Rule 111-8-40-.37 - Psychiatric and Substance Abuse Services(1) If the hospital provides psychiatric and/or substance abuse treatment services as an organized service, the scope of those services, including whether the services are provided for inpatients, outpatients, or both, shall be defined in the hospital's application for permit and meet the requirements set forth in this section and generally accepted standards of care.(2)Organization and Administration of Psychiatric and Substance Abuse Services. The hospital shall have a plan for the service which clearly defines lines of authority, responsibility, and accountability and which includes provision for adequate staffing to provide patient care according to generally accepted standards of practice. (a)Director of Psychiatric and Substance Abuse Services. The director of psychiatric and substance abuse services shall be a licensed physician member of the medical staff appropriately trained and qualified to supervise the provision of these services.1. If the hospital offers substance abuse services only, the director shall be a licensed physician member of the medical staff certified or eligible for certification in addiction medicine by the American Society of Addiction Medicine or the American Osteopathic Academy of Addiction Medicine or a licensed physician member of the medical staff appropriately trained and qualified to supervise the service. If the director of the substance abuse services meets this certification requirement but is not board certified in psychiatry, the hospital must have a board eligible or board certified psychiatrist on staff to be utilized for psychiatric consultation as needed.2. The director of the psychiatric and/or substance abuse services shall be responsible for all clinical aspects of the organization and delivery of services and for the evaluation of the effectiveness of the services in coordination with the hospital's quality management program.(b)Staffing for Psychiatric and Substance Abuse Services. The hospital shall provide sufficient clinical and support staff to assess and address the needs of psychiatric and substance abuse patients and to ensure the maintenance of a safe therapeutic environment for patients and staff. 1.Nursing Manager/Director. The nursing care for the psychiatric and/or substance abuse services shall be supervised by a licensed registered nurse with at least three (3) years of clinical psychiatric and/or substance abuse experience. Authorization from the Georgia Board of Nursing to practice as a Clinical Nurse Specialist, Psychiatric/Mental Health may substitute for two (2) years of the required clinical experience.2.Counseling Services. Counseling services for the psychiatric and substance abuse services shall be supervised by a master's level clinician licensed in social work, marriage and family therapy, professional counseling, or a clinical nurse specialist, psychiatric mental health.3.Clinical Psychologist. A licensed clinical psychologist shall be available to provide testing and treatment consultation for patients as needed.4.Child Psychiatrist. If psychiatric services are provided for children, a board eligible or board certified child psychiatrist shall be on staff.5.Special Staffing Requirements for Inpatient Psychiatric or Substance Abuse Services. Hospitals providing inpatient psychiatric and/or substance abuse care shall provide: (i) A physician, with training and qualifications appropriate to the services offered, present in the hospital or available on call on a twenty-four (24) hour basis;(ii) At least one registered nurse on duty at all times; and(iii) Rehabilitative and therapeutic activity staff, trained and qualified to meet the needs of the patients as specified in the patients' individualized service plans.(c)Policies and Procedures for Psychiatric and Substance Abuse Services. In addition to hospital policies and procedures otherwise required by these rules, the hospital providing psychiatric and/or substance abuse services shall develop and implement policies and procedures that address the special needs of the population served, to include at least:1. Admission and discharge criteria and procedures, which comply with Georgia laws concerning involuntary admissions or treatment;2. Safety and security precautions for the prevention of suicide, assault, and patient injury;3. The handling of medical emergencies, including but not limited to suicide attempts, cardiac arrest, aspiration, or seizures;4. Special procedures, such as electro convulsive therapy (ECT) and medical detoxification, as applicable; and5. Procedures for the use of seclusion and restraint in accordance with O.C.G.A. Chapters 3 and 7 of Title 37 and these rules.(3)Patient's Rights in Psychiatric and Substance Abuse Services.(a) In addition to the rights afforded all patients at the hospital, the hospital shall ensure that patients served by the psychiatric and substance abuse services shall have the right to:1. Receive treatment in the hospital using the least restrictive methods possible; and2. Participate to the extent possible in the development, implementation, and review of their individualized service plan.(b) Any permissible restriction of patient rights by the hospital program shall be imposed only in order to protect the health and safety of the patient or others and shall be temporary. The nature, extent, and reason for the restriction shall be entered into the patient's medical record as a written order by a physician or licensed psychologist and reviewed for necessity as required by state law.(4) Patient Assessment and Treatment.(a) In addition to other assessment and treatment procedures otherwise required by these rules, psychiatric and substance abuse service programs at the hospital shall provide:1. For inpatients: (i) With the admission assessments performed within twenty-four (24) hours of admission, a psychiatric or substance abuse evaluation as indicated by the reason for admission; and(ii) An individualized service plan, initiated within the first twelve (12) hours after admission and updated as needs are identified through assessments;2. For outpatients: (i) Within seven (7) days following the initiation of outpatient services, a complete assessment of patient needs, including an evaluation sufficient to identify significant medical conditions which may impact the course of treatment; and(ii) Within ten (10) days following initiation of outpatient services, an individualized service plan developed and implemented to address needs identified;3. Each patient's individualized service plan shall be developed from the patient's needs as identified through psychological, medical, and social assessment and shall be an organized statement of the proposed treatment process which serves to guide the providers and patient through the duration of the service provision. The service plan shall reflect the following:(i) The patient's participation, to the extent possible, in the development of the individualized service plan;(ii) Measurable goals and/or objectives to be met toward the established discharge criteria; and(iii) Regular review of the patient's progress toward goals and/or objectives in the individualized service plan, with modifications to the plan made in response to progress or lack of progress as reflected in progress notes recorded at each visit which document the patient's status and response to treatment;4. At the time of development of the patient's treatment plan and with the participation of the patient, a discharge plan shall be developed for each inpatient or an aftercare plan for each outpatient. The discharge/aftercare plan shall be re-evaluated periodically during treatment to identify any need for revision; and5. All medications administered or prescribed for psychiatric or substance abuse patients shall be solely for the purpose of providing effective treatment or habilitation as described in the individualized service plan and/or for protecting the safety of the patient or others and shall not be used for punishment or for the convenience of staff.(b) If the hospital is not able to meet the patient needs as identified, including any acute medical or surgical needs, the hospital shall assist the patient in locating and accessing services to meet those needs, which may include transfer to another facility.(5)Physical Space and Design Requirements for Inpatient Psychiatric and Substance Abuse Services.Hospitals providing inpatient psychiatric and substance abuse services shall have:
(a) At least one seclusion area must be available to be used for the involuntary confinement of patients when necessary. The seclusion area shall be large enough to provide access to the patient from all sides of the bed or mattress and to accommodate emergency life-sustaining equipment, have a door that opens outward, and have provision for direct patient observations at all times by staff;(b) A design conforming to the suicide prevention recommendations from the Guidelines for Design and Construction of Hospital and Healthcare Facilities, produced by the American Institute of Architects' Academy of Architecture for Health with the assistance of the U.S. Department of Health and Human Services, which is hereby adopted by reference;(c) A day room that allows for social interaction, dining, and group therapy activities;(d) Space for storage of patient's personal belongings and for securing valuables;(e) A system for summoning help from within the immediate service area or other areas of the hospital in the event of an emergency.Ga. Comp. R. & Regs. R. 111-8-40-.37
O.C.G.A. § 31-7-2.1.
Original Rule entitled "Psychiatric and Substance Abuse Services" adopted. F. Feb. 20, 2013; eff. Mar. 12, 2013.