Compilation of Rules and Regulations of the State of Georgia
Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH
Chapter 111-8 - HEALTHCARE FACILITY REGULATION
Subject 111-8-22 - END STAGE RENAL DISEASE FACILITIES
Rule 111-8-22-.11 - Patient Care Services
Universal Citation: GA Rules and Regs r 111-8-22-.11
Current through Rules and Regulations filed through September 23, 2024
(1) Nursing Services.
(a) Nursing services shall be provided in accordance with current standards of practice as defined by Georgia law.
(b) The facility shall employ a full-time registered nurse to be the nurse responsible for nursing services, and to supervise the provision of patient care by licensed practical nurses and unlicensed personnel.
(c) A licensed registered nurse shall be present in the treatment area when patient treatments are in progress.
(d) The facility shall ensure the following patient care activities are assigned to and performed by appropriately licensed nurses:
1. Conducting nursing assessments on admission and when indicated by an observed or reported change in the patients' health status;
2. Provision of nursing input for the team review of a patient's progress;
3. Recommending to the team changes in treatment suggested by the patient's needs;
4. Administration of medications, including the introduction of intravenous saline;
5. Initiation and discontinuation of hemodialysis via a central catheter, and manipulation of a central catheter or change of dressing for a central catheter;
6. Administration of blood or blood products;
7. The facilitation of communication between the patient, the patient's family, and other members of the treatment team; and
8. Provision of oversight and supervision for dialysis technician trainees, dialysis technicians, and other unlicensed personnel involved in patient care activities, including the recording of treatment observations and interventions in progress notes, as qualified for such oversight and supervision by the rules contained in this chapter.
(e) Dialysis treatments for pediatric patients under fourteen years of age or under 35 kilograms in weight shall be performed by a licensed registered nurse with experience in pediatric dialysis.
(2) Nutrition Services. The facility shall provide nutrition services to the patients and the patients' families and caregivers, which are designed to maximize the patient's nutritional status. Services shall be provided by a qualified dietitian, as defined by these rules, and shall include at a minimum:
(a) Basic nutritional education must be initiated within two weeks of admission by the nursing or dietary staff. A comprehensive nutritional assessment report with recommendations for patient education will be completed within thirty days of admission and at least annually thereafter;
(b) Participation as a member of the interdisciplinary treatment team in the development of each patient's plan(s) of care and review of that plan;
(c) Availability of a qualified dietitian to provide counseling and assistance to patients during regular treatment times;
(d) Recommendations of therapeutic diets specific to each patient's needs, counseling and training for patients related to the dietary recommendations, and monitoring of nutritional status and adherence to dietary requirements by objective and subjective means, with timely intervention when changes are indicated; and
(e) Regular recording in the patient's medical record of the patient's nutritional status, monitoring data, and progress in meeting nutritional goals.
(3) Social Work Services. The facility shall provide social services which are directed toward supporting and maximizing the patient's social functioning and adjustment to management of end stage renal disease. Services shall be provided by a qualified social worker, as defined by these rules, and shall include at a minimum:
(a) Psychosocial evaluation of each patient, completed within thirty (30) days of admission and at least annually thereafter;
(b) Participation as a member of the interdisciplinary treatment team in the development of each patient's plan(s) of care and review of that plan;
(c) Recommendations regarding changes in treatment which may be indicated by the patient's psychosocial needs;
(d) The provision of case work and group work services to patients and their families in dealing with the problems and complications associated with end stage renal disease and dialysis;
(e) Identification of community service agencies and other support resources, and facilitation of patients' access to those resources;
(f) Provision of access to social work services during times of patient treatment; and
(g) Regular reporting of the patient's contact with the social worker in the patient's medical record.
(4) Laboratory Services. The facility shall provide or arrange for the laboratory services needed for safe and effective patient treatment.
(a) If the facility provides its own laboratory services:
1. The facility shall have current Georgia licensure and federal certification as required for the tests performed, or a waiver for the tests performed if licensure and certification are not required.
2. The facility performing waived tests shall have policies and procedures for obtaining samples, performing tests, and reporting results, which conform to current standards of practice and the manufacturer's specifications.
(b) If the facility receives services from an outside laboratory, such arrangements shall be made by written contract, which shall ensure that the laboratory meets all applicable state and federal licensing and certification requirements for the tests performed, and which ensures the provision of test results in a timely manner.
(5) Administration and Storage of Controlled Substances and Dangerous Drugs.
(a) Controlled substances and dangerous drugs shall be administered to patients only with an order from a licensed physician or from a physician's assistant or nurse practitioner as permitted by Georgia law.
(b) Controlled substances and dangerous drugs shall be administered to patients only by those persons authorized under Georgia law to administer medications. However, trained and competent dialysis technicians are permitted to administer saline via the extracorporeal circuit as provided under Section 111-8-22-.10(3)(g)2.
(c) Medications shall be prepared for administration in a work area that prevents contamination during preparation.
(d) Medications not given immediately shall be labeled with the patient's name, the name of the medication, and the dosage, and the date and time opened, and initialed by the person preparing the medication. All medications shall be administered by the individual who prepares them.
(e) The facility shall establish and implement procedures for limiting access to medications by unauthorized personnel.
(f) Medications requiring refrigeration shall be stored in refrigerators used only for that purpose and stored at appropriate temperatures.
(g) The facility shall regularly inventory controlled substances and dangerous drugs and medication supplies to ensure that outdated supplies are immediately disposed of in an appropriate manner, and that sufficient supplies of usable controlled substances and dangerous drugs are available to meet patient needs.
(h) Controlled substances shall be stored and dispensed in accordance with the provisions of the Georgia Pharmacy Practice Act and the Georgia Controlled Substance Act.
(6) Home Training Services for Hemodialysis or Peritoneal Dialysis.
(a) If the facility provides services for training and support of home dialysis, the facility shall meet the requirements for care plans for those patients, to include interdisciplinary conferences.
(b) In addition to other facility services and support requirements, the facility shall provide for home dialysis patients:
1. A written outline of the home dialysis training program, including didactic and practice components, including the performance of dialysis treatments by patients and/or their assisting partner and the requirements for facility surveillance of the patient's home adaptation and water quality, with the requirement that each patient (and their assisting partner, if applicable), satisfactorily complete the training program before beginning home dialysis;
2. Sufficient teaching materials available for patient use during and after home dialysis training;
3. A program for surveillance of the patient's home adaptation, to include an initial visit in the patient's home and subsequent supervisory visits by a licensed registered nurse, as indicated by the patient's medical status and training needs or at least annually, with documentation of all home visits in the patient's medical record;
4. A procedure for continuous re-evaluation of the suitability of home dialysis for the patient, to include evaluation of the adherence of the patient to physician's orders and policies and procedures of the facility, and the adequacy of the dialysis performed in the home;
5. Provision of supplies for the home sufficient to sustain dialysis treatment;
6. Routine transfer set changes, where applicable, for peritoneal dialysis patients at least every six (6) months and as needed;
7. Installation and maintenance of dialysis equipment in the home, including training for the patient in identifying equipment malfunctions and mechanisms for accessing equipment service; and
8. A system for routine monitoring, culturing, and disinfection of the water in the home of each hemodialysis patient, to ensure that the water quality meets the standards recommended by the Association for the Advancement of Medical Instrumentation (AAMI).
(c) The facility shall provide dialysis services at the facility or arrange for the provision of services at a site mutually agreeable to the facility and the patient for the home dialysis patient on those occasions when the home dialysis patient is unable to perform safe and adequate dialysis in the home.
O.C.G.A. § 31-44-3.
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