216-40-10 R.I. Code R. § 12.5

Current through June 12, 2024

Section 216-RICR-40-10-12.5 - Patient care services

12.5.1Patient Care Management

A. Each patient shall be under the continuing supervision of a physician and provisions shall be made by the facility to assure the availability of medical care at all times to patients whether on chronic maintenance dialysis, self-care or home dialysis programs.

B. A mechanism shall be established for the development and periodic review and revision of patient care policies and procedures by a professional group including no less than the medical director of the facility, the nursing director and representatives of the Technical Advisory Group.

C. Patient care policies and procedures shall be established for each specific program carried by the facility, (chronic maintenance dialysis, self-care dialysis or home dialysis) and shall pertain to no less than the following:

1. Scope of services provided either directly or per contractual arrangement;

2. Criteria for admission, transfer or discharge from or to chronic maintenance, self-care or home dialysis, or to acute dialysis;

3. Availability and accessibility of services in medical or other emergency;

4. Medical supervision and physician services;

5. Patient care plans and methods of implementation;

6. Pharmaceutical, dietary and social services;

7. Availability of services for working patients;

8. Evaluation of patient care services by the technical advisory committee;

9. Transfer of patient to affiliate hospital; and

10. The self-care and home dialysis programs.

D. There shall be posted at each nursing station a roster with the names and telephone number(s) of physicians to be called in an emergency.

12.5.2Patient Care Plans

A. There shall be a patient care plan for each patient, developed by the professional team to ensure appropriate modality of care.

1. Such a plan shall be based on the nature of the patient's illness, treatment prescribed and assessment of patient's needs based on prior medical work up.

2. The patient care plan shall furthermore reflect medical, psychological and social needs of patients.

3. The plan shall be reviewed at least monthly until the patient is stable and thereafter every six (6) months and revised as necessary to meet ongoing needs of the patient.

4. The patient, parent, or legal guardian shall be involved in the development of the care plan with the professional team and due consideration shall be given to the patient's preferences when not medically contraindicated.

5. The frequency of home visits, if applicable, will be noted in the patient's care plan and based on each individual patient's needs.

12.5.3Nursing Services

A. The nursing service shall be under the supervision of a full time licensed registered nurse who has clinical nursing experience and training in dialysis techniques.

B. There shall be a sufficient number of registered nurses to plan, assign supervise and evaluate nursing care as well as a sufficient number of ancillary nursing personnel to meet patient care needs based on the types of programs (e.g., chronic maintenance, self-care or home dialysis) and staff capabilities.

C. A registered nurse with the experience in dialysis techniques shall be on the premises of the dialysis facility at all times whenever a patient is undergoing renal dialysis treatment.

12.5.4Medical Records

A. A member of the professional staff shall be designated to supervise the medical records and to ensure proper documentation, completion, indexing, filing, retrieval and safe storage.

B. A medical record shall be established and maintained for every patient treated on the premises or at his place of residence.

C. Each medical record shall contain sufficient information and data to support the diagnosis, plan of treatment to define treatment modalities, responses to treatment and on-going progress reports of patient care.

D. Each medical record shall contain no less than the following:

1. Documented evidence of assessment of the needs of the patient an of establishment of an appropriate plan of treatment;

2. Identification and social data;

3. Referral information with authentication of diagnosis;

4. Medical and nursing history of patient;

5. Report(s) of physician examination(s);

6. Observation and progress notes;

7. Reports of treatments and clinical findings;

8. Laboratory reports; and

9. Other related reports.

E. All medical records either original or accurate reproductions shall be retained for a minimum of five (5) years following discharge of the patient. Records of minors shall be kept for at least five (5) years after such minor shall have reached the age of eighteen (18) years.

12.5.5Laboratory Services

Each facility shall make provisions for laboratory services.

12.5.6Related Services

A. Social services and dietetic services shall be provided either directly or per contractual arrangements with qualified professional personnel, on either a full or part time basis, depending on the scope of the program and patient care needs.

B. The social worker and dietitian shall have clearly delineated responsibilities which shall include their participation with the professional team to plan and evaluate the psychosocial and nutritional needs of patients.

C. Accurate notations shall be made in the patient's medical record of all services rendered.

12.5.7Infection Control

A. A mechanism shall be established with appropriate professional staff to establish infection control policies and procedures for the mutual protection of patients, personnel and the public. Such policies and procedures shall pertain to:

1. Infection surveillance activities including a plan for systematic monitoring of hepatitis in patients and personnel.

2. Sanitation and asepsis;

3. Isolation of patients with known or suspected infectious disease;

4. Handling and disposal of waste and contaminants;

5. Sterilization, disinfection and laundry;

6. Reporting, recording and evaluation of occurrences of infections; and

7. Documentation of infection rate.

B. The facility shall report promptly to the licensing agency infectious diseases which may represent a potential hazard to patients, personnel and the public. Included are the reportable diseases and the occurrence of other diseases in outbreak form.

12.5.8Home Dialysis

A. The therapeutic regimen for any patient to be cared for at home shall be arranged after a sufficient period of initial study, dialysis, planning and self-care dialysis on the premises of the facility and with the responsible person(s) who will assist the patient.

B. Facilities providing home dialysis shall make available either directly or per contractual arrangements with a community agency(ies) the following services:

1. Home visits for supervision of care;

2. Consultation with qualified social worker and dietitian;

3. Installation and maintenance of equipment;

4. Testing appropriateness of water;

5. A record-keeping system to assure continuity of care;

6. Assurance of emergency coverage on a twenty-four (24) hours basis with affiliate hospital;

7. Arrangements for emergency transportation to affiliate hospital in the event of emergency; and

8. Ordering of supplies.

C. Patients on a home dialysis program shall be visited by facility professional staff to assess and review a patient's care plan and to observe a patient and "helper" perform dialysis. The frequency of such visits shall be determined by facility professional staff, applying clinical judgment to the specifics of a patient's case.

12.5.9Continuity of Care for Traveling Patients

A. Facilities shall be responsible to make temporary arrangements with dialysis facilities or centers throughout the country or outside the United States for patients who will be traveling and may be confronted with medical problems requiring acute care.

1. Patients shall be given the name and address of facilities in those states or countries in which the patient will be traveling. In addition instructions will be given to the patient in emergency measures to be taken in the event medical problems should arise.

216 R.I. Code R. § 216-RICR-40-10-12.5

Amended effective 9/28/2023
Amended effective 12/24/2023