216-40-10 R.I. Code R. § 11.6

Current through June 12, 2024

Section 216-RICR-40-10-11.6 - General Requirements for Inpatient Hospice Settings

11.6.1Hospice Inpatient Facilities

A. A licensed hospital, a licensed nursing facility, or a hospice inpatient facility with whom a hospice program enters into a written agreement for the provision of inpatient care (general inpatient, or respite care, as described above) for hospice patients shall be required to meet the following provisions pertaining to:

1. Staffing (see also §§11.5.9(I)(1) and 11.5.9(J)(1) of this Part); and

2. Patient areas pursuant to §11.6.1(B) of this Part.

3. Additionally, said facilities providing general inpatient care or inpatient respite care shall be required to meet the provisions of §§11.6.2 through 11.7.15(A) of this Part.

B. Patient Areas

1. The patient areas must be designed and equipped for the comfort and privacy of each patient/family that includes:

a. Physical space for private patient/family visiting;

b. Accommodations for family members, including children, if they wish to remain with patient overnight;

c. Accommodation for family privacy after a patient's death; and

d. Home-like interior.

2. Patients shall be permitted to receive visitors, including small children and pets, at any hour, provided that a therapeutic environment is maintained for all patients.

11.6.2Dietetic Services

A. Each facility shall maintain a dietetic service under the supervision of a full-time person who, as a minimum, is a graduate of a state approved course that provided instruction in food service supervision and nutrition and has experience in the organization and management of food service.

1. When the dietary manager is absent, a responsible person shall be assigned to supervise dietetic service personnel and food service operations.

B. The facility's food service operation shall comply with all appropriate standards of the Rhode Island Food Code (Part 50-10-1 of this Title).

1. Diet kitchens, nourishment stations, and any other related areas shall be the responsibility of the dietetic service.

C. There shall be a supply of staple foods for a minimum of seven (7) days and of perishable foods for a minimum of two (2) days in the facility.

11.6.3Infection Control

A. Infection control provisions shall be established for the mutual protection of patients, employees, and the public.

B. The facility shall be responsible for no less than the following:

1. Establishing and maintaining a facility-wide infection surveillance program;

2. Developing and implementing written policies and procedures for the surveillance, prevention, and control of infections in all patient care departments/services;

3. Establishing policies governing the admission and isolation of patients with known or suspected infectious diseases;

4. Developing, evaluating, and revising on a continuing basis infection control policies, procedures, and techniques for all appropriate areas of facility operation and services;

5. Developing and implementing a system for evaluating and recording the occurrences of all infections relevant to employment (e.g., skin rash) among personnel and infections among patients; such records shall be made available to the licensing agency upon request;

6. Consistent with "Policy and Procedures for Tuberculosis Screening of Health-Care Workers" incorporated above at § 11.2(C) of this Part, implementing a tuberculosis (TB) infection control program requiring risk assessment and development of a TB infection control plan; early identification, treatment and isolation of strongly suspected or confirmed infectious TB patients; effective engineering controls; an appropriate respiratory protection program; health care worker TB training, education, counseling and screening; and evaluation of the program's effectiveness, per guidelines in "Policy and Procedures for Tuberculosis Screening of Health-Care Workers" incorporated above at § 11.2(C) of this Part.

7. Developing and implementing an institution-specific strategic plan for the prevention and control of vancomycin resistance, with a special focus on vancomycin-resistant enterococci, per guidelines in "Guidelines for the Control of Vancomycin Resistant Enterococci (VRE) in Nursing Homes and Extended Care Facilities" (1996). (See also "Recommendations for Preventing the Spread of Vancomycin Resistance: Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)" incorporated above at § 11.2(D) of this Part for additional information on this issue).

8. Developing and implementing protocols for:

a. Discharge planning that includes full instruction to the family or caregivers regarding necessary infection control measures, and

b. Hospital transfer of patients with infectious diseases which may present the risk of continuing transmission. Examples of such diseases include, but are not limited to, TB, methicillin resistant staphylococcus aureus (MRSA), VRE, and clostridium difficile.

9. Assuring that all patient care staff are available in order to assist in the prevention and control of infectious diseases and are provided with adequate direction, training, staffing and facilities to perform all required infection surveillance, prevention and control functions.

C. A continuing education program on infection control shall be conducted periodically for all staff.

D. Reporting of Communicable Diseases

1. Each facility shall report promptly to the Department, cases of communicable diseases designated as "reportable diseases" when such cases are diagnosed in the facility in accordance with the Rules and Regulations Pertaining to the Reporting of Infectious, Environmental and Occupational Diseases (Part 30-05-1 of this Title).

2. When infectious diseases present a potential hazard to patients or personnel, these shall be reported to the Department, Center for Acute Infectious Diseases and Epidemiology even if not designated as "reportable diseases."

3. When outbreaks of food-borne illness are suspected, such occurrences shall be reported immediately to the Department, Center for Acute Infectious Diseases and Epidemiology or to the Center for Food Protection.

4. Facilities shall comply with the provisions of R.I. Gen. Laws § 23-28.36-3, which require notification of fire fighters, police officers, and emergency medical technicians after exposure to infectious diseases.

11.6.4Pharmaceutical Services

A. Each facility shall provide pharmaceutical services either directly within the facility or per contractual arrangement. Such services shall be provided in accordance with the requirements of the Rules and Regulations Pertaining to Pharmacists, Pharmacies and Manufacturers, Wholesalers and Distributors.

1. In either instance, appropriate methods and procedures for the procurement and the dispensing of drugs and biologicals shall be established in accordance with appropriate federal and state laws and regulations.

B. There shall be written policies and procedures relating to the pharmaceutical service that shall require no less than:

1. The authority, responsibility, and duties of the registered pharmacist;

2. The selection, procurement, distribution, storage, dispensing or other disposition of drugs and biologicals in accordance with appropriate federal and state laws and regulations;

3. Maintenance of records of all transactions, including recording of receipt and dispensing or other disposition of all drugs and biologicals;

4. Inspection of all drug and biological storage and medication areas and documented evidence of findings;

5. Automatic stop orders for drugs or biologicals;

6. The use of only approved drugs and biologicals;

7. Control of medications from any source;

8. A requirement that when automated storage and distribution devices are utilized, all pertinent provisions of the Rules and Regulations Pertaining to Pharmacists, Pharmacies and Manufacturers, Wholesalers and Distributors shall be met;

9. A monitoring program to identify adverse drug reactions, interactions and incompatibilities and antibiotic antagonisms; and

10. Drugs and biological stored outside of an automated storage and distribution device shall be labeled with the name of the patient, name of the physician, drug dosage, cautionary instructions, and expiration date.

C. Adequate space, equipment, supplies and locked storage areas shall be provided for the storage of drugs and biologicals based on the scope of services provided.

D. Refrigerated food storage units shall not be utilized for storage of drugs and/or biologicals except in facilities of thirty (30) beds or less, provided they are locked in an appropriate container.

E. Drugs may be administered to patients from bulk inventories of non-legend and non-controlled substance items such as aspirin or milk of magnesia, as ordered by a licensed physician.

F. An emergency medication kit, approved by the pharmaceutical service committee or its equivalent, shall be kept at each nursing station.

G. There shall be adequate drug and biological preparation areas with provisions for locked storage in accordance with federal and state laws and regulations.

H. The pharmaceutical service committee or its equivalent, consisting of not less than a registered pharmacist, a registered nurse, a physician, and the administrator, shall:

1. Serve as an advisory body on all matters pertaining to pharmaceutical services;

2. Establish a program of accountability for all drugs and biologicals;

3. Develop and review periodically all policies and procedures for safe and effective drug therapy; and

4. Monitor the pharmaceutical service.

I. A registered pharmacist shall assist in developing, coordinating, and supervising all pharmaceutical services in conjunction with the pharmaceutical services committee. In addition, a registered pharmacist shall:

1. Review the drug and biological regimen of each patient at least monthly;

2. Report any irregularities to the attending physician and/or medical director. These reports shall show documentation of review and response; and

3. Document in writing the performance of such review, which documentation shall be kept on file by the facility and shall be made accessible to the Department upon request.

11.6.5Laboratory and Radiologic Services

A. All facilities shall make provisions for laboratory, x-ray, and other services to be provided either directly by the facility or per contractual arrangements with an outside provider.

B. If the facility provides its own laboratory and x-ray services, these shall meet all applicable statutory and regulatory requirements.

C. All services shall be provided only per order of the attending physician who shall be promptly notified of the findings in accordance with a protocol established by the facility. Such a protocol shall describe which laboratory values mandate a call to the patient's attending physician.

D. Signed and dated reports of all findings shall become part of the patient's medical record.

11.6.6Equipment

A. Each facility shall maintain sufficient and appropriate types of equipment consistent with patient needs and sufficient to meet emergency situations.

B. All equipment to meet the needs of the patients shall be maintained in safe and effective operational condition.

11.6.7Housekeeping

A. An employee of the facility shall be designated responsible for housekeeping services, supervision, and training of housekeeping personnel.

B. Sufficient housekeeping and maintenance personnel shall be employed to maintain a comfortable, safe, clean, sanitary, and orderly environment in the facility.

C. Written housekeeping policies and procedures shall be established in accordance with §11.6.3 of this Part on infection control, for the operation of housekeeping services throughout the facility. Copies shall be made available to all housekeeping personnel.

D. Housekeeping personnel may assist in food distribution but not food preparation. Careful hand washing should be done prior to assisting in food distribution.

E. All parts of the facility and its premises shall be kept clean, neat, and free of litter and rubbish and offensive odors.

F. Equipment and supplies shall be provided for cleaning of all surfaces. Such equipment shall be maintained in a safe, sanitary condition and shall be properly stored.

G. Hazardous cleaning solutions, compounds, and substances shall be labeled, stored in a safe place, and kept in an enclosed section separate from other cleaning materials.

H. Cleaning shall be performed in such a manner so as to minimize the development and spread of pathogenic organisms in the facility environment.

I. Exhaust ducts from kitchens and other cooking areas shall be equipped with proper filters and cleaned at regular intervals. The ducts shall be cleaned as often as necessary and inspected by the facility no less than twice per year.

J. Facilities contracting with outside resources for housekeeping services shall require conformity with the regulations contained herein.

K. Each facility shall be maintained free from insects and rodents through the operation of a pest control program.

11.6.8Laundry Services

A. Each facility shall make provisions for the cleaning of all linens and other washable goods.

B. Facilities providing laundry service shall have adequate space and equipment for the safe and effective operation of laundry service and, in unsewered areas, shall obtain approval of the sewage system by the licensing agency to ensure its adequacy.

C. Written policies and procedures for the operation of the laundry service including special procedures for the handling and processing of contaminated linens, shall be established in accordance with §11.6.3 of this Part on infection control.

D. There shall be distinct areas for the separate storage and handling of clean and soiled linens.

1. The soiled linen area and the washing area shall be negatively pressurized or otherwise protected to prevent introduction of airborne contaminants.

2. The clean linen area and the drying area shall be physically separated from the soiled linen area and the washing area.

E. All soiled linen shall be placed in closed containers prior to transportation.

F. To safeguard clean linens from cross-contamination they shall be transported in containers used exclusively for clean linens which shall be kept covered at all times while in transit and stored in areas designated exclusively for this purpose.

G. A quantity of linen equivalent to three (3) times the number of beds including the set of linen that is in use shall be available and in good repair at all times.

H. Facilities contracting for services with an outside resource in accordance with §11.5.4 of this Part shall require conformity with these regulations as part of the contract.

11.6.9Disaster Preparedness

A. Each facility shall develop and maintain a written disaster preparedness plan that shall include plans and procedures to be followed in case of fire or other emergencies. The plan and procedures shall be developed with the assistance of qualified safety, emergency management, and/or other appropriate experts and shall be coordinated with the local emergency management agency.

B. The plan shall include procedures to be followed pertaining to no less than the following:

1. Fire, explosion, severe weather, loss of power and/or water, flooding, failure of internal systems and/or equipment, and other calamities;

2. Transfer of casualties;

3. Transfer of records;

4. Location and use of alarm systems, signals, and firefighting equipment;

5. Containment of fire;

6. Notification of appropriate persons;

7. Relocations of patients and evacuation routes;

8. Feeding of patients;

9. Handling of drugs and biologicals;

10. Missing patients; and

11. Any other essentials as required by the local emergency management agency.

C. A copy of the plan shall be available to the staff and to the public.

D. Emergency steps of action shall be clearly outlined and posted in conspicuous locations throughout the facility.

E. In-service training related to the disaster preparedness plan shall be conducted for all shifts at least semi-annually. Written documentation of all drills shall be maintained by the facility.

F. All personnel shall receive training in disaster preparedness as part of their employment orientation.

216 R.I. Code R. § 216-RICR-40-10-11.6

Amended effective 3/21/2023