Current through Reg. 50, No. 187; September 24, 2024
In addition to rule
65D-30.004, F.A.C., the
following standards apply to detoxification.
(1) Detoxification is a process involving
acute or subacute care that is provided on a non-hospital inpatient or an
outpatient basis to assist individuals who meet the placement criteria for this
component to withdraw from the physiological and psychological effects of
substance use.
(2) General
Requirements. Detoxification protocols shall be developed by the medical
director, or in accordance with the medical protocol established in subsection
65D-30.004(6),
F.A.C., and implemented upon admission according to the physiological and
psychological needs of the individual.
(3) Inpatient Detoxification.
(a) Services.
1. Stabilization. Stabilization services
shall be provided as an initial phase of detoxification.
2. Supportive Counseling. Each individual
shall participate in supportive counseling on a daily basis unless the
individual is not sufficiently stable. Supportive counseling sessions shall be
of sufficient duration to enable staff to make reasonable decisions regarding
the individual's need for other services. Services shall be directed toward
ensuring that the individual's most immediate needs are addressed and
encouraging the individual to remain engaged in treatment and to follow up on
referrals after discharge.
3. Daily
Activities. The provider shall develop a schedule of daily activities that will
be provided based on the detoxification protocols as defined in subsection
65D-30.002(27),
F.A.C. This shall include recreational and educational activities, and
participation shall be documented in the clinical record.
4. Involuntary Assessment and Disposition.
Individuals who are involuntarily admitted into a detoxification unit under
protective custody, emergency admission or involuntary assessment and
stabilization pursuant to section
397.6772,
397.6797, or
397.6811, F.S., shall be
assessed and referred as in subsection
65D-30.005(9),
F.A.C.
(b) Observation of
Individuals. Individuals requiring close medical observation, as determined and
documented by medical staff, shall be visible and readily accessible to nursing
staff. Individuals who do not require close medical observation shall be in a
bed area that allows for general nursing observation.
(c) Staff Coverage. Each facility shall have
a physician on call at all times to address medical problems and to provide
emergency medical services. The physician's name, telephone number, and
schedule for this arrangement shall remain current and clearly posted at the
nurse's station. An R.N. shall be the supervisor of all nursing services and
shall be on-call 24 hours per day, 7 days per week. An L.P.N. or R.N. shall be
on-site 24 hours per day, 7 days per week. All staff shall have immediate
access to a nurse supervisor or physician for consultation.
(d) Staffing Requirement and Bed Capacity.
The staffing requirement for nurses and nursing support personnel for each
shift shall be as follows:
|
Licensed Bed Capacity
|
Nurses
|
Nursing Support
|
|
1-15
|
1
|
1
|
|
16-20
|
1
|
2
|
|
21-30
|
2
|
2
|
The number of nurses and nursing support staff shall increase
in the same proportion as the requirement described above. In instances where
an inpatient detoxification component and a licensed crisis stabilization unit
are co-located, the staffing requirement for the combined components shall
conform to the staffing requirement of the component with the more restrictive
requirements.
(4)
Outpatient Detoxification. The following standards apply to outpatient
detoxification.
(a) Eligibility for Services.
Eligibility for outpatient detoxification shall be determined from the
following:
1. The individual's overall
medical condition;
2. The
individual's family or support system, for the purpose of observing the
individual during the detoxification process, and for monitoring compliance
with the medical protocol;
3. The
individual's overall stability and behavioral condition;
4. The individual's ability to understand the
importance of managing withdrawal utilizing medications and to comply with the
medical protocol; and
5. An
assessment of the individual's ability to abstain from the use of substances,
except for the proper use of prescribed medication.
(b) Drug Screening. A drug and alcohol screen
shall be conducted at admission. Thereafter, the program shall require random
drug and alcohol screening for each individual in accordance with the
provider's medical protocol.
(c)
Services.
1. Supportive Counseling. Each
individual shall participate in supportive counseling on a weekly basis.
Counseling sessions shall be of sufficient duration to enable staff to make
decisions regarding the individual's need for other services and to determine
progress.
2. Referral to Inpatient
Detoxification. Providers shall refer individuals to inpatient detoxification
or the appropriate level of care when there is evidence that the individual is
unable to comply with the outpatient protocol.
(d) Staffing Requirement. Staffing for
outpatient detoxification shall minimally consist of the following:
1. A physician, or an A.R.N.P. or a P.A.
working under the supervision of a physician, available and on-call during
operating hours,
2. An R.N., or an
L.P.N. working under the supervision of an R.N., on-site during operating
hours; and,
3. A counselor, on-site
during operating hours.
(e) Training. All direct services staff
working in outpatient detoxification shall be trained in the outpatient
detoxification protocol prior to having contact with the individual in need of
services.
(5) Additional
Requirements for the Use of Methadone in Detoxification. In cases where a
provider uses methadone in the detoxification protocol, the provider shall
comply with the minimum standards found under subsection
65D-30.006(2),
F.A.C., if methadone is provided as part of inpatient detoxification, and
subsection 65D-30.006(3),
F.A.C., if methadone is provided as part of outpatient detoxification. In
either case, methadone may be used short-term (no more than 30 days) or
long-term (no more than 180 days). Short-term detoxification is permitted on an
inpatient and an outpatient basis while long-term detoxification is permitted
on an outpatient basis only. A provider shall not admit an individual in more
than two (2) detoxification episodes in one (1) year. The physician or other
medically qualified professional designee identified in accordance with the
medical protocol established in subsection
65D-30.004(7),
F.A.C., shall assess the individual upon admission to determine the need for
other forms of treatment. Providers shall also comply with the standards found
under subsection 65D-30.014(4),
F.A.C., with the exception of the following conditions:
(a) Take-home methadone is not allowed during
short-term detoxification.
(b)
Individuals involved in long-term detoxification shall have a drug screen
initially and at least monthly thereafter.
(c) Individuals involved in short-term
detoxification shall have at least one (1) initial drug
screen.
(5) Hours of
Operation. Providers shall post their hours of operation and this information
shall be visible to the public.
Rulemaking Authority
397.321(5) FS.
Law Implemented 397.311(26),
397.321,
397.4014,
397.410
FS.
New 5-25-00, Amended 4-3-03,
8-29-19.
