Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule describes the goals, eligibility
and discharge criteria, levels of care, and performance indicators for
detoxification programs.
(1)
Goals. Detoxification is the process of withdrawing a person from alcohol,
other drugs or both in a safe, humane, and effective manner. The goals of
detoxification services are to help persons become
(A) Alcohol and drug free in a safe manner
without suffering severe physical consequences of withdrawal. Medical services
shall be provided or arranged, when clinically indicated; and
(B) Involved in continuing treatment. Each
person shall be oriented to treatment resources and recovery concepts and shall
be assisted in making arrangements for continuing treatment.
(2) Screening. Upon initial
contact, a person shall be screened by a trained staff member and assigned to a
level of care based on the signs and symptoms of intoxication, impairment or
withdrawal, as well as factors related to health and safety.
(A) A screening protocol approved by a
physician shall be used to evaluate the person's physical and mental condition
and to guide the level of care decision. The department may require, at its
option, the use of a standardized screening protocol for those services funded
by the department or provided through a service network authorized by the
department.
(B) The assigned level
of care shall have the ability to effectively address the person's physical and
mental condition.
(3)
Eligibility Criteria. In order to be eligible for detoxification services, a
person must present symptoms of intoxication, impairment or withdrawal and also
must require supervision and monitoring of their physical and mental status to
ensure safety. A person qualifies for detoxification services on a residential
basis if one or more of the following additional criteria are met:
(A) Demonstrates a current inability to
minimally care for oneself;
(B)
Lacks a supportive, safe place to go and demonstrates a likelihood of continued
use of alcohol or other drugs if free to do so;
(C) Requires ongoing observation and
monitoring of vital signs due to a prior history of physical complications
associated with withdrawal or the severity of current symptoms of intoxication,
impairment or withdrawal; or
(D)
Presents a likelihood of harm to self or others as a result of intoxication,
impairment or withdrawal.
(4) Certified Levels of Care. A person shall
be assigned to one (1) of the following levels of detoxification service in
accordance with the screening protocol and admission criteria. An agency may
offer and be certified for one (1) or more of the following levels of
detoxification service:
(A) Social Setting
Detoxification. This level of care is offered by trained staff in a residential
setting with services and admission available twenty-four (24) hours per day,
seven (7) days per week.
1. Medical personnel
are not available on site to prescribe, dispense or administer medications or
to diagnosis and treat health problems.
2. A person, who is admitted to social
setting detoxification with medication for an established physical or mental
health condition, may continue to self administer his or her
medication;
(B) Modified
Medical Detoxification. This level of care is offered by medical staff in a
non-hospital setting with services and admission available twenty-four (24)
hours per day, seven (7) days per week.
1.
Routine medical services are provided, and medications are used, when
clinically indicated, to alleviate symptoms of intoxication, impairment or
withdrawal.
2. A registered or
licensed nurse is on duty at all times. Licensed nursing staff receive clinical
supervision by a registered nurse.
3. There is on call at all times a physician
or an advanced practice nurse licensed and authorized to title and practice as
an advanced practice nurse pursuant to section
335.016, RSMo and who
is engaged in a written collaborative practice arrangement as defined by
law.
(C) Medical
Detoxification. This level of care is offered by medical staff in a licensed
hospital with services and admission available twenty-four (24) hours per day,
seven (7) days per week. Emergency and non-emergency medical services are
provided, and medications are used, when clinically indicated, to alleviate
symptoms of impairment or withdrawal.
(5) Safety and Supervision. All
detoxification services shall be provided in a humane manner and shall ensure
the safety and well being of persons served.
(A) There shall be monitoring and assessment
of the person's physical and emotional status during the detoxification
process.
1. Vital signs shall be taken on a
regular basis, with the frequency determined by client need based on a
standardized assessment instrument.
2. Blood alcohol concentration may be
monitored upon admission and thereafter as indicated. Further testing of urine
or blood may be conducted by qualified personnel.
(B) Staff coverage in residential settings
shall ensure the continuous supervision and safety of clients.
1. Two (2) staff members shall be on-site at
all times, and additional staff may be required, as warranted by the size of
the program and the responsibilities and duties of staff members.
2. Staff providing direct supervision and
monitoring of clients shall demonstrate competency in recognizing symptoms of
intoxication, impairment and withdrawal; monitoring vital signs; and
understanding basic principles and resources for substance abuse
treatment.
3. Clients shall be
supervised at all times by a staff member with current certification in first
aid and cardiopulmonary resuscitation.
(6) Continuing Treatment. Detoxification
services shall actively encourage each person to address substance abuse issues
and to make arrangements for continuing treatment. There shall be documentation
of services delivered and arrangements for continuing treatment. A
comprehensive assessment and master treatment plan are not required during
detoxification.
(A) Information and education
shall be given to each person regarding substance abuse issues.
(B) Individual and group sessions shall be
provided, and each person shall be expected to participate in these sessions,
to the extent warranted by their physical and mental status.
(C) Each person shall be encouraged to make
plans for continuing treatment.
1. Staff
shall assist in making referrals and other arrangements, as needed.
2. Any client refusal of treatment services
or referrals shall be documented.
(D) A qualified substance abuse professional
shall be available and involved in providing individual and group sessions and
making arrangements for continuing treatment.
(7) Discharge Criteria. A person shall be
successfully discharged or transferred from the detoxification service when
they are physically and mentally able to function without the supervision,
monitoring and support of this service.
(8) The program handles applications for
civil detention of intoxicated persons in accordance with sections
631.115,
631.120
and
631.125,
RSMo 2000 unless a waiver is granted in writing by the department.
*Original authority: 630.050, RSMo 1980, amended 1993,
1995; 630.655, RSMo 1980; and 631.010, RSMo
1980.
