Current through Register Vol. 39, No. 6, September 16, 2024
(a) The general
requirements in this Subchapter shall apply when applicable, but brain injury
long term care units shall meet the supplement requirements in Rules.3004 and
.3005 of this Section. The facility shall provide services through a medically
supervised interdisciplinary process as provided in Rule.2505 of this
Subchapter and that are directed toward maintaining the individual at the
optimal level of physical, cognitive and behavioral functioning. Following are
the minimum requirements for specific services that may be necessary to
maintain the individual at optimum level:
(1)
Overall supervisory responsibility for brain injury long term care services
shall be assigned to a registered nurse with one year experience in caring for
brain injured patients.
(2)
Physical therapy shall be provided by a physical therapist with a current valid
North Carolina license. Occupational therapy shall be provided by an
occupational therapist with a current valid North Carolina License. The
services of a physical therapist and occupational therapist shall be combined
to provide one full-time equivalent position for each 20 patients. The
assistance of a physical therapy aide and occupational therapy aide, with
appropriate supervision, shall be combined to provide one full-time equivalent
position for each 20 patients. A proportionate number of hours shall be
provided for a census less than 20 patients.
(3) Clinical nutrition services shall be
provided by a dietitian with two years clinical training and experience in
nutrition. The number of hours of clinical nutrition services on either a
full-time or part-time employment or contract basis shall be adequate to meet
the needs of the patients. Each patient's nutrition needs shall be reviewed at
least monthly. Clinical nutrition services shall include:
(A) Assessing the appropriateness of the
ordered diet for conformance with each patient's physiological and
pharmacological condition.
(B)
Evaluating each patient's laboratory data in relation to nutritional status and
hydration.
(C) Applying technical
knowledge of feeding tubes, pumps and equipment to each patient's specialized
needs.
(4) Clinical
social work shall be provided by a social worker meeting the requirements of
Rule.2802 of this Subchapter.
(5)
Recreation therapy, when required, shall be provided on either a full-time or
part-time employment or contract basis by a clinician eligible for
certification as a therapeutic recreation specialist by the State of North
Carolina Therapeutic Recreational Certification Board. The number of hours of
therapeutic recreation services shall be adequate to meet the needs of the
patients. In event that a qualified specialist is not locally available,
alternate treatment modalities shall be developed by the occupational therapist
and reviewed by the attending physician. The program designed shall be adequate
to meet the needs of this specialized population and shall be administered in
accordance with Section.3000 of this Subchapter.
(6) Speech therapy, when required, shall be
provided by a clinician with a current valid license in speech pathology issued
by the State Board of Speech and Language Pathologists and
Audiologists.
(7) Respiratory
therapy, when required, shall be provided by an individual meeting the same
qualifications for providing respiratory therapy under Rule.3003 of this
Section.
(b) Each
patient's program shall be governed by an interdisciplinary treatment plan
incorporating and expanding upon the health plan required under Section.2300 of
this Subchapter. The plan is to be initiated on the first day of admission.
Upon completion of baseline data development and an integrated
interdisciplinary assessment, the initial treatment plan is to be expanded and
finalized within 14 days of admission. Through an interdisciplinary process the
treatment plan shall be reviewed at least monthly and revised as appropriate.
In executing the treatment plan, the interdisciplinary team shall be the major
decision making body and shall determine the goals, process, and time frames
for accomplishment of each patient's program. Disciplines to be represented on
the team shall be medicine, nursing, clinical pharmacy and all other
disciplines directly involved in the patient's treatment or treatment
plan.
(c) Each patient's overall
program shall be assigned to an individually designated case manager. The case
manager acts as the coordinator for assigned patients. Any professional staff
member involved in a patient's care may be assigned this responsibility for one
or more patients. Professional staff may divide this responsibility for all
patients on the unit in the best manner to meet all patients' needs for a
coordinated, interdisciplinary approach to care. This case manager shall be
responsible for:
(1) coordinating the
development, implementation and periodic review of the patient's treatment
plan;
(2) preparing a monthly
summary of the patient's progress;
(3) cultivating the patient's participation
in the program;
(4) general
supervision of the patient during the course of treatment;
(5) evaluating appropriateness of the
treatment plan in relation to the attainment of stated goals; and
(6) assuring that discharge decisions and
arrangements for post discharge follow-up are properly made.
(d) For each 20 patients or
fraction thereof, dedicated treatment facilities and equipment shall be
provided as follows:
(1) a combined therapy
space equal to or exceeding 600 square feet, adequately equipped and arranged
to support each of the therapies;
(2) access to one full reclining wheel chair
per patient;
(3) special physical
therapy and occupational therapy equipment for use in fabricating positioning
devices for beds and wheelchairs including splints, casts, cushions, wedges,
and bolsters; and
(4) roll-in bath
facilities with a dressing area available to all patients, providing maximum
privacy to the patient.
Authority
G.S.
131E-104;
RRC objection due to
lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
1996;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. March 22,
2015.
