to patients during
regular treatment times;
(d)
Recommendations of therapeutic diets specific to each patient's needs,
counseling and training for patients related to the dietary recommendations,
and monitoring of nutritional status and adherence to dietary requirements by
objective and subjective means, with timely intervention when changes are
indicated; and
(e) Regular
recording in the patient's medical record of the patient's nutritional status,
monitoring data, and progress in meeting nutritional goals.
(3) Social Work Services. The
facility shall provide social services which are directed toward supporting and
maximizing the patient's social functioning and adjustment to management of end
stage renal disease. Services shall be provided by a qualified social worker,
as defined by these rules, and shall include at a minimum:
(a) Psychosocial evaluation of each patient,
completed within thirty (30) days of admission and at least annually
thereafter;
(b) Participation as a
member of the interdisciplinary treatment team in the development of each
patient's plan(s) of care and review of that plan;
(c) Recommendations regarding changes in
treatment which may be indicated by the patient's psychosocial needs;
(d) The provision of case work and group work
services to patients and their families in dealing with the problems and
complications associated with end stage renal disease and dialysis;
(e) Identification of community service
agencies and other support resources, and facilitation of patients' access to
those resources;
(f) Provision of
access to social work services during times of patient treatment; and
(g) Regular reporting of the patient's
contact with the social worker in the patient's medical record.
(4) Laboratory Services. The
facility shall provide or arrange for the laboratory services needed for safe
and effective patient treatment.
(a) If the
facility provides its own laboratory services:
1. The facility shall have current Georgia
licensure and federal certification as required for the tests performed, or a
waiver for the tests performed if licensure and certification are not
required.
2. The facility
performing waived tests shall have policies and procedures for obtaining
samples, performing tests, and reporting results, which conform to current
standards of practice and the manufacturer's specifications.
(b) If the facility receives
services from an outside laboratory, such arrangements shall be made by written
contract, which shall ensure that the laboratory meets all applicable state and
federal licensing and certification requirements for the tests performed, and
which ensures the provision of test results in a timely manner.
(5) Administration and Storage of
Controlled Substances and Dangerous Drugs.
(a)
Controlled substances and dangerous drugs shall be administered to patients
only with an order from a licensed physician or from a physician's assistant or
nurse practitioner as permitted by Georgia law.
(b) Controlled substances and dangerous drugs
shall be administered to patients only by those persons authorized under
Georgia law to administer medications. However, trained and competent dialysis
technicians are permitted to administer saline via the extracorporeal circuit
as provided under Section
111-8-22-.10(3)(g)2.
(c) Medications shall be prepared
for administration in a work area that prevents contamination during
preparation.
(d) Medications not
given immediately shall be labeled with the patient's name, the name of the
medication, and the dosage, and the date and time opened, and initialed by the
person preparing the medication. All medications shall be administered by the
individual who prepares them.
(e)
The facility shall establish and implement procedures for limiting access to
medications by unauthorized personnel.
(f) Medications requiring refrigeration shall
be stored in refrigerators used only for that purpose and stored at appropriate
temperatures.
(g) The facility
shall regularly inventory controlled substances and dangerous drugs and
medication supplies to ensure that outdated supplies are immediately disposed
of in an appropriate manner, and that sufficient supplies of usable controlled
substances and dangerous drugs are available to meet patient needs.
(h) Controlled substances shall be stored and
dispensed in accordance with the provisions of the Georgia Pharmacy Practice
Act and the Georgia Controlled Substance Act.
(6) Home Training Services for Hemodialysis
or Peritoneal Dialysis.
(a) If the facility
provides services for training and support of home dialysis, the facility shall
meet the requirements for care plans for those patients, to include
interdisciplinary conferences.
(b)
In addition to other facility services and support requirements, the facility
shall provide for home dialysis patients:
1. A
written outline of the home dialysis training program, including didactic and
practice components, including the performance of dialysis treatments by
patients and/or their assisting partner and the requirements for facility
surveillance of the patient's home adaptation and water quality, with the
requirement that each patient (and their assisting partner, if applicable),
satisfactorily complete the training program before beginning home
dialysis;
2. Sufficient teaching
materials available for patient use during and after home dialysis
training;
3. A program for
surveillance of the patient's home adaptation, to include an initial visit in
the patient's home and subsequent supervisory visits by a licensed registered
nurse, as indicated by the patient's medical status and training needs or at
least annually, with documentation of all home visits in the patient's medical
record;
4. A procedure for
continuous re-evaluation of the suitability of home dialysis for the patient,
to include evaluation of the adherence of the patient to physician's orders and
policies and procedures of the facility, and the adequacy of the dialysis
performed in the home;
5. Provision
of supplies for the home sufficient to sustain dialysis treatment;
6. Routine transfer set changes, where
applicable, for peritoneal dialysis patients at least every six (6) months and
as needed;
7. Installation and
maintenance of dialysis equipment in the home, including training for the
patient in identifying equipment malfunctions and mechanisms for accessing
equipment service; and
8. A system
for routine monitoring, culturing, and disinfection of the water in the home of
each hemodialysis patient, to ensure that the water quality meets the standards
recommended by the Association for the Advancement of Medical Instrumentation
(AAMI).
(c) The facility
shall provide dialysis services at the facility or arrange for the provision of
services at a site mutually agreeable to the facility and the patient for the
home dialysis patient on those occasions when the home dialysis patient is
unable to perform safe and adequate dialysis in the home.
Notes
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No prior version found.