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CODE OF MARYLAND REGULATIONS
TITLE 10. DEPARTMENT OF HEALTH AND MENTAL HYGIENE
SUBTITLE 47. ALCOHOL AND DRUG ABUSE ADMINISTRATION
CHAPTER 01. REQUIREMENTS
Date:
08/31/2009
Document:
.27 Non-Hospital Detoxification Program.
A. Scope of Service. The non-hospital detoxification program shall provide 24 hour supervised medical care under the direction of a physician in a suitably equipped residential setting. Services will be designed for the diagnosis or treatment of alcohol abuse and alcohol problems. The non-hospital detoxification program shall provide, directly or indirectly, appropriate services to meet the physical, social and emotional needs of the acutely intoxicated client. The primary focus of the program shall be to systematically reduce the amount of alcohol and other toxic agents in the client's body, manage withdrawal symptoms, and to refer the client to on-going treatment for his or her alcoholism or dependency. Non-hospital detoxification programs provide short term services generally of 3 to 7 days duration. In order to be eligible for this form of service, clients shall be ambulatory or otherwise able to participate in programmatic activities and may not be in need of hospital or acute nursing care.
B. Plan for Service.
(1) The program shall have a written plan for services describing both the program's treatment philosophy and objectives. The plan shall include the following components:
(a) A statement describing and justifying the primary diagnostic and treatment modalities used within the program;
(b) A statement of organizational objectives consistent with the program's philosophy;
(c) A description of the criteria used to measure progress toward attainment of the program's objectives;
(d) A description of alternative resources which may be used to provide diagnostic, treatment or support services that the non-hospital detoxification program does not provide directly; and
(e) A description of the discharge planning procedures used to insure continuity of care for clients who are referred to alternative treatment programs.
(2) The program shall have a written plan describing its organization which shall include a description of:
(a) The interrelationship of the non-hospital detoxification program and any other services provided by the facility;
(b) An organizational chart showing the relationship between and the function of all program staff and administrators; and
(c) A written rationale for the proposed program staffing.
(3) The program shall maintain documentation demonstrating that the program's governing authority, executive director, clinical and administrative staff have annually updated and approved the program's plan for service and organizational plan.
(4) The program shall maintain documentation verifying that each administrative and clinical staff member of the non-hospital detoxification program has reviewed a copy of the plan for service as part of their orientation process.
C. Minimum Physical Facility Requirements.
(1) The non-hospital detoxification program may be a self-contained unit or a separate area of an intermediate care facility. It shall have sufficient space to adequately house those clients who are recuperating and shall be equipped to handle those suffering from withdrawal symptoms.
(2) Useable Space Required. The interior of the facility shall include nurse's stations, dining rooms, bathrooms, dormitories or wards, and space for privacy for visits, leisure time activities, and office. Each program shall provide at least 25 square feet of useable floor space per resident. Useable floor space may not include closets, stairways, entrance ways, and bedroom space. The program shall be designed, located, constructed and equipped to promote the effective operation of its programs and to protect the health and safety of its clientele, staff, and equipment. The premises shall be kept in a clean and sanitary condition.
(3) Bedrooms. The following minimal requirements shall be met:
(a) More than 6 residents may not share a bedroom. There shall be a minimum distance of 3 feet between the beds.
(b) The furniture in the room shall be well arranged. Beds may not be located within 18 inches of radiators, registers, or sources of drafts.
(c) A room which opens into the kitchen may not be used as a resident's bedroom.
(d) A room may not be used as a resident's bedroom which necessitates passing through a kitchen to reach the bathroom or living room.
(e) All occupants of any bedroom shall be of the same sex, except in the case of a bedroom used solely by a husband and wife.
(f) Each resident shall be provided with his own bed which shall be at least 36 inches wide, be substantially constructed and in good repair. Rollaway type beds, cots, or folding beds may not be used.
(g) Each bed shall be provided with satisfactory type springs in good repair, and a clean, comfortable mattress which is comparable in size to the bed.
(h) Each resident shall be provided with at least two dresser drawers and an enclosed space for hanging his clothes.
(i) The program shall provide a method for safely storing resident's valuables. This may be accomplished by providing a lock on at least one dresser drawer or by providing other safekeeping facilities.
(j) Each bedroom shall have a wall mirror and window shades or drapes which are in good repair.
(4) Living Room. At least one comfortably furnished living room shall be available for the use of residents. The living room may not be used as a bedroom. The living room shall:
(a) Be well lighted and ventilated, and easily accessible to all residents.
(b) Have sufficient windows to provide adequate ventilation and lighting or be an interior room with air conditioning. Additional interior rooms may be used for television, crafts, or similar recreation.
(c) Be so located that the room does not serve as an entrance vestibule from the out-of-doors or as a passageway into or out of the facility.
(d) Each living room for residents' use shall be provided with a sufficient number of reading lamps, tables, and comfortable chairs or settees in good repair.
(5) Supplies. The minimum supply of linen and bedding in good condition to be provided for the residents shall be:
(a) Sheets, 2 sets per bed;
(b) Pillow cases, 2 per bed;
(c) Bed blankets, 2 per bed;
(d) Bed spreads, 2 per bed;
(e) Wash cloths and hand towels, 2 per bed;
(f) Bath towels, 2 per bed; and
(g) Pillows, 1 per bed.
(6) Dining Room. A well-lighted and ventilated dining room area shall be provided.
(7) Food Facilities. When food is prepared on the premises, the program shall adhere to the applicable sections of COMAR 10.15.03 relating to approved source of food, food temperatures and storage, storage of dangerous chemicals, handwashing, and dishwashing.
(8) Fire and Safety. The facility shall be designed, located, constructed and equipped so as to promote the effective operation of its programs and to protect the health and safety of its clients and staff. The program shall maintain a written evacuation plan to be used in the case of fire or other disaster. Programs are not eligible for any form of certification unless a written certificate of compliance is obtained from the local fire marshal indicating all applicable fire and safety code requirements have been satisfied.
(9) The non-hospital detoxification program shall make reasonable provisions to accommodate handicapped individuals according to State and federal law.
D. Staffing. The amount of staff required for the non-hospital detoxification program will vary with the complexity of the service and the number of clients to be served. The optimal bed capacity for a non-hospital detoxification program is 20 clients. There shall be a minimum of two staff on duty at all times which shall include one registered nurse or licensed practical nurse. The following are minimum staffing patterns for a non-hospital detoxification program:
(1) One physician 1 hour per day in addition to 24 hour on-call physician coverage.
(2) One registered nurse shall be on duty 8 hours a day, 7 days per week and either a licensed practical nurse or a registered nurse shall cover the remaining 16 hours of each day. Registered nurses or licensed practical nurses shall be certified in cardiopulmonary resuscitation.
(3) One full-time counseling staff for every six clients.
(4) One full-time support staff for every eight clinical staff members.
(5) A minimum of one certified alcoholism counselor or a person who has a level of training and experience equivalent to that required for certification as an alcoholism counselor for every three counselors.
E. Intake.
(1) The program shall maintain documentation verifying that a medical examination of the client has been conducted within 24 hours of the client's admission to the program. The examination shall be conducted by a licensed physician, physician assistant or nurse practitioner. A psycho-social evaluation shall be developed for each client.
(2) An evaluation of the treatment needs of the client shall be completed by an alcoholism counselor or approved staff before discharge from the program.
(3) The program shall maintain written documentation concerning the medical and treatment evaluation of each client.
F. Treatment Plan.
(1) The program shall develop a written, individualized treatment plan on behalf of every client. The treatment plan shall be based on the psycho-social evaluation and any other psychiatric and psychological assessments which have been performed on behalf of the client. Pertinent findings from the medical examination shall be included in the treatment plan.
(2) The client shall be encouraged to participate in the development of the individualized treatment plan. The nature of this participation shall be described in the client's record. The program shall maintain documentation indicating the client has been informed of and has assented to the treatment plan and has been afforded an opportunity to assist in the development of treatment goals and objectives.
(3) Progress notes on the client shall be documented in the client's treatment record on a daily basis.
G. Family Care Services. The non-hospital detoxification facility shall provide education and support services to the client's family according to confidentiality provisions of 42 CFR 2.1 et seq. When permitted by the federal regulations mentioned above, the program shall attempt to notify the client's family within 24 hours of the client's admission and refer them to appropriate community agencies involved in the treatment of alcoholics.
H. Medication Control. Medication may only be administered to a client with the signed specific authorization of a physician and only by a person authorized to do so in accordance with federal, State and local laws and regulations.
I. Dietary Services.
(1) Every non-hospital detoxification program that serves meals to clients shall have a written plan describing the organization and delivery of dietary services which shall insure that the services are provided in compliance with appropriate local, State and federal rules and regulations. Programs providing dietary services shall serve at least three meals on a daily basis. Meals shall be served at regular times with not more than a 14 hour interval between the evening meal and breakfast.
(2) The program shall utilize the services of a qualified dietician in developing and implementing the dietary service plan. The dietician may serve on a full-time, part-time, or consultant basis.
J. Emergency Transfer of Clients. Each program shall have a written transfer agreement with at least one nearby hospital to provide emergency medical care.
K. Cooperation with Outside Service Providers. Program staff shall cooperate with community service providers and groups such as Alcoholics Anonymous and Al-Anon to insure that appropriate services are available to clients. When appropriate, the program shall enter into qualified service organization agreements in accordance with federal regulations.
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