Section 16.03.14.470 - PSYCHIATRIC SERVICEIf the hospital offers psychiatric service it must be organized, staffed and equipped to provide inpatient and outpatient treatment to the mentally ill.
01.Staffing. If the hospital offers psychiatric service, it must be directed and evaluated by a psychiatrist and staffed by adequate numbers of qualified personnel to meet patient needs.a. A licensed registered nurse qualified by training or experience in psychiatric nursing must supervise the nursing care rendered in the psychiatric service.b. Psychiatric service staff must collaborate with medical, nursing, and other professional personnel in patient care planning, and provide consultation to staff of other services regarding the psychiatric problems of patients.02.Patient Treatment Plan. Patient's records must reflect that an individualized plan of treatment is developed for each patient that is specific and appropriate to individual problems and takes into consideration strengths as well as disabilities. The plan must designate the persons responsible for each component of care and must be reviewed, evaluated, and updated at regularly scheduled intervals by all professional personnel involved in the patient's care.03.Policies and Procedures. Policies and procedures governing the service must be developed by appropriate representatives of each discipline and in collaboration with other appropriate services.04.Examination to Assess Mental Status. All examinations to assess the patient's mental status must be recorded, signed and dated as soon as possible after admission and must include a description of the patient's physical and emotional state and intellectual functions. There must be an initial patient history and report of the patient's mental status within twenty-four (24) hours after admission that may be based on the results of prior examinations by the reporting physician.05.Records. Adequate and comprehensive records must be retained for assessment, evaluation and treatment purposes. Admitting and subsequent psychiatric diagnoses must be recorded in currently accepted terminology; and a. The patient's psychiatric history and social evaluation must provide information regarding the patient's background, the onset and development of the illness, including factors and precipitating circumstances that led to the patient's admission, and data useful for patient care and discharge planning; andb. A properly executed consent form must be obtained and incorporated into the record in any case of treatment approach that carries significant risks, and shows that the patient, his family, or other legally responsible person is informed of available alternative approaches;c. Documentation must show that the patient, his family, or other legally responsible person is informed of the treatment to be given; andd. Documentation must show that planning for continued care and treatment in the community are coordinated with the patient's family and others in his social environment.06.Special Medical Record Requirements for Psychiatric Hospitals or Services. In addition to meeting all the requirements contained in Section 360 of these rules, patient medical records maintained by a psychiatric hospital or service unit must clearly reflect the types and intensity of treatment provided to patients in the hospital. The records must contain the following:a. Information essential for identifying the patient's problems, for developing treatment objectives, and other information necessary for psychiatric evaluation and diagnosis;b. A record of the treatment received by the patient, including records of all treatment related to short-term and long-term goals, including discharge planning;c. The medical record must provide information regarding the management of the patient's condition and of changes in treatment and patient status. Progress notes must reflect that care provided in accordance with the treatment plan is recorded at least weekly for the first two (2) months after admission and at least monthly thereafter; andd. Every safeguard must be employed to preserve confidentiality of the patient-therapist relationship and to prevent revelation of information that would be harmful or embarrassing to the patient, his family, or others.07.Discharge Planning. Consideration for continued care and services in the community after discharge, placement alternatives, and utilization of community resources must be initiated on admission and carried out to ensure that each patient has a documented plan for continuing care that meets his individual needs. Provision must be made for exchange of appropriate information with outside resources.08.Physician Services. A board certified or board eligible psychiatrist must provide the overall direction of the service including monitoring and evaluating the quality and appropriateness of psychiatric services rendered. Physicians must be available at all times to provide medical and surgical diagnosis and treatment services.09.Nursing Service. The nursing service must be under the overall direction of a psychiatric nurse qualified by training or experience in psychiatric nursing, who monitors and evaluates nursing care provided. a. A licensed registered nurse must be on duty twenty-four (24) hours a day, seven (7) days a week to provide direct patient care, and to assign and supervise nursing care activities performed by other nursing personnel.b. There must be adequate numbers of qualified licensed registered nurses, licensed practical (vocational) nurses, psychiatric technicians, and other supportive nursing personnel to carry out the nursing aspects of the individual treatment plan for each patient and capable of maintaining progress notes on all patients.10.Psychological Services. The director of the psychological services must be a clinical psychologist who continually monitors and evaluates the quality and appropriateness of psychological services rendered (in accordance with standards of practice, service objectives, and established policies and procedures).11.Social Services. The director of social services must be a social worker who monitors and evaluates the quality and appropriateness of social services (in accordance with service objectives, standards of practice, and established policies and procedures).12.Therapeutic Activities. The hospital must provide a therapeutic activities program appropriate to meet the needs and interests of patients that is directed toward rehabilitation to and maintenance of optimal levels of physical and psychosocial functioning, and toward attaining a life style appropriate for each patient.a. If occupational therapy services are offered, they must be under the supervision of an occupational therapist.b. Adequate numbers of qualified therapists, supportive personnel, and consultants must be available to provide comprehensive therapeutic activities in conjunction with each patient's treatment plan.c. Therapeutic recreational activities must be under the supervision of a designated member of the staff who has demonstrated competence in therapeutic recreational activities programs.d. The supportive staff of the occupational therapy and therapeutic recreational activities services must be provided formal orientation and inservice training to enable them to carry out assigned functions.e. If volunteers are utilized in the therapeutic activities program, they must be provided appropriate orientation, training, and supervision by qualified professional staff.13.Physical Therapy Service. If physical therapy services are offered, the director of the service must be a physical therapist who monitors the quality and appropriateness of services rendered.14.Psychiatric Unit Space. After the effective date of these rules, any psychiatric unit not free standing must be separated and able to be secured form the general hospital with which it is associated. Each psychiatric service unit, free standing or not, must include the following:a. Consultation room or rooms;b. Facilities for examination and a treatment room for medical procedures;c. At least one (1) observation room for acutely disturbed patients, with facilities for visual observation;d. Facilities for dining; ande. Indoor and outdoor facilities for therapeutic activities.15.Construction of Psychiatric Hospitals. New construction, alterations, or modifications must not be made until plans and specifications have been approved by the licensing agency.Idaho Admin. Code r. 16.03.14.470