Rule 111-8-19-.19 - Ambulatory Detoxification ProgramsPrograms offering outpatient ambulatory detoxification services must meet the rules listed in this subsection (.19) in addition to the general rules set forth.
(a) The program shall establish and implement written policies and procedures that address how the program manages the medical and detoxification services that it provides. The program shall be open and operate five days a week with on-call physician coverage as outlined below.(b) Staffing. Treatment is provided by qualified medical staff and other professionals who are qualified by education, training, experience, and who are licensed/certified if required by state practice acts to perform detoxification services that meet the needs of clients.1. Medical Staff. The medical staff is headed by a medical director who is licensed to practice medicine in Georgia, and all other medical staff are licensed to practice in Georgia. The medical director must approve all medical policies and procedures, including assessment tools, treatment protocols, and emergency procedures.2. Medical Coverage. There shall be a physician, nurse practitioner, physician's assistant, registered nurse, or licensed practical nurse with at least two years of substance abuse experience under RN supervision on duty during all hours of operation to provide or supervise client treatment and assess individual clients as needed. Each physician employed by the program is determined qualified by training, education, and experience to manage detoxification treatment and assumes responsibility for the medical services provided by the staff.3. On-Call Coverage. A staff physician shall provide 24-hour, on-call coverage when the program is closed or a physician is not present on the premises.4. Other Medical Services.(i) Diagnostic Services. Clinical laboratory services and x-ray services shall be provided in accordance with the Department of Community Health's' Rules for Licensure of Clinical Laboratories, Chapter 111-8-10, and Rules for X-Ray, Chapter 290-5-22.(ii) Emergency Medical Services. The program's medical policies and procedures include arrangements for the delivery of emergency medical services.(iii) Pharmacy Services. Pharmaceutical services are provided through a licensed pharmacy in the community or the program's own licensed pharmacist.(c) Treatment - Assessment. Admission Assessment of client shall be performed by a physician, nurse practitioner, physician's assistant or a registered nurse. If an assessment is done by other than a physician, then the assessment must be communicated to a physician by telephone prior to the client's admission. The assessment must include: 1. Drug history including past detoxification episodes, and current use of drugs and medications;2. Causes that triggered the present need for services;3. Descriptions of medical risks and any behavioral or emotional problems;4. Taking and documentation of vital signs;5. Determination of whether or not a physical and/or psychiatric examination by a physician is needed immediately, and arrangements for such examinations, if indicated, if the assessment was done by a registered nurse; and6. Determination that the prospective client appears to have the needed support and supervision from family members and others to benefit from ambulatory treatment.7. Laboratory tests will be ordered as indicated, but at a minimum will include: CBC, RPR, urinalysis (routine and microscopic), TB screening and urine drug screens.(d) Treatment - Admission. Clients are admitted to treatment by physicians' orders only following assessment and determination that the medical, emotional, and behavioral status of the client and his or her support systems are adequate to justify admission to an ambulatory program. Persons treated in ambulatory detoxification settings are without unusual or significant medical or behavioral problems that would pose a significant risk to the safe completion of an ambulatory detoxification program. The initial detoxification care plan must be documented in the record and may be initiated by the order of the physician following admission.(e) Treatment. 1. Within twenty-four hours of admission, or the next normal business day if admission occurred on a weekend or holiday, the client must be seen by the physician, nurse practitioner, or physicians assistant if the assessment required by rule .13(1)(b) and subparagraph (3) above was done by a registered nurse. If a physical examination is needed, such examination shall be done at that time.2. Within 48 hours of admission, a Detoxification Care Plan shall be developed by a registered nurse, physician's assistant, or the physician. If not done by a physician, the development of the plan shall be supervised and signed by a physician. Any changes to the plan must be documented in the plan and reviewed and signed by the physician. The plan shall address the nursing and medical procedures and monitoring activity needed to stabilize the client and to manage the withdrawal.3. For the length of the detoxification care plan and while on medication, the client shall be required to visit the program at least once a business day for a check of vital signs and monitoring of medication by one of the medical staff.4. In addition to medical management services, the program shall provide the client counseling and support by staff who are determined qualified by training, education, experience, and who are licensed/certified if required by state practice acts to provide such services. Such services shall be provided to clients as soon as it is determined that they can benefit from such services but no later than within three work days of admission.5. A discharge summary and an aftercare plan, if applicable, shall be completed in accordance with rule .17.Ga. Comp. R. & Regs. R. 111-8-19-.19
O.C.G.A. §§ 26-5-5, 26-5-6.
Original Rule entitled "Ambulatory Detoxification Programs" adopted. F. Sep. 9, 2013; eff. Sept. 29, 2013.