Section 11-93-29 - Psychiatric services(a) If individuals suffering from mental illness or substance abuse are cared for in the hospital, the requirements of this section, in addition to the basic rules contained in this subchapter, shall be required in order to provide the psychiatric services. This section shall apply to either an entire hospital or a distinct part of a hospital.(b) As used in this section: "Psychiatric facility" means a public or private hospital or a distinct part thereof which provides inpatient care, custody, diagnosis, treatment or rehabilitation services for mentally ill persons or persons habituated to the excessive use of drugs or alcohol. A distinct part of a hospital means a physically identifiable unit designated as the psychiatric inpatient facility where the beds are reserved for such patients.
(c) Program requirements. The following shall be met by the psychiatric facility in addition to those requirements enumerated under section 11-93-14, governing body and management, and section 11-93-22, medical staff. (1) The facility shall develop, maintain, and update at least annually, a comprehensive written program plan which serves as the basis for the overall administration of its functions. (A) The purpose, functions, activities, and services shall be clearly described in the plan.(B) The plan shall include a clear statement of program goals and objectives as well as procedures for achieving these goals and objectives.(2) The facility shall establish and maintain a current policy and procedures manual governing its overall procedures. (A) The policies and procedures shall be in compliance with all applicable federal, state, and local requirements and shall include but not be limited to the following: (i) Administration of electroconvulsive therapy.(ii) Administration of drugs.(iii) Use of restraints on patients.(iv) Use of seclusion room.(v) Assurance and protection of patient's rights including grievance mechanism and confidentiality, and the rights enumerated under chapter 334E, HRS.(vi) Type and method of program evaluation, research and data collection.(B) All staff shall be familiar with these policies and procedures and have ready access to the manual.(C) The policies and procedures shall be reviewed and updated at least annually by appropriate personnel in the facility.(3) A wide range of mental health services shall be provided to patients and their families. (A) Services to all patients shall be appropriate to their disability, age, level of development, social, ethnocultural, educational, religious, and economic background.(B) Services shall be available to voluntary and involuntary patients, providing at a minimum, evaluation, diagnosis, treatment, and discharge plans. In those instances where the facility lacks the capacity to adequately manage and provide the needed services, arrangements shall be made to transfer the patient to another suitable psychiatric facility. Transfer or referral documents and records shall be complete and in proper order at the time of the transfer or referral.(C) All services shall be coordinated and integrated with other service units within the facility, patient support system, and with human service agencies in the community.(D) Any service or activity shall be conducted in conformance with all applicable federal, state and local requirements and consistent with good medical practice.(E) Services shall be provided in a timely manner.(F) An individualized treatment plan shall be formulated for each patient within forty-eight hours following admission, reviewed, and modified periodically as changes occur in the patient's condition or status. In every instance, to the extent possible, the patient shall participate in the patient's treatment planning.(G) Therapeutic interventions shall be based upon the patient's individualized treatment plan, and provided at the level of frequency, intensity, and duration to facilitate the patient's return to community living.(4) The environment of the psychiatric service shall contribute to establishing and enhancing a positive self-image for each patient. (A) The physical facilities and equipment shall be pleasant, comfortable and promote the patient's perception and awareness of the surroundings.(B) Rules of daily living shall be communicated to the patient and shall be consistent in preserving and enhancing human dignity and individuality.(5) Facilities and equipment necessary for the proper management of agitated, aggressive, disoriented, or otherwise disturbed patients shall be provided to protect the safety of the patient and of others. (A) Physical restraints used on patients, including use of seclusion rooms, shall, except for emergencies, require prior authorization by a physician. In the event of an emergency requiring unanticipated use of restraints, prompt notification of a physician shall be made and written authorization shall be obtained from a physician within twenty-four hours. No "as needed" orders will be allowed without specific circumstances being delineated.(B) Written policies and procedures on the use of restraints, including the use of seclusion rooms, shall be developed and maintained to ensure safe and humane care of patients.(C) The policies and procedures shall identify the staff authorized to apply physical restraints in an emergency.(6) Post discharge and follow-up services, as needed, shall be arranged to promote continuity of care for patients.(d) Staffing requirements. The facility shall have staff adequate in number and qualifications to carry out an active treatment program. (1) The facility shall be staffed with sufficient qualified personnel, technical, support personnel and consultants to carry out an intensive and comprehensive treatment program. The program shall include assessment of individual patient needs, establishment of treatment goals, and implementation, either directly or by arrangement, of a broad range of therapeutic services. Therapeutic services shall include at a minimum, psychiatric, medical, nursing, social work, psychological and recreational activity as required to carry out an individualized treatment plan for each patient.(2) The services shall be under the supervision of a clinical director or service chief. (A) The clinical director or service chief shall be certified by the American Board of Psychiatry and Neurology or meet the training and experience requirements for examination by the board ("board eligible").(B) The medical staff shall meet the qualifications required by law.(C) The number of psychiatrists and psychologists shall be commensurate with the size and scope of the treatment services.(3) A psychiatrist shall be available to provide services for psychiatric emergencies at all times and to provide consultation as requested by staff.(4) When certain necessary diagnostic and therapeutic services are not available within the psychiatric facility, qualified consultants or attending physicians shall be promptly available, or else provisions shall be made for prompt transfer of a patient to an appropriate facility providing the needed services.(5) Nursing services shall be under the direct supervision of a registered professional nurse who is qualified by education and experience for the position. The number of registered professional nurses, licensed practical nurses, and other nursing personnel shall be sufficient to formulate and carry out the nursing components of the individualized treatment plan for each patient. (A) The registered professional nurse supervisor shall have a master's degree in psychiatric nursing from a school of nursing accredited by the National League of Nursing, or two years of psychiatric nursing experience.(B) The staffing pattern on a psychiatric unit shall have a registered professional nurse on duty twenty-four hours each day.(C) The nursing staff shall be sufficient in number, training, and ability to meet the needs of the patients.(6) Adequate psychological services shall be available to all patients. These services shall be provided by a licensed psychologist who may be employed on a full time, regular part time, or consulting basis, or be a member of the medical staff.(7) Social work services shall be available to all patients. The social work staff shall be sufficient in number to meet the needs of the patients. The social work services shall be under the supervision of a full time qualified social worker.(8) Qualified therapist, consultants, volunteers, assistants or aides shall be sufficient in number to provide comprehensive therapeutic activities, including occupational and recreational therapies, and to ensure that appropriate treatment is rendered for each patient. (A) Occupational therapy services shall be conducted or supervised by a qualified occupational therapist who may be employed on a full time, regular part time, or consulting basis.(B) Recreational or activity therapy services shall be available under the direct supervision of a member of the staff who has demonstrated competence in therapeutic recreation programs.(C) Volunteers shall work under the supervision of the facility staff and shall be provided appropriate orientation and training.(e) Medical record requirements. In addition to those requirements covered under section 11-93-21, the medical records of the psychiatric patient shall contain: (1) The results of a psychiatric evaluation including a mental status examination.(2) Neurological findings.(3) The results of any psychological tests.(4) Psychosocial evaluations.(5) An individualized comprehensive treatment plan based on an inventory of the patient's assets and liabilities, including a diagnostic formulation, prognosis, short and long range treatment goals in measurable time frames, the specific treatment modalities to be carried out, and by whom, as well as any modifications to the treatment plan as changes may occur in the patient's condition or status.(6) Progress notes which: (A) Document the patient's behavior and response to all treatments rendered.(B) Document contacts made with outside persons on behalf of the patient.(f) Physical facility requirements. (1) Sociotherapeutic areas. There shall be appropriate areas allowing for thirty square feet per patient, which may be used for patients' socialization, activity therapy, and other therapeutic functions. It shall be suitably equipped for such activities and functions.(2) Dining area. There shall be designated a common dining area for patients allowing twenty square feet per patient. If the dining room is combined with the sociotherapeutic areas, such combined area shall allow for fifty square feet per patient.(3) Conference or interview areas. There shall be one or more rooms which are adequate to provide privacy for individual, family, small group therapy, and consultation. Each unit shall have at least one conference room.(4) Visiting areas. There shall be comfortably and attractively furnished areas to allow patients to visit with families, friends and others in reasonable privacy.(5) Outdoor areas. There shall be outdoor areas for recreation, social, and visiting purposes.(6) Seclusion room. If a room or specialized area is used for seclusion purposes, it shall include adequate ventilation and lighting, access to bathroom facilities, visual observation of the patient, and other measures to protect the patient. If a patient is confined in a seclusion room for more than twelve hours in any twenty-four hour period, the room shall be a minimum of one hundred square feet in size excluding closets, bathrooms, alcoves, and entryways.(7) Drinking water shall be conveniently located and in sufficient number of places for patients and personnel.(8) Smoking shall be permitted only in approved areas.(g) Patient's rights and responsibilities. All patients shall have the following rights in addition to those stated in section 11-93-26. (1) To obtain from the patient's physician complete current information concerning the patient's diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand. When it is not medically advisable to give such information to the patient, the information shall be made available to an appropriate person in the patient's behalf. The patient shall have the right to know by name, the physician responsible for coordinating the patient's care.(2) To receive from the patient's physician information necessary to give consent prior to the start of any procedure or treatment. Except in emergencies, the information for consent shall include but not be limited to the proposed specific procedure or treatment, the reasons for and benefits of proposed procedure or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist or when the patient requests information concerning medical alternatives, the patient shall have the right to the information. The patient shall also have the right to know the name of the person responsible for the procedure or treatment.(3) To participate in the patient's treatment plan designed to achieve maximum recovery.[Eff. 3/3/86; am and ren AUG 3, 1992] (Auth: HRS §§ 321-9, 321-11) (Imp. HRS §§ 321-9, 321-11)