La. Admin. Code tit. 48 § I-8553

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-8553 - Health Care Services

A. General Provisions

1. An ICF/DD shall ensure the availability of a comprehensive program of preventive, routine and emergency medical and dental care, as appropriate, for all individuals. The ICF/DD shall have a written plan for providing such care. This plan shall include:

a. ongoing appraisal of the general health of each individual;

b. provisions of health education, as appropriate;

c. establishment of an ongoing immunization program;

d. approaches that ensure that any medical treatment administered will be explained to the individual in language suitable to his/her age and understanding;

e. an ongoing relationship with a licensed physician and dentist to advise the ICF/DD concerning medical and dental care;

f. availability of a physician on a 24-hour a day, seven days a week basis; and

g. the ICF/DD shall show evidence of access to the resources outlined in this plan.

2. An ICF/DD shall have access to psychiatric and psychological resources, on both an emergency and ongoing basis, as appropriate to meet the needs of individuals.

B. Physician Services. An ICF/DD shall arrange a general medical examination by a physician for each individual within a week of admission unless the individual has received such an examination within 30 days before admission and the results of this examination are available to the ICF/DD.

1. This examination shall include:

a. an examination of the individual for physical injury and disease;

b. vision and hearing screening;

c. a current assessment of the individual's general health; and

d. whenever indicated, the individual shall be referred to an appropriate medical specialist for either further assessment or treatment.

2. The ICF/DD shall arrange an annual physical examination of all individuals.

3. Physicians shall participate, when appropriate, in the continuous interdisciplinary evaluation of an individual for the purposes of initiation, monitoring, and follow-up of service plans; and

4. An ICF/DD must ensure that an individual receives timely, competent medical care, in keeping with community standards of medical practice when he/she is ill.

C. Immunizations

1. Individuals receiving services shall have proper immunizations and infection control.

2. The ICF/DD shall ensure:

a. that the individual has received all immunizations and booster shots which are required by the Department of Health and Hospitals within 30 days of his/her admission; and

b. reporting of communicable diseases and infections in accordance with law.

D. Medications

1. An ICF/DD shall ensure that no medication is given to any individual except in accordance with the written order of a physician.

a. There shall be no standing orders for prescription medications.

b. The prescribing physician must be immediately informed of any side-effects observed by staff or any medication errors.

2. An ICF/DD using psychotropic medications on a regular basis shall have a written description of the use of psychotropic medications at the facility including:

a. a description of procedures to ensure that medications are used for therapeutic purposes and in accordance with accepted clinical practice;

b. a description of procedures to ensure that medications are used only when there are demonstrable benefits to the individual unobtainable through less restrictive measures;

c. a description of procedures to ensure continual review of medication and discontinuation of medication when there are no demonstrable benefits to the individual; and

d. a description of an ongoing program to counsel individual's and, where appropriate, their families on the potential benefits and negative side-effects of medication and to involve individuals and, where appropriate, their families in decisions concerning medication.

3. An ICF/DD shall ensure that medications are either self-administered or administered by qualified persons according to state law.

4. A medication shall not be administered to any individual for whom the medication has not been ordered.

5. An ICF/DD shall ensure that medication is used for therapeutic and medical purposes only and are not administered in excessive dosages.

6. Medication shall not be used as a disciplinary measure, a convenience for staff or as a substitute for adequate, appropriate programming.

E. Nursing Services

1. An ICF/DD shall ensure that individuals are provided with nursing services, in accordance with their needs.

2. Nursing services to individuals shall include, as appropriate, registered nurse participation in:

a. the pre-admission study;

b. the service plan and any reviews and revisions of the service plan;

c. the development of aftercare plans;

d. the referral of individuals to appropriate community resources;

e. training in habits in personal hygiene, family life, and sex education (including family planning and venereal disease counseling);

f. control of communicable diseases and infections through identification and assessment, reporting to medical authorities and implementation of appropriate protective and preventive measures; and

g. modification of the nursing part of the service plan, in terms of the individual's daily needs, at least annually for adults and more frequently for children, in accordance with developmental changes.

3. A registered nurse shall participate, as appropriate, in the planning and implementation of training of direct service personnel including training in:

a. detecting signs of illness or dysfunction that warrant medical or nursing intervention;

b. basic skills required to meet the health needs and problems of the individual; and

c. first aid in the event of accident or illness.

4. An ICF/DD shall have available sufficient, appropriately licensed and qualified nursing staff, which may include licensed practical nurses and other supporting personnel, to carry out the various nursing service activities. The ICF/DD shall verify that all nursing staff has a current Louisiana license upon hire and at least annually.

5. Nursing service personnel at all levels of experience and competence shall be assigned responsibilities in accordance with their qualifications, delegated authority commensurate with their responsibility and provided appropriate professional nursing supervision.

F. Pharmacy Services

1. An ICF/DD shall ensure that pharmacy services are provided under the direction of a qualified licensed pharmacist.

2. There shall be a formal arrangement for qualified pharmacy services, including provisions for emergency service.

3. The pharmacist shall:

a. receive the original, or a direct copy of the physician's drug treatment order;

b. maintain for each individual an individual record of all medications (prescription and nonprescription) dispensed, including quantities and frequency of refills);

c. participate, as appropriate, in the continuing interdisciplinary evaluation of individuals for the purposes of initiation, monitoring, and follow-up of service plans; and

d. establish quality specifications for drug purchases and ensure that they are met.

4. Qualified pharmacy or medical personnel shall:

a. quarterly review the record of each individual on medication for potential adverse reactions, allergies, interactions, contraindications, rationality and laboratory test modifications; and

b. advise the physician of any recommended changes, stating the reasons for such changes and providing an alternate drug regimen.

5. Poisons, drugs used externally and drugs taken internally shall be stored on separate shelves or in separate cabinets at all locations.

6. Medications that are stored in a refrigerator containing things other than drugs shall be kept in a separate compartment with proper security.

7. If there is a drug storeroom, there shall be an inventory of all drugs kept in such storeroom.

8. Discontinued and outdated drugs, and containers with worn, illegible, or missing labels, shall be removed and returned to the pharmacist for proper disposition.

9. There shall be an effective drug recall procedure that can be readily implemented.

10. There shall be a procedure for reporting adverse drugs to the Federal Food and Drug Administration.

11. An ICF/DD shall have written policies and procedures that govern the safe administration and handling of all drugs developed by the responsible pharmacist, physician, nurse and other professional staff, as appropriate to the ICF/DD.

12. An ICF/DD shall have a written policy governing the self-administration of both prescription and nonprescription drugs.

13. The compounding, packaging, labeling and dispensing of drugs, including samples and investigational drugs, shall be done by the pharmacist or under his supervision, with proper controls and records.

14. Each drug shall be identified up to the point of administration.

15. Whenever possible, drugs that require dosage measurement shall be dispensed by the pharmacist in a form ready to administer to the individual.

16. Drugs shall be stored under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation and security.

17. All drugs shall be kept under lock and key except when authorized personnel are in attendance.

18. The security requirements for drugs of Federal and State laws shall be satisfied in storerooms, pharmacies, and living units.

G. Dental Services

1. An ICF/DD shall have an organized system for providing comprehensive diagnostic dental services for all individuals which include a complete extra and intra-oral examination, utilizing all diagnostic aids necessary to properly evaluate the individual's oral condition, within a period of 90 days following admission unless such an examination shall be in the individual's case record.

2. An ICF/DD shall have access to comprehensive dental treatment services for all individuals which include:

a. provision for dental treatment;

b. provision for emergency treatment on a 24-hour, seven-days-a-week basis by a qualified dentist; and

c. a recall system that will assure that each individual is re-examined at specified intervals in accordance with his/her needs, but at least annually.

3. An ICF/DD shall have a dental hygiene program that includes imparting information regarding nutrition and diet control measures to individuals and staff, instruction of individuals and staff in living units in proper oral hygiene methods and instructions of family in the maintenance of proper oral hygiene, where appropriate.

4. Dental progress reports shall be entered in the individual's case record.

5. A copy of the permanent dental record shall be provided to an ICF/DD to which an individual is transferred.

6. There shall be available sufficient, appropriately qualified dental personnel and necessary supporting staff to carry out the dental services programs.

La. Admin. Code tit. 48, § I-8553

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:3195 (December 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2180-2180.5.