216-40-10 R.I. Code R. § 16.11

Current through June 12, 2024

Section 216-RICR-40-10-16.11 - Patient Care Services

16.11.1Management Responsibility

A. The rehabilitation hospital center through its Medical Director shall be responsible to ensure that all health and holistic rehabilitation services and programs, including services provided per contract or arrangement are rendered in a safe and effective manner consistent with acceptable standards of practice, policies of the center and the requirements of this Part.

1. Furthermore, the Medical Director shall be responsible to ensure that all patients receive adequate medical/surgical treatment, as may be required for specific conditions, in an appropriate facility.

B. The center shall assure the continuity of patient care in the inpatient, day patient and outpatient settings through written policies, procedures and criteria pertaining to no less than the following:

1. Criteria and policies and procedures for admissions to each level of care and initial assessment of patient care needs;

2. Signed informed consent;

3. Ongoing assessment of patient/family needs;

4. Development and review of the plan of care by the interdisciplinary team;

5. Transfer of patients for acute medical-surgical problems; (see §16.11.1(A) of this Part)

6. The provision of appropriate information to patient/family at the points of transfer between levels of care;

7. Community or other resources, including consultation services, to insure continuity of care to meet patient care needs;

8. Constraints imposed by limitations of services, patient and home conditions, or other; and

9. Such other criteria as may be deemed appropriate.

16.11.2Plan of Care

A. After initial assessment of patient rehabilitative needs, a written plan of care shall be established by the interdisciplinary team for each patient admitted to the center and at each level of care and with the participation of the patient or responsible party. Such plan shall designate the intensity of services required in relation to the disability and the individual's response to treatment and shall include provisions pertaining to:

1. Pertinent diagnosis and prognosis;

2. Identification of the intensity of patient care needs including:

a. The range of rehabilitation services required;

b. The level of care required;

c. The frequency of therapeutic services required;

d. Medications;

e. Management of discomfort and pain control; and

f. Other rehabilitative needs and prescribed therapies;

3. Such other relevant modalities of care, training and services as may be appropriate to meet the patient's rehabilitative needs.

B. Patient care plans shall be reviewed and updated at periodic intervals as specified in the plan of care by the multidisciplinary team.

16.11.3Levels of Care

A. Inpatient Care: shall be for the provision of intensive functional rehabilitation services through the interdisciplinary team, for patients who require uninterrupted rehabilitation and nursing care services including a range of intensive rehabilitation services referred to in §16.11.4 of this Part as related to patient's disability and response to treatment.

B. Day Care: shall be for the provision of rehabilitation services through the Interdisciplinary Team to patients whose condition continues to require intensive functional rehabilitation services as provided in the inpatient setting, but who can accommodate to a less protective environment such as his or her home, without interrupting the rehabilitation process.

C. Outpatient: shall refer to the provision of coordinated and integrated assessment and/or rehabilitation services with emphasis on continuity of care, education and training to individuals with disabling impairments requiring less intensive rehabilitation, supervision and support services.

16.11.4Rehabilitation Services

A. Physician Services: shall be available and/or on call on a twenty-four (24) hour basis and be provided by physician(s) who shall be responsible for the diagnosis and treatment of disabled patients, and who shall participate with members of the interdisciplinary team in the development, implementation and assessment of patient care plans.

B. Nursing Services: shall be provided on a twenty-four (24) hour basis under a licensed professional (registered) nurse in accordance with R.I. Gen. Laws Chapter 5-34, who has training and experience in rehabilitation nursing and who shall be responsible to meet the rehabilitative nursing needs of patients as prescribed in the patient's plan of care and in accordance with acceptable standards of practice.

1. There shall be a sufficient number of licensed professional (registered) nurses on duty at all times to plan, assign, supervise, implement and evaluate nursing care as well as to provide direct patient care as required.

2. The number and type of licensed nurses and ancillary nursing personnel shall be based on evaluation of patient care needs and staff capabilities for each patient care unit.

3. Administration of drugs by non-licensed personnel, selected non-licensed personnel with demonstrated competency, who have satisfactorily completed a state approved training program in drug administration may administer oral or topical drugs, if adequate medical and nursing supervision is provided in accordance with R.I. Gen. Laws Chapter 5-34.

C. Social Services: shall be provided as prescribed in the plan of care and in accordance with acceptable standards of practice and center policies. Social Workers hired after January 1, 2019 shall be qualified on the basis of education, training and experience in accordance with the provisions of R.I. Gen. Laws Chapter 5-39.1. Staff providing social services hired before December 31, 2018 shall have at least a bachelor's degree in social work from a school accredited or approved by the Council on Social Work Education.

D. Therapeutic Services: All therapeutic services shall be provided as prescribed by the interdisciplinary team in the plan of care. Such therapeutic services shall be provided by appropriate staff or consultants in accordance with the center's policies and procedures and consistent with prevailing standards of practice. Furthermore, therapists staff or consultants shall participate in the development, implementation and assessment of patient care plans.

1. Therapists and assistants (physical, occupational, speech, audiologist) shall furthermore hold current licensure, certification or registration as may be required under R.I. Gen. Laws Chapters 5-34, 5-40, and 5-40.1.

E. Psychological Services: shall be provided by qualified psychologists who are certified in the State of Rhode Island in accordance with R.I. Gen. Laws Chapter 5-44. Such services shall be provided as prescribed in the plan of care and the psychologist(s) shall also participate in the development, implementation and assessment of the patient's plan of care.

F. Pastoral Care: Clergymen or members of various denominational organizations or churches shall have access to patients. Patients shall be notified of the availability of such services.

G. Prosthetic/Orthotic Services: shall be rendered as prescribed in the plan of care and provided by individuals with training and experience in prosthetics and/or orthotic services, who shall also participate in the development, implementation and assessment of the plan of care.

H. Allied Rehabilitation Services: such as pre-vocational, vocational, driver training shall also be provided in accordance with center policies and through written agreement with agencies providing vocational training or driver education.

I. Other Rehabilitation Services: all other rehabilitation services, including recreation services, provided by the center shall be provided by individuals with appropriate qualifications and rendered in accordance with acceptable standards or practice.

16.11.5Infection Control

A. The center shall make provisions through patient care and personnel policies for the control of infection and for the protection of patients and personnel. Policies shall pertain to no less than the following:

1. Sanitation and medical asepsis;

2. Disposal of solid waste materials;

3. Admission and isolation of patients with known or suspected infections, diseases and other protective isolation;

4. The establishment of a center-wide surveillance program which shall include an infection surveillance officer to conduct all infection surveillance activities. This shall include a system of periodic reporting, evaluation and recording of the occurrence of infections among personnel and patients;

5. The monitoring of staff personnel to insure the implementation of policies and procedures for the control of infection control.

B. Reporting of Communicable Diseases: Each center shall report promptly to the Rhode Island Department of Health, Division of Disease Control, cases of communicable diseases designated as "reportable diseases" in accordance with the rules and regulations pertaining to Reporting and Testing of Infectious, Environmental, and Occupational Diseases (Part 30-05-1 of this Title) when such cases are diagnosed.

1. When outbreaks of food borne illness are suspected, such occurrences shall be updated immediately to the Rhode Island Department of Health, Division of Disease Control or to the Division of Food Protection and Sanitation.

16.11.6Dietary Services

A. A center shall maintain a dietary service directed by a full-time person qualified by training and experience in organization and administration of food service.

B. Each center shall have at least one Registered Dietitian, licensed by the state and certified by the Commission on Dietetic Registration, employed on either a full-time, or regular part-time basis to direct nutritional aspects of patient care and to advise on food preparation and service.

C. Adequate space, equipment and supplies shall be provided for the efficient, safe and sanitary receiving, storage, refrigeration, preparation and service of food and other related aspects of the food service operation in accordance with the Rhode Island Food Code (Part 50-10-1 of this Title)

1. Any construction, addition, alteration affecting food service operations shall be in conformance with the requirements of R.I. Gen. Laws § 23-1-31.

D. The food service operation shall comply with applicable standards of the Rhode Island Food Code (Part 50-10-1 of this Title).

E. Written policies and procedures shall be established for dietary services, pertaining to but not limited to the following:

1. Responsibilities and functions of personnel;

2. Advising the administrator on all nutritional aspects of patient care, food service and preparation;

3. Alterations or modification to diet orders;

4. Food purchasing, storage preparation and service;

5. Safety and sanitation relative to personnel and equipment;

6. Ancillary dietary services, including food storage and preparation in satellite kitchens, and vending operations;

7. Providing dietary counseling to patients when necessary; and

8. Ice making in accordance with Good Manufacturing Practices for Food (Part 50-10-4 of this Title).

F. Any center engaged in processing or handling or both, of frozen foods shall be subject to standards of Good Manufacturing Practices for Food (Part 50-10-4 of this Title).

G. There shall be a diet manual maintained by the dietary service which shall be reviewed, periodically revised as necessary and approved by the medical staff. Diets served to patients shall comply with the principles set forth in the diet manual.

H. All patient diets shall be ordered in writing by the physician.

I. A dining room shall be available for those patients who wish to participate in group dining in accordance with §16.13.3(A)(5) of this Part.

J. Self-help feeding program shall be available to those patients who need them to maintain maximum independence in the activities of daily living.

K. A center contracting for food service shall require as a part of the contract, that the contractor comply with the provisions of the rules and regulations of this Part.

L. All menus shall be planned at least one week in advance and shall provide for a variety of foods, adjusted for seasonal changes, and reflecting the dietary preferences of patients. Menus shall be posted in a conspicuous place in the dietary department and records of such shall be retained for thirty (30) days.

16.11.7Laboratory and Radiology Services

A. Clinical laboratory services shall be in accordance with the provisions of R.I. Gen. Laws § 23-16.2-3 and the Federal CLIA regulation: 42 C.F.R. § 439. The Center must also maintain the appropriate CLIA certificate to the level of testing being performed.

B. A center providing radiology services must meet the requirements of regulations regarding Radiation (Subchapter 20 of this Chapter).

1. Authentication reports of radiological interpretations, consultations shall be part of the patient's clinical record.

C. Centers contracting with outside resources for laboratory and/or radiology services shall contract only with:

1. Laboratories which meet the requirements of the rules and regulations for Clinical Laboratories and Stations (Part 60-05-4 of this Title); and

2. Radiation facilities which meet the requirements of the rules and regulations for Radiation (Subchapter 20 of this Chapter).

16.11.8Pharmacy

A. Each Rehabilitation Hospital Center shall provide pharmaceutical services either directly within the institution or by contractual arrangement. In either instance, there shall be evidence of a current pharmacy license in compliance with R.I. Gen. Laws § 5-19.1-8. Pharmaceutical services shall be provided in accordance with the rules and regulations pertaining to Pharmacists, Pharmacies, and Manufacturers, Wholesalers and Distributors (Subchapter 15 Part 1 of this Chapter).

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

16.11.9Quality Assurance Program

A. Each center shall establish and maintain on an ongoing basis a Quality Assurance Program which involves assessment of all quality assurance activities conducted in the provision of its health care and rehabilitation program and services at all levels which shall include no less than:

1. Establishment of standards and criteria for the assessment of the quality of health and rehabilitation program and services provided and the appropriateness of the resources utilized;

2. Assessment of rehabilitation outcomes;

3. Ongoing review of rehabilitation programs and services by physicians and other health professionals;

4. A mechanism to assure the utilization of systematic data collection based on valid samples of the total patient population to measure performance and patient results, and to make recommendations to physicians and centers of needed changes;

5. Provisions for combining utilization data and financial data into management reports which shall be available to the Director of Health;

6. Arrangements of routine reporting of results of quality assurance program activities to the governing body, administration, providers, and the Director of Health; and

7. Written procedures for taking appropriate remedial action whenever, as determined under the quality assurance program, inappropriate or substandard services have been provided or services which should have been furnished have not been provided.

16.11.10Equipment

A. Each center shall have an assortment of styles and sizes of adaptive equipment for patient evaluation and training in the following areas:

1. Beds - e.g., beds && accessories, mattresses, waterproof bed protection, enuresis, alarms, self-fitting aids, bed and cantilever tabled, protective devices for incontinency.

2. Pressure relief -e.g., beds and cushions designed for pressure relief, sheepskins.

3. Chairs -e.g., geriatric, adjustable and mobile chairs, self-lift seats, therapeutic training wheelchairs.

4. Communication -e.g., reading aids, writing and speech aids, deaf aids, remote control apparatus.

5. Eating and Drinking Aids -e.g., non-slip materials, trays, cutlery.

6. Electro Diagnostic - EMG

7. Hoists and Lifting Equipment -e.g., portable, fixed and electric hoists, manual lifting aids, car hoists, stair climbers.

8. Leisure Activities - e.g., music, sports, hobbies, crafts, sewing.

9. Sport && Physical Recreation -e.g., (facilities for disabled people) clubs concerned with sports for disabled.

10. Personal Toilet and Personal Care -e.g., commodes, hair washing, showers, aids for incontinency.

11. Prosthetics and Orthotics - adjustable models.

12. Walking Aids and Wheelchairs

13. Household equipment/fittings

14. Clothing/footwear

15. Therapeutic Devices: nerve muscle stimulators; exercise equipment -e.g., weight/pulleys, ergometer, treadmill; Modalities: mv/heat/ microwave, traction; Positioning; Hydrotherapy (whirlpool and therapeutic pool)

16. Other Diagnostic: E.K.G.; Pulmonary function; Biofeedback && video feedback; audio and visual equipment; and prevocational, e.g. adjustable heights and accessible work stations.

216 R.I. Code R. § 216-RICR-40-10-16.11