Section 0250-04-08-.06 - MEDICAL SERVICES(1) When a youth requires medical care, the facility staff shall transport or arrange for transportation of the youth to a medical facility. If a youth is in need of urgent or emergency care, the facility staff shall transport them to the nearest or designated urgent care clinic or hospital emergency department as soon as possible. Diligent efforts shall be made to immediately notify the youth's parent or guardian. Medical complaints, diagnoses, treatment received, diligent efforts, and parental notification shall all be documented.(2) First aid kits shall be available to and fully accessible by staff. A licensed medical professional shall approve the number and contents of such kits. Documentation of such approval shall be in the facility's permanent records or attached to the kit itself and shall be renewed annually. Outdated medications, including topical ointments, shall be removed and replaced.(3) Wellness/Health screenings shall be performed on all youth, in a confidential environment, upon admission to a Juvenile Detention Center and before their placement in the general housing area. The findings shall be recorded on a printed or electronic screening form. The juvenile detention center staff member performing this duty shall inquire and check for evidence or appearance of:(a) A serious illness or communicable disease or condition;(c) Prescribed medications;(d) Intoxication - alcohol or drug use;(e) Pregnancy (last menstrual cycle);(f) Physical or sexual abuse;(h) Past or current suicidal ideations and/or attempts;(i) Mental health issues, including any prior mental health treatment;(j) Recent significant loss, including but not limited to, the death of a family member or close friend;(k) History of mental health diagnosis or suicidal behavior by family members and/or close friends; and(l) Suicidal issues or mental health diagnosis during any prior confinement.(4) A physical/health history examination shall be completed on all youth admitted to a Juvenile Detention Center within fourteen (14) days of their initial admission date unless documentation of such an examination dated within six (6) months prior to admission is available. A physician, nurse practitioner or registered nurse shall perform this examination. This examination shall include: (a) Monitoring of vital signs;(e) Diagnoses and treatment recommendations as necessary.(5) Sick call, conducted by a physician or other person designated by a physician as capable of performing such duty, shall be available to each youth admitted to a Juvenile Detention Center according to written triage procedure for the center. All sick call requests shall be documented and logged for review. These logs should reflect the date and time of the sick call request and any subsequent follow up. The youth shall be informed of these procedures upon admission. Triage policy and procedure, including documentation of access to emergency health services, shall be made available for review by licensing staff.(6) Dental treatment shall be provided when the health of the youth would otherwise be adversely affected during confinement as determined by a physician or dentist.(7) Youth on prescription medications shall, whenever possible, have their medications continued without interruption unless a qualified medical professional determines that continuing the medication is clinically inappropriate. Medication continuity decisions are made through a same-day evaluation by a physician, nurse practitioner or psychiatrist or appropriate phone consultation between a nurse and a physician or psychiatrist, or sooner if medically necessary. The facility shall not administer any medications that are expired or not in original containers.(8) There shall be strict control of medications to be issued to youth. All medications shall be prescribed by a physician or nurse practitioner at the time of use. Over the counter medications can be administered by written medical protocol approved by a licensed medical provider. A trained staff member shall be responsible to see that medication is administered as prescribed.(9) All medication shall be double-locked within the medical area of the facility or other area approved by DCS Licensing. A medication receipt, log, and administration system shall be established. A running count of all prescribed medications shall be documented on an approved Medication Administration Record (MAR) including controlled medications and prescribed medications. A continuous inventory shall be maintained for syringes and other sharps. All used syringes and other contaminated material shall be disposed of in compliance with guidelines for disposal of bio-hazardous waste. All medication, including topical ointments, shall be checked monthly for expiration dates and expired medication shall be disposed of immediately.(10) Medical records shall be maintained on each youth's physical condition upon admission, during confinement, and at discharge. The medical record shall include all medical orders issued by the physician and any other medical personnel who are responsible for rendering health care services. These records shall be retained until the youth's nineteenth (19th) birthday.(11) In case of medical or mental health emergencies, specific resource information shall be readily accessible to all staff members including, but not limited to, local hospital emergency department, local physician's office, crisis intervention services, 911 or local emergency response, and poison control numbers. Contact information for parent, guardian, or family member of each youth shall also be readily available in case of emergency.(12) Staff shall immediately place youth identified as needing further evaluation for suicide risk or other acute mental health conditions on constant observation until they can be formally assessed by a qualified mental health professional such as, but not limited to, a mobile crisis response unit. Staff shall promptly contact a qualified mental health professional in order to develop an emergency intervention plan for such youth. The qualified mental health professional shall conduct an assessment of the youth within twenty-four (24) hours. Only a qualified mental health professional may remove a youth from constant observation.(13) Youth who are identified as requiring additional medical or mental health follow-up for reasons other than significant medical or mental health needs or suicide risk shall be immediately referred for an assessment by a qualified medical or qualified mental health professional, as appropriate.(14) Youth who are identified upon initial screening, or at a later date, as having experienced prior sexual victimization or who previously perpetrated sexual abuse shall be offered a meeting with a qualified mental health professional within seventy-two (72) hours of either admission to the facility or request by the youth.(15) The facility shall develop and implement written policies, procedures and practices, in conjunction with the health authority, that ensure sufficient supervision of youth identified with potential medical problems (e.g., diabetes, asthma) until the youth receives a full health assessments.(16) Provisions for appropriate medical and neonatal care shall be made for pregnant youth.(17) For youth in the custody of the Department, if health or behavioral health services are not provided directly by the facility, but received by the child through community clinicians, the facility shall complete CS-0689, Health Services Confirmation and Follow up Notification to the community provider. The Health Services Confirmation provides information about the service that was received and notes any follow-up services needed.Tenn. Comp. R. & Regs. 0250-04-08-.06
New rules filed March 17, 2017; effective 6/15/2017.Authority: T.C.A. §§ 37-5-105; 37-5-106; and 37-5-501, et. seq.