| (a) Patient plan of care.
(1) A facility shall develop, implement, and enforce
policies and procedures on the patient's plan of care process which
specifies the services necessary to address the patient's comorbid
conditions and other needs based on the patient's interdisciplinary
assessment. The patient services are coordinated using an interdisciplinary
team approach. The interdisciplinary team shall consist of the patient,
the patient's primary dialysis physician, registered nurse, social
worker, and dietitian.
(2) The interdisciplinary team shall engage in an interactive
conference in order to develop a written, individualized, comprehensive
patient plan of care that specifies the services necessary to address
the patient's medical, psychological, social, and functional needs,
and includes treatment goals.
(3) The plan of care shall include measurable and expected
outcomes and estimated timetables to achieve these outcomes. The plan
of care shall include, but not be limited to, the patient's current
dose of dialysis, dialysis adequacy, other medical comorbidity issues,
nutritional status, mineral metabolism, anemia, vascular access, psychosocial
status, modality, transplantation status, rehabilitation status, patient's
goals, and patient education and training.
(4) The patient plan of care shall include evidence
of coordination with other service providers (e.g., hospitals, long
term care facilities, home and community support services agencies,
or transportation providers) as needed to assure the provision of
continuity of safe care.
(5) The patient plan of care shall include evidence
of the patient's (or patient's legal representative's) input and participation,
unless they refuse to participate. At a minimum, the patient plan
of care shall demonstrate that the content was discussed with the
patient or the patient's legal representative by a member of the interdisciplinary
team.
(6) The patient plan of care shall be developed and
implemented within 30 calendar days or 13 outpatient dialysis treatments
from the patient's admission to the facility. The plan of care shall
be revised due to the patient's lack of progress towards the goals
of the plan of care, marked deterioration in health status, significant
changes in the patient's psychosocial needs, or changes in the patient's
nutritional condition, as needed but no less than annually after the
date of the patient's last plan of care.
(7) The facility shall monitor the plan of care at
least monthly to recognize and address any deviations from the plan
of care as follows:
(A) implement changes in interventions due to the lack
of progress toward the goals of the plan of care;
(B) document as to the reasons why the patient was
unable to achieve the goals; and
(C) implement changes to address the revised plan of
care.
(8) An interdisciplinary team conference may be conducted
via phone conferencing. A phone plan of care conference conducted
with the interdisciplinary team and the patient (or their legal representative)
shall be documented as a phone conference.
(9) In the case of disruptive patients or family members
or patients who do not conform to the treatment plan, the facility
shall develop, implement, and enforce a process for more intensive
interdisciplinary team intervention with this patient to include assessment
of needs and planned interventions to assist the patient in adjusting
to the requirements for safe care.
(b) Emergency preparedness.
(1) In this subsection, unless the context clearly
indicates otherwise, "emergency" means an incident likely to threaten
the health, welfare, or safety of a facility's patients, facility
staff, or the public, including a fire, equipment failure, power outage,
flood, interruption in utility service, medical emergency, or natural
or other disaster.
(2) In accordance with Texas Health and Safety Code §251.016,
a facility shall implement a written emergency preparedness and contingency
operations plan that describes staff and patient actions to manage
potential medical and nonmedical emergencies, including fire, equipment
failure, power outages, medical emergencies, and natural or other
disasters which are likely to threaten the health, welfare, or safety
of facility patients, the staff, or the public. The plan shall comply
with the following requirements.
(A) The facility shall update the plan at least annually.
(B) The facility's leadership shall approve the plan
each time the facility updates the plan.
(C) The plan shall include:
(i) procedures for notifying each of the following
entities, as soon as practicable, regarding the closure or reduction
in hours of operation of the facility due to an emergency:
(I) the Texas Health and Human Services Commission
(HHSC);
(II) each hospital with which the facility has a transfer
agreement in accordance with paragraph (10) of this subsection;
(III) the trauma service area regional advisory council
that serves the geographic area in which the facility is located;
and
(IV) each applicable local emergency management agency;
(ii) a documented patient communications plan that
includes procedures for notifying a patient when that patient's scheduled
dialysis treatment is interrupted;
(iii) a continuity of care plan for the provision of
dialysis treatment to facility patients during an emergency that meets
the requirements under paragraph (4) of this subsection; and
(iv) a disaster preparedness plan for natural and other
disasters that:
(I) is specific to the facility based on an assessment
of the probability and type of disaster in the region and the local
resources available to the facility;
(II) incorporates the use of the HHSC-approved reporting
system and participation in the ESRD Network of Texas disaster preparedness
activities;
(III) includes procedures designed to minimize harm
to patients and staff along with ensuring safe facility operations;
(IV) along with in-service programs for patients and
staff, includes provisions or procedures for responsibility of direction
and control, communications, alerting and warning systems, evacuation,
and closure;
(V) requires each staff member employed by or under
contract with the facility to be able to demonstrate their role or
responsibility to implement the facility's disaster preparedness plan.
(VI) designates a person in each facility to monitor
and coordinate disaster preparedness activities;
(VII) maintains in each facility documentation of the
monitoring and coordination of disaster preparedness activities; and
(VIII) addresses the continuity of essential building
systems, including emergency power and water, or a contract with another
licensed ESRD facility to provide emergency contingency care to patients
to meet the requirements of §117.91(h) of this chapter (relating
to Fire Prevention, Protection, and Emergency Contingency Plan); and
(D) except as provided by paragraph (3) of this subsection,
requires a facility to execute a contract with another ESRD facility
located within a 100-mile radius of the facility stipulating that
the other ESRD facility will provide dialysis treatment to facility
patients who are unable to receive scheduled dialysis treatment due
to the facility's closure or reduction in hours.
(3) A facility is not required to contract with another
ESRD facility under paragraph (2)(D) of this subsection if:
(A) no other ESRD facility is located within a 100-mile
radius of the facility; and
(B) the facility obtains written approval from HHSC
exempting the facility from that requirement.
(4) A facility shall develop a continuity of care plan
for the provision of dialysis treatment to facility patients during
an emergency that:
(A) includes procedures for distributing written materials
to facility patients that specifically describe the facility's emergency
preparedness and contingency operations plan;
(B) includes detailed procedures on the facility's
continency plans, based on the facility's patient population, including
transportation options, for patients to access dialysis treatment
at each ESRD facility with which the facility has an agreement or
made advance preparations to ensure that the facility's patients have
the option to receive dialysis treatment and procedures for notifying
a patient when that patient's scheduled dialysis treatment is interrupted;
(C) is approved by the facility's leadership; and
(D) is provided by the facility to each patient before
providing or scheduling dialysis treatment.
(5) On request, a facility shall provide the facility's
emergency preparedness and contingency operations plan adopted under
paragraph (2) of this subsection to:
(A) HHSC;
Cont'd... |
