10A NCAC 13B .1928. BRAIN INJURY LONG‑TERM CARE PROGRAM REQUIREMENTS

(a)  The general requirements in this Subchapter shall apply when applicable, but brain injury long‑term care units shall meet the supplement requirements in this Rule and Rules .1901 (4) and .1929 of this Section.  Brain injury long‑term care is an interdisciplinary, intensive maintenance program for patients who have incurred brain damage caused by external physical trauma and who have completed a primary course of rehabilitative treatment and have reached a point of no gain or progress for more than three consecutive months.  Services are provided through a medically supervised interdisciplinary process as provided in Rule .1927 of this Section and are directed toward maintaining the individual at the optimal level of physical, cognitive and behavioral functioning.  Following are the minimum requirements for specific services that may be necessary to maintaining the individual at optimum level:

(1)           Overall supervisory responsibility for brain injury long‑term care services shall be assigned to a registered nurse with one year experience in caring for brain injured patients.

(2)           Physical therapy shall be provided by a physical therapist with a current valid North Carolina license.  Occupational therapy shall be provided by an occupational therapist with a current valid North Carolina License.  The services of a physical therapist and occupational therapist shall be combined to provide one full‑time equivalent for each 20 patients.  The assistance of a physical therapy aide and an occupational therapy aide with appropriate supervision shall be combined to provide one full‑time equivalent for each 20 patients.  A proportionate number of hours shall be provided for a census less than 20 patients.

(3)           Clinical nutrition services shall be provided by a qualified dietician with two years clinical training and experience in nutrition.  The number of hours of clinical nutrition services on either a full‑time or part‑time employment or contract basis shall be adequate to meet the needs of the patients. Each patient's nutrition needs shall be reviewed at least monthly.  Clinical nutrition services shall include:

(A)          Assessing the appropriateness of the ordered diet for conformance with each patient's physiological and pharmacological condition;

(B)          Evaluating each patient's laboratory data in relation to nutritional status and hydration;

(C)          Applying technical knowledge of feeding tubes, pumps and equipment to each patient's specialized needs.

(4)           Clinical Social Work shall be provided by a Social Worker meeting the requirements of Rule .1923 of this Section.

(5)           Recreation therapy, when required, shall be provided on either a full‑time or part‑time employment or contract basis by a clinician eligible for certification as a therapeutic recreation specialist by the State Board of Therapeutic Recreation Certification. The number of hours of therapeutic recreation services shall be adequate to meet the needs of the patients.  In the event that a qualified specialist is not locally available, alternate treatment modalities shall be developed by the occupational therapist and reviewed by the attending physician.  The program designed must be adequate to meet the needs of this specialized population and must be administered in accordance with Section .1200 of this Subchapter.

(6)           Speech therapy, when required, shall be provided by a clinician with a current valid license in speech pathology issued by the State Board of Speech and Language Pathologists and Audiologists.

(7)           Respiratory therapy, when required, shall be provided and supervised by a respiratory therapist currently registered by the National Board for Respiratory Care.

(b)  Each patient's program shall be governed by an interdisciplinary treatment plan incorporating and expanding upon the health plan required under Rules .1908 and .1909 of this Section.  The plan is to be initiated on the first day of admission.  Upon completion of baseline data development and an integrated interdisciplinary assessment the initial treatment plan is to be expanded and finalized within 14 days of admission.  Through an interdisciplinary process the treatment plan shall be reviewed at least monthly and revised as appropriate.  In executing the treatment plan the interdisciplinary team shall be the major decision‑making body and shall determine the goals, process, and time frames for accomplishment of each patient's program.  Disciplines to be represented on the team shall be medicine, nursing, clinical pharmacy and all other disciplines directly involved in the patient's treatment or treatment plan.

(c)  Each patient's overall program shall be assigned to an individually designated case manager.  The case manager acts as the coordinator manager for assigned patients.  Any professional staff member involved in the patient's care may be assigned this responsibility for one or more patients. Professional staff may divide this responsibility for all patients on the unit in the best manner to meet all patients' needs for a coordinated interdisciplinary approach to care. The case manager shall be responsible for:

(1)           coordinating the development, implementation and periodic review of the patient's treatment plan;

(2)           preparing a monthly summary of the patient's progress;

(3)           cultivating the patient's participation in the program;

(4)           general supervision of the patient during the course of treatment;

(5)           evaluating appropriateness of the treatment plan in relation to the attainment of stated goals; and

(6)           assuring that discharge decisions and arrangements for post discharge follow‑up are properly made.

(d)  For each 20 patients or fraction thereof dedicated treatment facilities and equipment shall be provided as follows:

(1)           A combined therapy space equal to or exceeding 600 square feet, adequately equipped and arranged to support each of the therapies.

(2)           Access to one full reclining wheelchair per patient.

(3)           Special physical therapy and occupational therapy equipment for use in fabricating positioning devices for beds and wheelchairs including splints, casts, cushions, wedges, and bolsters.

(4)           There shall be roll‑in bath facilities with a dressing area available to all patients which shall afford maximum privacy to the patient.

 

History Note:        Authority G.S. 131E‑79;

Eff. December 1, 1991;

Amended Eff. February 1, 1993.