1. (a) Psychiatric care units in general hospitals shall meet the construction requirements of 20 CAR § 41-151, physical facilities — psychiatric nursing unit, and shall in all respects comply with the requirements of 20 CAR § 41-147, physical facilities — patient accommodations — adult medical, surgical — communicable or pulmonary disease, except furniture, equipment, and supplies may be modified by the attending physician on an individual patient basis as verified by signed orders.

2. (b) General requirements.

   1. (1) Each psychiatric care unit shall have a written plan describing the organization of services or the arrangement for the provision of such services to meet patient needs.

   2. (2) The services shall include, but not be limited to:

      1. (A) Diagnostic evaluation;
      2. (B) Individual or group therapy;
      3. (C) Consultation; and
      4. (D) Rehabilitation.

   3. (3) The unit shall be under the direction and management of a psychiatrist who is:

      1. (A) Qualified by training and experience for examination by the American Board of Psychiatry and Neurology, Inc., or the American Osteopathic Board of Neurology and Psychiatry; and
      2. (B) Licensed in the State of Arkansas.
   4. (4) The program director of the unit shall be an individual with at least two (2) years of administrative experience.

   5. (5) The unit shall furnish, through the use of qualified personnel:

      1. (A) Psychological services;
      2. (B) Social work services;
      3. (C) Occupational therapy;
      4. (D) Recreational therapy; and
      5. (E) Psychiatric nursing.

   6. (6)

      1. (A) The unit shall have a qualified director of nursing:

3. (i) With a master’s degree; or

   1. (ii) Qualified by education and experience in the care of individuals with mental illness.

      1. (B) If the director does not meet the qualifications, there shall be regular documented consultation by a qualified registered nurse.

   2. (7)

      1. (A) Staffing for the unit shall ensure the presence in the unit of a registered nurse at all times.
      2. (B) There shall be adequate numbers of registered nurses, licensed practical nurses, and mental health workers to provide the care necessary under each patient’s active treatment program.
   3. (8) The unit shall provide or have available psychological services to meet the needs of the patients.

   4. (9) There shall be a social service staff to provide services in accordance with:

      1. (A) Accepted standards of practice; and
      2. (B) Established policies and procedures.

   5. (10)

      1. (A) The unit shall provide a therapeutic activities program.

      2. (B) The program shall be:

         1. (i) Appropriate to the needs and interests of the patients; and
         2. (ii) Directed toward restoring and maintaining optimal levels of physical and psychosocial functioning.
   6. (11) There shall be a procedure for referrals for needed services.

   7. (12)

      1. (A) There shall be adequate space, equipment, and supplies for services to be provided effectively and efficiently in functional surroundings that are readily accessible to the patients.

      2. (B) All space, equipment, and facilities, both within the psychiatric facility and those utilized outside the facility, shall:

         1. (i) Be well-maintained; and
         2. (ii) Meet applicable federal, state, and local requirements for:
4. (a) (a) Safety;

5. (b) (b) Fire;

   1. (c) (c) Health; and

      1. (d) (d) Sanitation.

   2. (13)

      1. (A) Policies and procedures shall have evidence of ongoing review and/or revision.

      2. (B) The first page of each manual shall have the:

         1. (i) Annual review date; and
         2. (ii) Signature of the department director and/or person or persons conducting the review.

   3. (14)

      1. (A) Clinically relevant educational programs shall be conducted on a regularly scheduled basis of not less than twelve (12) per year.

      2. (B) There shall be evidence of:

         1. (i) Program dates;
         2. (ii) Attendance; and
         3. (iii) Subject matter.

   4. (15)

      1. (A) Staff meetings shall be held at least monthly.
      2. (B) Dated minutes of each meeting shall be kept in writing.
   5. (16) There shall be an ongoing program for orientation of staff.
   6. (17) All psychiatric services personnel shall maintain competency in life support measures.

   7. (18) There shall be an ongoing QA/PI program.

      1. (c) Medical records shall include at least:
   8. (1) Identification data including patient’s legal status;
   9. (2) Admitting psychiatric diagnosis as well as diagnoses of medical problems;
   10. (3) Reason for the patient’s admission;

   11. (4) Social service records including:

       1. (A) Reports of interviews with patients, family members, and others; and
       2. (B) A social history and assessment;

   12. (5)

       1. (A) Psychiatric evaluation.
       2. (B) See 20 CAR § 41-114, medical record requirements for outpatient services, emergency room, observation services, and psychiatric records; and

   13. (6)

       1. (A) Treatment plan.

       2. (B) See 20 CAR § 41-114, medical record requirements for outpatient services, emergency room, observation services, and psychiatric records.

          1. (d) Medications. See 20 CAR § 41-115, pharmacy.
6. (e) Food and nutritional services. See 20 CAR § 41-116, food and nutrition services.

7. (f) Organization of psychiatric nursing units and services in general hospitals.

   1. (1) Medical direction shall be provided by a qualified psychiatrist and under the supervision of a registered nurse qualified by training and experience in psychiatric nursing.
   2. (2) In addition to the requirements set forth for nursing services in 20 CAR § 41-110, patient care service, policies and procedures shall be developed specific to the care of the psychiatric patient.
8. (g) Supplies and equipment shall be commensurate with the types of services offered.
9. (h) Medical records. See 20 CAR § 41-114, medical record requirements for outpatient services, emergency room, observation services, and psychiatric records.

Codification Notes: “QA/PI” means quality assurance/performance improvement.