Current through April 3, 2024
(1) All personnel
providing professional support services shall assure that their efforts
effectively complement other services provided to the consumer, are
functionally integrated into the individual daily routine and support the
outcome outlined in the individual support plan. A written report of progress
shall be provided to the consumer's support coordinator/case manager monthly. A
written summary report for each consumer shall be sent to the attending
physician at least annually.
(2)
Plan of Care.
(a) The written plan of care,
developed in consultation with the agency staff, shall cover all pertinent
diagnoses, including mental status, types of services and equipment required,
frequency of services, prognosis, rehabilitation potential, functional
limitations, activities permitted, nutritional requirements, medications and
treatments, any safety measures to protect against injury, instructions for
timely discharge or referral, and any other appropriate items. If a physician
refers a consumer under a plan of care which cannot be completed until after an
evaluation visit, the physician shall be consulted to approve additions or
modifications to the original plan. Orders for professional support services
shall include the specific treatment or modalities to be used and their amount,
frequency and duration. The therapist and other agency personnel shall
participate in developing the plan of care.
(b) The plan(s) of care for acute or episodic
illness shall be reviewed by the attending physician and agency personnel
involved in the consumer's care as often as the severity of the consumer's
condition requires, but at least annually. Plans of care resulting from
Comprehensive Nursing Assessment will be reviewed in accordance with the
physical status review schedule. Evidence of review by the physician must
include the physician's signature and date of the review on the plan of care. A
facsimile of the physician's signature is acceptable. Professional staff shall
promptly alert the physician to any changes that suggest a need to alter the
plan of care.
(3) Drugs
and treatments shall be administered by appropriately licensed agency
personnel, acting within the scope of their licenses. Orders for drugs and
treatments shall be signed and dated by the physician.
(4) Skilled Nursing Services.
(a) When skilled nursing is provided, the
services shall be provided by or under the supervision of a registered nurse
who has no current disciplinary action against his/her license, in accordance
with the plan of care. This person shall be available at all times during
operating hours and participate in all activities relevant to the professional
support services provided, including the development of qualifications and
assignment of personnel.
(b) The
registered nurse's duties shall include but are not limited to the following:
make the initial evaluation visit, except in those circumstances where the
physician has ordered therapy services as the only skilled service; regularly
evaluate the consumer's nursing needs; initiate the plan of care and necessary
revisions; provide those services requiring substantial specialized nursing
skill; initiate appropriate preventive and rehabilitative nursing procedures;
prepare clinical and progress notes; coordinate services; inform the physician
and other personnel of changes in the consumer's condition and needs; counsel
the consumer and family in meeting nursing and related needs; participate in
in-service programs; supervise and teach other nursing personnel. The
registered nurse or appropriate agency staff shall initially and periodically
evaluate drug interactions, duplicative drug therapy and non-compliance to drug
therapy.
(c) The licensed practical
nurse shall provide services in accordance with agency policies, which may
include but are not limited to the following: prepare clinical and progress
notes; assist the physician and/or registered nurse in performing specialized
procedures; prepare equipment and materials for treatments; observe aseptic
technique as required; and assist the consumer in learning appropriate
self-care techniques.
(5)
Therapy Services.
(a) All therapy services
offered by the agency directly or under arrangement shall be planned,
delegated, supervised or provided by a qualified therapist in accordance with
the plan of care. A qualified therapist assistant may provide therapy services
under the supervision of a qualified therapist in accordance with the plan of
care. The therapist shall assist the physician in evaluating the level of
function, helping develop the plan of care (revising as necessary), preparing
clinical and progress notes, advising and consulting with the family and other
agency personnel, and participating in in-service programs.
(b) Speech therapy services shall be provided
only by or under supervision of a qualified speech language pathologist in good
standing, or by a person qualified as a Clinical Fellow subject to Tennessee
Board of Communications Disorders and Sciences Rule
1370-01-.10.
(6) Performance Improvement.
(a) An agency shall have a committee or
mechanism in place to review, at least annually, past and present professional
support services including contract services, in accordance with a written
plan, to determine their appropriateness and effectiveness and to ascertain
that professional policies are followed in providing these services.
(b) The objectives of the review committee
shall be:
1. To assist the agency in using its
personnel and facilities to meet individual and community needs;
2. To identify and correct deficiencies which
undermine quality of care and lead to waste of agency and personnel
resources;
3. To help the agency
make critical judgments regarding the quality and quantity of its services
through self-examination;
4. To
provide opportunities to evaluate the effectiveness of agency policies and when
necessary make recommendations to the administration as to controls or changes
needed to assure high standards of consumer care;
5. To augment in-service staff education,
when applicable;
6. To provide data
needed to satisfy state licensure and certification requirements;
7. To establish criteria to measure the
effectiveness and efficiency of the professional support services provided to
consumers; and
8. To develop a
record review system for the agency to evaluate the necessity or
appropriateness of the professional support services provided and their
effectiveness and efficiency.
(7) Infection Control.
(a) There must be an active performance
improvement program for developing guidelines, policies, procedures and
techniques for the prevention, control and investigation of infections and
communicable diseases.
(b) Formal
provisions must be developed to educate and orient all appropriate personnel
and/or family members in the practice of aseptic techniques such as handwashing
and scrubbing practices, proper hygiene, use of personal protective equipment,
dressing care techniques, disinfecting and sterilizing techniques, and the
handling and storage of consumer care equipment and supplies.
(c) A Home Care Organization Providing
Professional Support Services shall have an annual influenza vaccination
program which shall include at least:
1. The
offer of influenza vaccination to all staff and independent practitioners at no
cost to the person or acceptance of documented evidence of vaccination from
another vaccine source or facility. The Home Care Organization Providing
Professional Support Services will encourage all staff and independent
practitioners to obtain an influenza vaccination;
2. A signed declination statement on record
from all who refuse the influenza vaccination for reasons other than medical
contraindications (a sample form is available at
https://www.tn.gov/content/dam/tn/health/documents/SampleIndividualFluForm.pdf);
3. Education of all employees about the
following:
(i) Flu vaccination,
(ii) Non-vaccine control measures,
and
(iii) The diagnosis,
transmission, and potential impact of influenza;
4. An annual evaluation of the influenza
vaccination program and reasons for nonparticipation; and
5. A statement that the requirements to
complete vaccinations or declination statements shall be suspended by the
administrator in the event of a vaccine shortage as declared by the
Commissioner or the Commissioner's designee.
(d) Continuing education shall be provided
for all agency consumer care providers on the cause, effect, transmission,
prevention and elimination of infections, as evidenced by the ability to
verbalize/or demonstrate an understanding of basic techniques.
(e) The agency shall develop policies and
procedures for testing a consumer's blood for the presence of the hepatitis B
virus and the HIV (AIDS) virus in the event that an employee of the agency, a
student studying at the agency or other health care provider rendering services
at the agency is exposed to a consumer's blood or other body fluid. The testing
shall be performed at no charge to the consumer, and the test results shall be
confidential.
(f) The agency and
its employees shall adopt and utilize standard precautions (per CDC) for
preventing transmission of infections, HIV and communicable diseases.
(g) Precautions shall be taken to prevent the
contamination of sterile and clean supplies by soiled supplies. Sterile
supplies shall be packaged and stored in a manner that protects the sterility
of the contents.
(8)
Medical Records.
(a) A medical record
containing past and current findings in accordance with accepted professional
standards shall be maintained for every consumer receiving professional support
services. In addition to the plan of care, the record shall contain:
appropriate identifying information; name of physician; all medications and
treatments; signed and dated clinical notes. Clinical notes shall be written
the day on which service is rendered and incorporated no less often than
weekly; copies of summary reports shall be sent to the physician; and a
discharge summary shall be dated and signed within 7 days of
discharge.
(b) All medical records,
either in written, electronic, graphic or other acceptable form, must be
retained in their original or legally reproduced form for a minimum period of
at least ten (10) years after which such records may be destroyed. However, in
cases of consumers under mental disability or minority, their complete agency
records shall be retained for the period of minority or known mental
disability, plus one (1) year, or ten (10) years following the discharge of the
consumer, whichever is longer. Records destruction shall be accomplished by
burning, shredding or other effective method in keeping with the confidential
nature of the contents. The destruction of records must be made in the ordinary
course of business, must be documented and in accordance with the agency's
policies and procedures, and no record may be destroyed on an individual
basis.
(c) Even if the agency
discontinues operations, records shall be maintained as mandated by this
chapter and the Tennessee Medical Records Act (T.C.A. §§
68-11-308). If a consumer is
transferred to another health care facility or agency, a copy of the record or
an abstract shall accompany the consumer when the agency is directly involved
in the transfer.
(d) Medical
records information shall be safeguarded against loss or unauthorized use.
Written procedures shall govern use and removal of records and conditions for
release of information. The consumer's written consent shall be required for
release of information when the release is not otherwise authorized by
law.
(e) For purposes of this rule,
the requirements for signature or countersignature by a physician or other
person responsible for signing, countersigning or authenticating an entry may
be satisfied by the electronic entry by such person of a unique code assigned
exclusively to him or her, or by entry of other unique electronic or mechanical
symbols, provided that such person has adopted same as his or her signature in
accordance with established protocol or rules.
Authority: T.C.A. §§
4-5-202,
4-5-204,
68-11-202, 68-11-206, 68-11-209,
and 68-11-304.