Ga. Comp. R. & Regs. R. 111-8-40-.37 - Psychiatric and Substance Abuse Services
(1) If the hospital provides psychiatric
and/or substance abuse treatment services as an organized service, the scope of
those services, including whether the services are provided for inpatients,
outpatients, or both, shall be defined in the hospital's application for permit
and meet the requirements set forth in this section and generally accepted
standards of care.
(2)
Organization and Administration of Psychiatric and Substance Abuse
Services. The hospital shall have a plan for the service which clearly
defines lines of authority, responsibility, and accountability and which
includes provision for adequate staffing to provide patient care according to
generally accepted standards of practice.
(a)
Director of Psychiatric and Substance Abuse Services. The director
of psychiatric and substance abuse services shall be a licensed physician
member of the medical staff appropriately trained and qualified to supervise
the provision of these services.
1. If the
hospital offers substance abuse services only, the director shall be a licensed
physician member of the medical staff certified or eligible for certification
in addiction medicine by the American Society of Addiction Medicine or the
American Osteopathic Academy of Addiction Medicine or a licensed physician
member of the medical staff appropriately trained and qualified to supervise
the service. If the director of the substance abuse services meets this
certification requirement but is not board certified in psychiatry, the
hospital must have a board eligible or board certified psychiatrist on staff to
be utilized for psychiatric consultation as needed.
2. The director of the psychiatric and/or
substance abuse services shall be responsible for all clinical aspects of the
organization and delivery of services and for the evaluation of the
effectiveness of the services in coordination with the hospital's quality
management program.
(b)
Staffing for Psychiatric and Substance Abuse Services. The
hospital shall provide sufficient clinical and support staff to assess and
address the needs of psychiatric and substance abuse patients and to ensure the
maintenance of a safe therapeutic environment for patients and staff.
1.
Nursing Manager/Director. The
nursing care for the psychiatric and/or substance abuse services shall be
supervised by a licensed registered nurse with at least three (3) years of
clinical psychiatric and/or substance abuse experience. Authorization from the
Georgia Board of Nursing to practice as a Clinical Nurse Specialist,
Psychiatric/Mental Health may substitute for two (2) years of the required
clinical experience.
2.
Counseling Services. Counseling services for the psychiatric and
substance abuse services shall be supervised by a master's level clinician
licensed in social work, marriage and family therapy, professional counseling,
or a clinical nurse specialist, psychiatric mental health.
3.
Clinical Psychologist. A
licensed clinical psychologist shall be available to provide testing and
treatment consultation for patients as needed.
4.
Child Psychiatrist. If
psychiatric services are provided for children, a board eligible or board
certified child psychiatrist shall be on staff.
5.
Special Staffing Requirements for
Inpatient Psychiatric or Substance Abuse Services. Hospitals providing
inpatient psychiatric and/or substance abuse care shall provide:
(i) A physician, with training and
qualifications appropriate to the services offered, present in the hospital or
available on call on a twenty-four (24) hour basis;
(ii) At least one registered nurse on duty at
all times; and
(iii) Rehabilitative
and therapeutic activity staff, trained and qualified to meet the needs of the
patients as specified in the patients' individualized service plans.
(c)
Policies and
Procedures for Psychiatric and Substance Abuse Services. In addition to
hospital policies and procedures otherwise required by these rules, the
hospital providing psychiatric and/or substance abuse services shall develop
and implement policies and procedures that address the special needs of the
population served, to include at least:
1.
Admission and discharge criteria and procedures, which comply with Georgia laws
concerning involuntary admissions or treatment;
2. Safety and security precautions for the
prevention of suicide, assault, and patient injury;
3. The handling of medical emergencies,
including but not limited to suicide attempts, cardiac arrest, aspiration, or
seizures;
4. Special procedures,
such as electro convulsive therapy (ECT) and medical detoxification, as
applicable; and
5. Procedures for
the use of seclusion and restraint in accordance with O.C.G.A. Chapters 3 and 7
of Title 37 and these rules.
(3)
Patient's Rights in Psychiatric and
Substance Abuse Services.
(a) In
addition to the rights afforded all patients at the hospital, the hospital
shall ensure that patients served by the psychiatric and substance abuse
services shall have the right to:
1. Receive
treatment in the hospital using the least restrictive methods possible;
and
2. Participate to the extent
possible in the development, implementation, and review of their individualized
service plan.
(b) Any
permissible restriction of patient rights by the hospital program shall be
imposed only in order to protect the health and safety of the patient or others
and shall be temporary. The nature, extent, and reason for the restriction
shall be entered into the patient's medical record as a written order by a
physician or licensed psychologist and reviewed for necessity as required by
state law.
(4)
Patient Assessment and Treatment.
(a)
In addition to other assessment and treatment procedures otherwise required by
these rules, psychiatric and substance abuse service programs at the hospital
shall provide:
1. For inpatients:
(i) With the admission assessments performed
within twenty-four (24) hours of admission, a psychiatric or substance abuse
evaluation as indicated by the reason for admission; and
(ii) An individualized service plan,
initiated within the first twelve (12) hours after admission and updated as
needs are identified through assessments;
2. For outpatients:
(i) Within seven (7) days following the
initiation of outpatient services, a complete assessment of patient needs,
including an evaluation sufficient to identify significant medical conditions
which may impact the course of treatment; and
(ii) Within ten (10) days following
initiation of outpatient services, an individualized service plan developed and
implemented to address needs identified;
3. Each patient's individualized service plan
shall be developed from the patient's needs as identified through
psychological, medical, and social assessment and shall be an organized
statement of the proposed treatment process which serves to guide the providers
and patient through the duration of the service provision. The service plan
shall reflect the following:
(i) The patient's
participation, to the extent possible, in the development of the individualized
service plan;
(ii) Measurable goals
and/or objectives to be met toward the established discharge criteria;
and
(iii) Regular review of the
patient's progress toward goals and/or objectives in the individualized service
plan, with modifications to the plan made in response to progress or lack of
progress as reflected in progress notes recorded at each visit which document
the patient's status and response to treatment;
4. At the time of development of the
patient's treatment plan and with the participation of the patient, a discharge
plan shall be developed for each inpatient or an aftercare plan for each
outpatient. The discharge/aftercare plan shall be re-evaluated periodically
during treatment to identify any need for revision; and
5. All medications administered or prescribed
for psychiatric or substance abuse patients shall be solely for the purpose of
providing effective treatment or habilitation as described in the
individualized service plan and/or for protecting the safety of the patient or
others and shall not be used for punishment or for the convenience of
staff.
(b) If the
hospital is not able to meet the patient needs as identified, including any
acute medical or surgical needs, the hospital shall assist the patient in
locating and accessing services to meet those needs, which may include transfer
to another facility.
(5)
Physical Space and Design Requirements for Inpatient Psychiatric and
Substance Abuse Services.
Hospitals providing inpatient psychiatric and substance abuse services shall have:
(a) At least one
seclusion area must be available to be used for the involuntary confinement of
patients when necessary. The seclusion area shall be large enough to provide
access to the patient from all sides of the bed or mattress and to accommodate
emergency life-sustaining equipment, have a door that opens outward, and have
provision for direct patient observations at all times by staff;
(b) A design conforming to the suicide
prevention recommendations from the Guidelines for Design and
Construction of Hospital and Healthcare Facilities, produced by the
American Institute of Architects' Academy of Architecture for Health with the
assistance of the U.S. Department of Health and Human Services, which is hereby
adopted by reference;
(c) A day
room that allows for social interaction, dining, and group therapy
activities;
(d) Space for storage
of patient's personal belongings and for securing valuables;
(e) A system for summoning help from within
the immediate service area or other areas of the hospital in the event of an
emergency.
Notes
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