Current through Rules and Regulations filed through September 23, 2024
Programs offering residential sub-acute detoxification programs must meet the rules listed in this subsection (.18), in addition to the general rules set forth.
(a) The program shall establish and implement written policies and procedures that address how the program manages the medical and detoxification services that it provides. The program shall operate 24 hours a day.
(b) Staffing. Treatment is provided by qualified medical staff and other professionals who are qualified by education, training, experience, and who are licensed/certified if required by state practice acts to perform detoxification services that meet the needs of clients.
1. Medical Staff. The medical staff is headed by a medical director who is licensed to practice medicine in Georgia, and all other medical staff are licensed to practice in Georgia. The medical director must approve all medical policies and procedures, including assessment tools, treatment protocols, and emergency procedures. Such policies and procedures shall include provisions for an effective infection control program.
2. Director of Nursing. A licensed registered nurse determined qualified by education, training, and experience to supervise nursing services for detoxification shall be designated as the Director of Nursing.
3. Medical Coverage.
(i) Physician coverage shall be provided in accordance with the treatment protocol. At a minimum, there shall be on call physician coverage 24 hours a day, and a physician must be on site daily as medically indicated.
(ii) Nursing coverage shall be provided in accordance with clients needs as determined by the number and condition of client population. At a minimum, there shall be one registered or licensed practical nurse awake and on duty on premises 24 hours per day to respond to client needs.
4. Other Medical Services.
(i) Diagnostic Services. Clinical laboratory services and x-ray services shall be provided in accordance with the Department of Community Health's Rules for Licensure of Clinical Laboratories, Chapter 111-8-10, and Rules for X-Ray, Chapter 290-5-22.
(ii) Emergency Medical Services. The program's medical policies and procedures include provisions for the delivery of emergency, medical services, which services are either provided directly or through an established procedure specifying how emergency services will be accessed.
(iii) Pharmaceutical Services. Pharmaceutical services are offered through a licensed pharmacy service in the community or by the program's own licensed pharmacist.
(c) Treatment - Assessment. Admission Assessment of clients shall be performed by a physician, nurse practitioner, physician's assistant, or registered nurse. If an assessment is done by other than a physician, then the assessment must be communicated to physician by telephone prior to the client's admission. The assessment must include:
1. Drug history including past detoxification episodes, and current use of drugs and medications;
2. Causes that triggered the present need for services;
3. Descriptions of medical risks and any behavioral or emotional problems.
4. Taking and documentation of vital signs; and
5. Determination of whether or not a physical and/or psychiatric examination by a physician is needed immediately and arrangements for such examination, if the assessment was done by a registered nurse. If the assessment is done by a physician, nurse practitioner or physician's assistant, it will include a physical examination.
6. Laboratory tests will be ordered as indicated, but at a minimum will include: CBC, RPR, urinalysis (routine and microscopic). TB screening and urine drug screens.
(d) Treatment - Admission. Clients are admitted to treatment by physician's orders only following assessment and determination that the medical, emotional, and behavioral status of the client justifies admission. The initial detoxification care plan must be documented in the record and may be initiated by the order of the physician following admission.
(e) Treatment.
1. Within twenty-four hours of admission, or the next normal business day if admission occurred on a weekend or holiday, the client must be seen by a physician, nurse practitioner, or physician's assistant if the assessment required by rule .13(1)(b) and subparagraph (3) above was done by a registered nurse. If a physical examination is needed, such examination shall be done at that time.
2. Within 48 hours of admission, a complete Detoxification Care Plan shall be developed by a registered nurse, physician's assistant, or physician. If not done by a physician, the development of the plan shall be supervised and signed by a physician. Any changes to the plan must be documented in the plan and reviewed and signed by the physician. The plan shall address the nursing and medical procedures needed to stabilize the client and to manage the withdrawal.
3. In addition to medical management, the program shall provide the client substance abuse counseling and support by staff who are determined qualified by training, education, experience, and who are licensed/certified if required by state practice acts to provide such services. Such services shall be provided to clients as soon as it is determined that they can benefit from such services but no later than within three work days of admission.
4. A discharge summary and aftercare plan, if applicable, shall be completed in accordance with rule .17.
O.C.G.A. §§
26-5-5, 26-5-6.
