Current through Reg. 50, No. 187; September 24, 2024
In addition to Rules
65E-12.104,
65E-12.105, and
65E-12.106, F.A.C., above, these
standards apply to CSU programs.
(1)
Emergency Screening. All persons who apply for admission pursuant to Section
394.4625, F.S., or for whom
involuntary examination is initiated pursuant to Section
394.463, F.S., shall be assessed
by the CSU or by the emergency services unit of the public receiving facility.
Each receiving facility shall provide emergency screening services on a
24-hours-a-day, 7-days-a-week basis and shall have policies and procedures for
identifying individuals at high risk. No person can be detained for more than
12 hours without being admitted or released. Everyone for whom involuntary
examination is initiated pursuant to Section
394.463, F.S., shall receive a
face-to-face examination by a physician or clinical psychologist prior to
release. The examination shall include a psychiatric evaluation, including a
mental status examination, or a psychological status report.
(a) Unit policies and procedures shall be
written concerning the detainment of persons who are awaiting an involuntary
examination and disposition. These procedures shall address protection from
harm, and the prevention of departure from the unit prior to the
examination.
(b) Referral.
Individuals referred, or to be referred, to a receiving facility under Chapter
394, Part I, F.S., who also require treatment for an acute physical condition
shall be delivered and, if appropriate, admitted to an emergency medical or
inpatient service for health care until medically cleared and stabilized to
meet the CSU's medical criteria as prescribed in its policies and procedures.
Medical clearance shall be documented in the clinical record.
(c) Paying Fees. Individuals who can pay for
services and who wish to be admitted to a private hospital facility authorized
to provide services under Chapter 394, Part I, F.S., may be referred without
prior examination by the receiving facility.
(2) Admission.
(a) All persons admitted to a CSU shall be
admitted pursuant to Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C. Each
CSU shall provide admission services on a 24-hours-a-day, 7-days-a-week
basis.
(b) Initial Assessment.
1. Upon admission to the CSU an emotional and
behavioral assessment as specified in subsection (d), below, shall be made
based on facility program policy and procedures. This assessment shall be made
by a mental health professional, registered nurse, or other unit staff under
the supervision of a mental health professional. The consultation of a
physician, psychiatrist, or clinical psychologist shall be available to the CSU
staff for purposes of assisting in this assessment. Examination and disposition
of a person who has been admitted involuntarily shall be in accordance with the
provisions of Section
394.463, F.S.
2. All persons admitted to a CSU shall be
provided a nursing assessment, begun at time of admission and completed within
24 hours, by a registered nurse as part of the assessment
process.
(c) Physical
Examination. All persons admitted to a CSU shall be provided a physical
examination within 24 hours of admission, based on program policies and
procedures. The physical examination shall include a complete medical history
and documentation of significant medical problems. It shall contain specific
descriptive terms and not the phrase, "within normal limits." General findings
shall be written in the clinical records within 24 hours.
(d) Emotional and Behavioral Assessment. For
everyone admitted to a CSU an emotional and behavioral assessment shall be
completed within 72 hours and entered into the clinical record. The assessment
shall be made by a mental health professional or other unit staff under the
supervision of a mental health professional. The assessment shall include the
following.
1. A history of previous emotional,
behavioral, and substance abuse problems and treatment.
2. A social assessment to include a
determination of the need for participation of family members or significant
others in the individual's treatment; the social, peer-group, and environmental
setting from which the person comes; family circumstances; current living
situation; employment history; social, ethnic, cultural factors; and childhood
history.
3. A direct psychiatric
evaluation to be completed by a physician or psychiatrist to include a mental
status examination which includes behavioral descriptions, including symptoms,
not summary conclusions, and concise evaluation of cognitive functioning. A
diagnosis, made by the physician or psychiatrist, shall be recorded in the
clinical record, with a minimum of Axes I, II, and III, from the American
Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Third Edition, Revised, Washington, DC, American Psychiatric Association, 1987,
which is incorporated by reference and may be obtained from the American
Psychiatric Association, 1400 K Street, N.W., Washington, DC
20005.
(e) Laboratory
Work. Laboratory work and other diagnostic procedures deemed necessary shall be
performed as ordered by the physician or psychiatrist.
(3) Medical Care.
(a) The development of medical care policies
and procedures shall be the responsibility of the psychiatrist or physician.
The policies and procedures for medical care shall include the procedures that
may be initiated by a registered nurse in order to alleviate a life threatening
situation. Medication or medical treatment shall be administered upon direct
order from a physician or psychiatrist, and orders for medications and
treatments shall be written and signed by the physician or
psychiatrist.
(b) There shall be no
standing orders for any medication used primarily for the treatment of mental
illness.
(c) Every order given by
telephone shall be received and recorded immediately only by a registered nurse
with the physician's or psychiatrist's name, and signed by the physician or
psychiatrist within 24 hours. Such telephone orders shall include a progress
note that an order was made by telephone, the content of the order,
justification, time and date.
(d)
Physical, medical and nursing care standards shall provide for continuity and
follow-up of acute medical problems.
(4) Service Implementation Plan. A service
implementation plan shall be initiated by the service plan manager with
documented input from the person receiving services and signed by the person
receiving services, the responsible physician, psychiatrist, or a staff member
privileged by policies and procedures within 24 hours of the individual's
admission. The CSU shall develop a service implementation plan that has
objectives and action steps written for the person in behavioral terms. The
objectives shall be related directly to one or more goals in the person's
comprehensive service plan, if there is one. The plan shall be fully developed
within 5 days of admission and must contain short-term treatment objectives
stated in behavioral terms relative to the long-term view and goals in the
comprehensive service plan, if there is one, an aftercare plan, and a
description of the type and frequency of services to be provided in relation to
treatment objectives. A copy of the service implementation plan shall be
provided to the person receiving services and his guardian as provided for by
law.
(5) Required CSU Services.
(a) Each CSU shall provide the following
services on a 24-hour-a-day, 7-days-a-week basis:
1. Emergency reception,
2. Evaluation,
3. Observation,
4. Crisis counseling,
5. Therapeutic activities, including
recreational, educational, and social, whose intent is to involve the
individual in reality-oriented events and interpersonal interactions shall be
provided 3-hours-a-day, 7-days-a-week, with participation and non-participation
documented in the individual's clinical record; and,
6. Referral to other service components of a
mental health agency, a private care facility, or another appropriate care
agency.
(b) Routine
Activities. Basic routine activities for persons admitted to a CSU shall be
delineated in program policies and procedures which shall be available to all
personnel. The daily activities shall be planned to provide a consistent, well
structured, yet flexible, framework for daily living and shall be periodically
reviewed and revised as the needs of individuals or the group change. Basic
daily routine shall be coordinated with special requirements of the service
implementation plan. A schedule of daily activities shall be posted or
otherwise available to all persons receiving services.
(c) Off premises activities by two or more
persons being served are not permitted except in cases as documented in the
individual's clinical record pursuant to subsection
65E-12.106(24),
of this rule.
(d) Continuity of
Care.
1. Discharge Preparation. Prior to
discharge or departure from the CSU, the staff with the consent of the person
receiving services shall work with the individual's support system including
family, friends, employers and case manager, as appropriate, to assure that all
efforts are made to prepare the individual for returning to a less restrictive
setting.
2. Referral Services. All
CSUs shall develop and maintain written referral
agreements.
(e) Referral
to Hospital Inpatient Care. The CSU shall have access to a hospital inpatient
unit to assure that individuals being referred are admitted as soon as
necessary.
(f) Transportation. The
CSU shall provide or have access to transportation to a hospital inpatient unit
on an emergency basis when necessary.
(g) Laboratory and Radiology Services.
1. Requirement. The CSU shall provide or
contract with licensed laboratory and radiology services commensurate with the
needs of the persons receiving services.
a.
Emergency. Provision shall be made for the availability of emergency laboratory
and radiology services 24-hours-a-day, 7-days-a-week, including
holidays.
b. Orders. All laboratory
tests and radiology services shall be ordered by a physician or
psychiatrist.
c. Records. All
laboratory and radiology reports shall be filed in the clinical
record.
d. Specimens. The CSU shall
have written policies and procedures governing the collection, preservation and
transportation of specimens to assure adequate stability of
specimens.
2. Contracts.
When the CSU depends on an outside laboratory or radiology clinic for services,
there shall be a written contract detailing the conditions, procedures and
availability of work performed. The contract shall be reviewed and approved by
the CSU director or administrator.
(6) Space. Each person receiving services
shall be provided a minimum of 175 square feet of usable client space within
the CSU. Bedrooms shall be spacious and attractive, and activity rooms or space
shall be provided.
(7) Locked
Doors. CSU facilities shall be locked to provide reasonable control over access
to and egress from the unit and emergency reception areas. When individuals are
moved to other areas, the pathways shall also be locked or have adequate
control provisions to prevent elopement. Such controlled passageways shall
include access to the emergency reception area, unit proper, off unit doorways,
and recreational areas. All unit door locks shall employ a common key for rapid
access in emergency situations with quick releasing or single-turn
mechanisms.
Rulemaking Authority
394.457(5),
394.879(1), (2)
FS. Law Implemented 394.459(2),
394.463,
394.465,
394.875,
394.879(1)
FS.
New 2-27-86, Amended 7-14-92, Formerly 10E-12.107, Amended
9-1-98.
