(a) Staff Requirements. Psychiatric Hospitals shall have staff adequate in number and qualifications to carry out an active program of treatment for individuals who are furnished services in the facility. - (i) Inpatient psychiatric facilities (Psychiatric Hospitals, distinct parts of Psychiatric Hospitals or inpatient components of community mental health centers) shall be staffed with the number of qualified professional, technical, supporting personnel, and consultants required to carry out an intensive and comprehensive treatment program that shall include: evaluation of individual needs; establishment of treatment and rehabilitation goals; and implementation, directly or by arrangement, of a broad range of therapeutic programs including professional psychiatric, medical, surgical, nursing, social work, psychological and activity therapies required to carry out an individual treatment plan for each patient.
- (A) Qualified professional, technical and consultant personnel shall be available to evaluate each patient at the time of admission. The evaluation shall include diagnosis of any inter-current disease. Services necessary for such evaluation shall include laboratory, radiological, and other diagnostic tests, psycho-social data, psychiatric and psychological evaluations, and a physical examination which includes a complete neurological examination when indicated, shortly after admission.
- (B) The number of qualified professional personnel, consultants, technical and supporting personnel shall be adequate to assure representation of the disciplines necessary to establish short-range and long-term goals; to plan, carry out and periodically revise a written individualized treatment program for each patient based on scientific interpretation of:
- (I) Degree of physical disability and indicated remedial or restorative measures (including nutrition, nursing, physical medicine and pharmacological therapeutic interventions).
- (II) Degree of psychological impairment and appropriate measures to be taken relieving treatable distress and compensation for nonreversible impairments.
- (III) Capacity for social interaction and appropriate nursing measures and milieu therapy to be undertaken (including group living experiences, occupational and recreational therapy and other prescribed rehabilitative activities to maintain or increase each patients capacity to manage activities of daily living).
- (IV) Environmental and physical limitations required to safeguard each patients health and safety.
(b) Director of Inpatient Psychiatric Services-Medical Staff. - (i) Inpatient psychiatric services shall be under the supervision of a clinical director, service chief or equivalent who shall be qualified to provide the leadership required for an intensive treatment program. The number and qualifications of physicians shall be adequate to provide essential psychiatric services.
- (ii) The medical staff shall be qualified legally, professionally and ethically for the positions to which they are appointed.
- (iii) Residency training shall be under the direction of a qualified psychiatrist.
(c) Nursing Service. - (i) Nursing services shall be under the direct supervision of a registered nurse who shall be qualified by education and experience for the position. The number of registered nurses, licensed practical nurses and other nursing personnel shall be adequate to formulate and carry out the nursing components of the individualized treatment plan for each patient.
- (ii) The number of registered nurses, including nurse consultants, shall be adequate to formulate in writing, that a nursing care plan for each patient is carried out.
- (iii) Registered nurses and other nursing personnel shall be prepared by continuing inservice and staff development programs for active participation in interdisciplinary meetings affecting the planning or implementation of nursing care plans for patients (including diagnostic conferences, treatment planning sessions, and meetings held to consider alternative facilities and community resources).
(d) Psychological Services. - (i) Psychology services shall be under the supervision of a psychologist with a doctoral degree in psychology from an American Psychological Association approved program in clinical psychology or its equivalent.
- (i) The psychology staff, including consultants shall be adequate in numbers and by qualifications to plan and carry out assigned responsibilities.
Note: Where a psychologist who does not hold the doctoral degree directs the program, he/she shall have attained recognition of competency through the American Board of Examiners for Professional Psychology, state certification or licensing, or through endorsement by his/her state psychological association.
- (iii) Psychologists, consultants and supporting personnel shall be adequate in number and by qualifications to assist in essential diagnostic formulations, and to participate in program development and evaluation of program effectiveness, in training and research activities, in the therapeutic interventions such as milieu, individual or group therapy, and in interdisciplinary conferences and meetings held to establish diagnoses, goals and treatment programs.
(e) Social Services. - (i) Social services shall be under the supervision of a qualified social worker. The social work staff shall be adequate in numbers and by qualifications to fulfill responsibilities related to the specific needs of individual patients and their families, the development of community resources and consultation to other staff and community agencies.
- (ii) Social work staff, including other social workers, consultants, and other assistants or case aides, shall be qualified and numerically adequate to conduct pre-hospitalization studies. They shall provide psychological data for diagnosis and treatment planning, direct therapeutic services to patients, patient groups or families, to develop community resources, including family or foster care programs. They shall conduct appropriate social work research and training activities; and participate in interdisciplinary conferences and meetings concerning diagnostic formulation and treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment.
(f) Qualified Therapists, Consultants, Volunteers, Assistants and Aides. - (i) Qualified therapists, consultants, volunteers, assistants or aides shall be sufficient in number to provide comprehensive therapeutic activities. They shall include occupational, recreational, and physical therapists to assure that appropriate treatment shall be rendered for each patient, and to establish and maintain a therapeutic milieu.
- (ii) Occupational therapy services shall be under the supervision of a graduate of an occupational therapy program approved by the Council on Education of the American Medical Association and who has passed or is eligible for the National Registration Examination of the American Occupational Therapy Association.
Note: In the absence of a full-time, fully qualified occupational therapist, a certified occupational therapy assistant as defined in W.S. § 33-40-102 may function as the director of the activities program with consultation from a fully qualified occupational therapist.
- (iii) When physical therapy services are offered, the services are given by or under the supervision of a qualified physical therapist who is a graduate of a physical therapy program approved by the Council on Medical Education of the American Medical Association or its equivalent. In the absence of a full time, fully qualified physical therapist, physical therapy services shall be available by arrangement with a licensed and certified hospital or by consultation or part-time services furnished by a fully qualified physical therapist.
- (iv) Recreational or activity therapy services shall be available under the direct supervision of a member of the staff who has demonstrated competence in therapeutic recreation programs.
- (v) Other occupational, recreational, activity and physical therapy assistants or aides shall be directly responsible to qualified supervisors and shall be provided special on-the-job training to fulfill assigned functions.
- (vi) The total number of occupational, recreational, activity and rehabilitation personnel, including consultants, shall permit adequate representation and participation in the interdisciplinary conference and meetings affecting the planning and implementation of activity and rehabilitation programs, including diagnostic conferences. All daily schedule and prescribed activities including maintenance of appropriate progress records of individual patients shall be maintained.
- (vii) Voluntary services workers shall be: under the direction of a paid professional supervisor of volunteers; provided appropriate orientation and training; and available daily in sufficient numbers to be of assistance to patients and their families in support of therapeutic activities.
(g) Physical and Therapeutic Environment. - (i) Areas for private conversations, group activities or therapy sessions, recreational and hobby activities and dining shall be provided commensurate with the number and characteristics of the patient population.
- (ii) If staff members do not eat with the patients, dining areas shall be adequately supervised.
- (iii) There shall be a written policy regarding any activities involving travel and use of facilities away from the hospital of which the service or unit is a part. This policy shall address the manner in which security of patients and staff will be ensured and shall also include a description of the way in which community law enforcement and other community resources will be informed when patient elopement occurs.
- (iv) A minimum of one detention room shall be provided.
- (v) Recreational equipment, games, books and magazines shall be provided in accordance with the backgrounds and needs of the patients.
- (vi) Therapeutic Environment.
- (A) Written policies and procedures shall be in place which govern the use of seclusion, restraints, psycho surgery, electroconvulsive therapy, behavior modification procedures that use painful stimuli, scheduled drugs and experimental treatment activities. These policies shall require specific written justification to be made and entered in the patients record for the use of such treatment.
- (B) The Psychiatric Hospital Administrator, or his/her designee, shall be the authorizing official for the use of mechanical restraints. The order to use the restraints and the reasons why they were used shall be documented in the patients clinical record and signed by the Psychiatric Hospital Administrator, or his/her designee. The patients clinical record shall also contain documentation of what restraints were used, and the time they were applied and released. Frequent monitoring of patients in restraints shall ensure that patients are safe and that restraints are used for the minimum amount of time clinically indicated.
- (C) Written policies and procedures shall be in place regarding elopement and the use of discipline. Such policies and procedures shall include a detailed description of staff action to be taken when elopement occurs and how community law enforcement shall be informed and involved.
- (D) Rehabilitation therapy shall be provided by the facility or by arrangement with other service providers, as appropriate, to meet the needs of the patient population. Rehabilitation therapy includes:
- (I) Activities which shall be provided daily, including evenings and weekends;
- (III) Speech and hearing services which shall be provided to assess, as well as treat; and
- (IV) Vocational services.
- (E) Patients shall be encouraged to take responsibility for maintaining their own living quarters.
- (I) Except for the responsibilities identified in (vi)(E) above, patients may not be required to work unless it is part of the individual treatment plan and fair compensation is paid. Any such work arrangement shall be documented and included in the patients record.
(h) Patients Rights. - (i) Every effort shall be made to insure that the patient or the person responsible for the patients care or custody understands at the time of admission the policies relating to the patients rights and responsibilities during hospitalization. This shall include the patients rights and an explanation of the facilitys policies regarding seclusion and restraints, discipline, and elopement. A copy of the written policy concerning patients rights and responsibilities shall be provided to the patient or person responsible for the patients care or custody at the time of admission.
- (ii) A written policy shall be in place which describes the rights of patients, including a description of the circumstances under which, and to what extent, rights may be limited. Patients rights include, but are not necessarily limited to:
- (A) Communicate by sealed mail or otherwise with persons, including official agencies, inside or outside the hospital;
- (C) Make and receive telephone calls within reasonable limits;
- (D) Wear his/her own clothing;
- (E) An independent or in-house medical review, upon written request;
- (F) Review the proceedings involving his/her commitment; and
- (G) An explanation and a written copy of these rights.
- (iii) A copy of these rights shall be posted in a prominent location that is available to the patients.
- (iv) Any limitation of the patients rights shall be documented in the patients record by the Psychiatric Hospital Administrator, or his/her designee, and explained to the patient.
- (v) The patients right to communicate with an attorney by sealed mail shall not in any way be subject to limitation.
(i) Grievance Procedure. - (i) The written grievance procedure shall establish a system of reviewing complaints and allegations of patients right violations to include, but not limited to:
- (A) How to voice grievances;
- (B) Documentation of the providers response to verbal and written patient grievances;
- (C) List of agencies, with addresses and telephone numbers for patients to contact if grievances are not addressed satisfactorily; and
- (D) Written reports of the grievances and resolutions shall be provided to the Licensing Division within ten (10) days after the grievance is filed.
- (ii) The written grievance procedure shall be posted in a conspicuous place, and there shall be documentation in each patients medical record that the resident has read or had such policy for handling grievances explained upon admission.
(j) Complaint Investigations. - (i) Patient complaints and grievances shall be referred in writing to the Licensing Division.
- (ii) Written reports of investigations and the status of the resolutions shall be provided to the Licensing Division, within thirty (30) days after the investigation.
(l) Special Administrative Requirements. - (i) Inpatient psychiatric services shall be included in the program evaluation, quality assurance and utilization review policies and procedures of the Psychiatric Hospital.
- (ii) Designated inpatient psychiatric services shall have a written policy regarding the contents, filing and distribution of reports required by the Department of Health and those reports required to be filed with the court pursuant to W.S. § 25-10-110 et. seq. for involuntarily hospitalized patients.
- (iii) At least every six (6) months the Psychiatric Hospital Administrator, or his/her designee, shall reexamine every patient involuntarily hospitalized to determine if the patient should be released, released on convalescent leave or remain hospitalized.
048-15 Wyo. Code R. § 15-8