Specialized requirements - personnel and policy

(a) Personnel. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 66 September 13, 2019 (1) A physician with training and experience in psychiatry shall be appointed as medical director of the hospital or unit by the governing body based upon a recommendation from the medical staff. The medical director shall coordinate with other services provided by the hospital, and shall be responsible for developing policies concerning treatment and staffing. (2) The diagnosis and treatment rendered to each patient in psychiatric hospitals or units shall be under the direction of a physician or licensed independent practitioner with training and experience in psychiatry. (3) A registered nurse with experience in psychiatric nursing shall be responsible for nursing administration. At least one (1) registered nurse shall be assigned to care and provide active treatment for every fifteen (15) patients on each shift, except that if the unit census exceeds fifteen (15) patients but does not exceed twenty (20) patients during the shift, a licensed practical nurse may be substituted for the second required registered nurse. Licensed practical nurses and/or psychiatric nurse support staff shall be assigned by the registered nurse to support the care provided by the registered nurse and provide necessary active treatment. (4) All personnel working within an area of psychiatric patients shall be trained in psychiatric patient care. (b) Polices and procedures shall be developed and implemented that include at least the following: (1) Seclusion. Patients shall be placed in seclusion only on the written order of the attending physician or licensed independent practitioner. Secluded patients shall be constantly monitored by facility staff while in seclusion. Patient seclusion shall terminate after four (4) hours unless the patient is reevaluated by the attending physician or licensed independent practitioner and a renewal order is received for the seclusion. Patients shall not be continuously secluded for longer than twenty-four (24) hours unless the attending physician or licensed independent practitioner attests in the patient's medical record that seclusion is necessary for the continued treatment of the patient. (2) Restraint. Physical and chemical restraints shall be used in accordance with guidance outlined at OAC 310:667-3-5 and OAC 310:667- 15-8 & 9. All staff providing active treatment or monitoring patients shall be trained in facility methods approved to physically hold or restrain patients before patient care responsibilities are assigned. These staff members shall be reoriented regarding these policies annually or when policies are revised. (3) Accommodations. (A) Patients shall be grouped for accommodations by gender, age, and treatment needs except as provided for at 310:667-33- 2(b)(3)(B). As a minimum, children, adolescent, and adult treatment programs shall be separate with distinct units for each. Nursing staff and support staff shall be assigned to each program and unit to appropriately monitor patients and provide active treatment. Children, adolescents, and adult patient groups shall not be allowed to commingle at anytime. (B) Patients being primarily treated with diagnosis of anorexia nervosa, bulimia nervosa or other unspecified eating disorder OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 67 September 13, 2019 diagnosis, who are separated by gender, and from other non-eating disorder patients, may be grouped for accommodations and treatment with adolescent and adult patients. Such programs shall ensure appropriate monitoring of commingled populations at all times, and shall provide sleeping arrangements with all private rooms, or separate semi-private rooms for adolescent patient(s) and adult patient(s). (4) Procedures. General procedures for the unit shall include at least the following: (A) A description of the scope of each therapeutic service provided and the qualifications of staff providing these services. (B) A description of the process for the appointment of a medical director, who shall be a physician with qualifications as specified in section (a). The medical director shall be appointed by the governing body based upon recommendations made by the medical staff. (C) A description of how staffing for monitoring and active treatment is provided on a twenty-four (24) hour basis. (D) A description of how comprehensive treatment plans for each patient are developed and time-frames allowed for the development of an initial plan. Procedures shall also state how often comprehensive treatment plans are reviewed for possible revisions. (E) If the patient is school age, the policies shall include arrangements to initiate appropriate educational exposure if the patient is to be hospitalized over five (5) days. SUBCHAPTER 35. SPECIALIZED REQUIREMENTS REHABILITATION