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 111-8-37 - RULE AND REGULATIONS FOR HOSPICES
Rule 111-8-37-.15 - Assessment and Plan of Care
Universal Citation: GA Rules and Regs r 111-8-37-.15
Current through Rules and Regulations filed through September 23, 2024
(1) The hospice must designate a hospice care team for each patient admitted by the hospice. The hospice care team must be composed of individuals who provide or supervise the care and services offered by the hospice.
(2) The hospice care team must include at least the following individuals:
(a) A physician;
(b) A registered nurse;
(c) A social worker;
(d) A member of the clergy or other counselors; and
(e) Volunteers.
(3) The appropriate members of the hospice care team must provide a comprehensive assessment, as dictated by the identified needs of the patient, no later than five days after admission that includes at least medical, nursing, psychosocial, and spiritual evaluations of the patient, as well as the capability of the family unit in meeting the care needs of the patient and the need for bereavement services.
(a) The assessment must be designed to trigger identification of any referral needed by the patient for additional services, including at a minimum:
1.Professional counseling;
2.Spiritual counseling by a member of the clergy or other counselor;
3.Bereavement services;
4.Dietitian services; and
5.Other therapeutic services, as needed.
(b) If additional services are identified for a terminally ill patient, the hospice must ensure that those services are provided by qualified individuals who must be added to the patient's hospice care team. Such qualified individuals include, but are not limited to:
1.Other appropriately licensed counselors, as applicable to the patient's needs; and
2.Volunteers who provide services for the patient.
(4) Based on the results of the assessment of the patient, the hospice care team must:
(a) Establish the plan of care; and
(b) Provide and supervise hospice care and services in accordance with accepted standards of care and the plan of care.
(5) The hospice care team must establish and maintain a written plan of care for each patient prior to providing care.
(a) The plan of care must be developed with the input of the patient, the patient's family unit if designated by the patient, the patient's caregivers where the patient resides in a licensed facility, and the patient's representative, if any.
(b) The plan of care must detail the scope and frequency of services to be provided to meet the needs of the patient and the patient's family unit.
(c) The hospice care team must meet as a group to review each terminally ill patient's plan of care. The plan of care must be reviewed and updated as the patient's condition changes and as additional service needs are identified. The plan of care for terminally ill patients must be reviewed and updated at intervals of no more than 15 days. All reviews and updates shall be documented in the patient's medical record. Plans of care for patients receiving palliative care who have not been determined to be terminally ill will be reviewed and updated as the patient's condition changes or the patient requests additional services.
(d) Documentation of plan of care review for the terminally ill patient must include a record of those participating and must also include evidence of the attending physician's opportunity to review and approve of any revised plans of care. In the absence of the attending physician's written approval of the revised plan of care, the revised plan of care must have the written approval of the medical director.
(6) The hospice care team must ensure that the patient receives treatment free from restraints, unless use of such restraints has been determined by a physician to be necessary for a temporary period to protect the patient from injury.
(a) Prior to using any restraint with a patient, the hospice care team must attempt less restrictive measures to accomplish the patient's treatment while affording the patient the maximum amount of personal freedom possible. The hospice must document the attempts at use of such less restrictive measures in the patient's medical record.
(b) If it is determined that restraints are necessary to prevent patient injury:
1.The hospice must obtain and document consent, specific to the type of restraint proposed, from the patient and/or the patient's representative for use of the restraint and such consent shall be obtained prior to the use of the restraint;
2.There must be a physician's order for the restraint, specifying the type of restraint to be used and the circumstances under which the restraint is to be applied, which is subject to the following conditions:
(a) The physicians order must be time limited; and
(ii) The order for the restraint must be re-evaluated prior to subsequent orders for the restraint;
3.The plan of care for the patient must include the plan and standard of care for use of the restraint, including the type and frequency of monitoring of the patient when the restraint is used. The plan must include maximum duration for each restraint application, with mandatory release at least every two hours, and a requirement that time, date, and duration of each restraint application are recorded and documented;
4.The plan of care must include procedures to ensure that the patient's comfort and safety needs are addressed during any period of restraint use;
5.The hospice must ensure safe and proper application and monitoring of the use of the restraint by adequately training staff and evaluating competency of each staff member treating patients in the use of the restraint and by directly observing staff performance with patients; and
6.The hospice staff must provide training to other patient caregivers in safe and proper use and monitoring of the restraint. Such training must be documented in the patient's medical record.
(c) A positioning or securing device utilized during medical treatment procedures to temporarily maintain the patient's position or immobilize the patient will not be considered a restraint, provided such necessity is documented in the patient's plan of care and the physician orders it. Such devices must only be applied by trained nursing or medical personnel and the plan of care must require monitoring sufficient to ensure the patient's safety.
O.C.G.A. §§ 31-7-170et seq.
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