1. (a) In addition to the preceding sections, inpatient direct care shall also comply with 20 CAR §§ 47-121 – 47-132.

2. (b) Administration shall be responsible for the following:

   1. (1)

      1. (A) Policies and procedures shall be provided for:

3. (i) The general administration of the institution; and

   1. (ii) Each department, section, or service in the facility.

      1. (B) All policies and procedures for departments or services shall have evidence of ongoing review and/or revision.

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

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

   2. (2)

      1. (A) The facility shall have visitation policies determined by the medical staff, governing body, and administration which comply with the No Patient Left Alone Act, Arkansas Code § 20-6-401 et seq.
      2. (B) Patients shall be permitted to receive visitors at any hour, including small children and clergy members.

      3. (C) Visitation restriction may include:

         1. (i) When the presence of a visitor would be medically or therapeutically contraindicated;
         2. (ii)
4. (a) (a) If the person has signs or symptoms of a transmittable disease.

5. (b) (b) The facility shall allow access through telephone, telecommunications, or other means when visitation is restricted by subdivision (b)(2)(C)(i) of this section or subdivision (b)(2)(C)(ii) of this section;

   1. (iii) At the request of the patient, law enforcement, or court order;

      1. (iv) If the presence of a visitor would interfere with the care of or rights of any patient; and

         1. (v) If the person is determined to be:

6. (a) (a) A danger to:

   1. (1) (1) Staff;
   2. (2) (2) Other patients; or
   3. (3) (3) Visitors;

7. (b) (b) Noncompliant with healthcare facility policies; or

   1. (c) (c) Engaging in disruptive, threatening, or violent behavior toward any:
   2. (1) (1) Staff member;
   3. (2) (2) Patient; or

   4. (3) (3) Other visitor.

      1. (D) The healthcare facility may require the clergy member to comply with reasonable health and safety precautions, including reasonable health screenings and wearing personal protective equipment, imposed by the healthcare facility in connection with in-person visitation for the prevention of the spreading of communicable disease unless the precautions substantially burden the ability of the clergy member to freely exercise his or her religion.
      2. (E) If the requirements substantially burden the ability of the clergy member, the healthcare facility may require compliance with the precautions only if compliance in that instance furthers a compelling government interest and imposes the least restrictive burden on the clergy member’s exercise of religion.
      3. (F) Notwithstanding any other provision in Arkansas Code § 20-6-101 et seq., a healthcare facility may restrict visits of a clergy member who fails a reasonable health screening measure or tests positive for a communicable disease; and

   5. (3)

      1. (A) Disaster preparedness.

      2. (B) A written disaster preparedness plan shall be developed and communicated to staff through:

         1. (i) Orientation;
         2. (ii) Education; and
         3. (iii) Ongoing reviews.

      3. (C) The plan shall include:

         1. (i) A definition of “disaster” for the hospice inpatient facility’s given location and circumstances;
         2. (ii) Arrangements for prompt identification and transfer of patients and records to another facility if necessary;
         3. (iii) Arrangements for coordination of community resources; and
         4. (iv) Menus to coincide with a twenty-four-hour supply of perishable and seventy-two-hour supply for nonperishable food available for emergencies.
         5. (c) Nursing.

   6. (1)

      1. (A) The facility shall provide twenty-four-hour nursing service sufficient to meet patient needs in accordance with the patient plan of care.

      2. (B) Each patient:

         1. (i) Receives treatments, medications, and diet as prescribed; and
         2. (ii) Is kept:
8. (a) (a) Comfortable;

9. (b) (b) Clean;

   1. (c) (c) Well-groomed; and

      1. (d) (d) Protected from:
   2. (1) (1) Accident;
   3. (2) (2) Injury; and
   4. (3) (3) Infection.

   5. (2)

      1. (A) Each shift shall include:

         1. (i) A registered nurse onsite to supervise and provide direct patient care; and
         2. (ii) One (1) other nursing personnel type (e.g., RN, LPN, and/or hospice aide).
      2. (B) A ratio of at least one (1) nursing personnel to every four (4) patients shall be maintained from 7:00 a.m. to 7:00 p.m. and a ratio of one (1) to six (6) from 7:00 p.m. to 7:00 a.m.

   6. (3) A registered nurse shall assign the patient care of each patient to other nursing personnel in accordance with the patient’s needs.

      1. (d) Dietary.
   7. (1) Meal service, menu planning, and supervision.

   8. (2) The hospice shall:

      1. (A)

         1. (i) Serve at least three (3) meals or their equivalent each day at regular times, with not more than fourteen (14) hours between an evening meal and breakfast.
         2. (ii) Meals may be adjusted according to the request of and as tolerated by the patient;
      2. (B) Procure, store, prepare, distribute, and serve all food under sanitary conditions in accordance with the current Rules Pertaining to Retail Food Establishments, 20 CAR pt. 170;

      3. (C) Employ a registered dietician or have a formal agreement with a registered dietician who is responsible for:

         1. (i) Planning menus that meet nutritional needs of each patient in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences; and
         2. (ii) Supervising the meal preparation and service to ensure the menu plan is followed;
      4. (D) Have menus prepared by a registered dietitian for patients who require medically prescribed special diets; and
      5. (E) Have bedtime and between-meal snacks or supplements available.

10. (e) Pharmaceutical service.

    1. (1) Appropriate methods and procedures for the dispensing and administering of drugs and biologicals shall be developed.

    2. (2) Whether drugs and biologicals are obtained from community or institutional pharmacists or stocked by the facility, the facility is responsible for:

       1. (A) Drugs and biologicals for patients insofar as they are covered under the program; and

       2. (B) Ensuring that pharmaceutical services are provided in accordance with:

          1. (i) Accepted professional principles; and
          2. (ii) Appropriate federal, state, and local laws.

    3. (3) In facilities that obtain drugs and biologicals from community or institutional pharmacies:

       1. (A) The hospice shall have contractual arrangements to ensure services are available twenty-four (24) hours a day, seven (7) days a week to the patients in the hospice facility;
       2. (B) All prescription medications in the facility shall be patient-specific and appropriately labeled; and
       3. (C) No prescription drug floor stock shall be allowed in the facility.

    4. (4) The hospice shall:

       1. (A) Employ a licensed pharmacist or have a formal agreement with a licensed pharmacist to advise the hospice on ordering, storage, administration, disposal, and recordkeeping of drugs and biologicals; and

       2. (B)

          1. (i) Have a pharmaceutical service committee that meets quarterly consisting of at least the:
11. (a) (a) Medical director;

12. (b) (b) Pharmacist;

    1. (c) (c) Nurse manager; and

       1. (d) (d) Administrator.

          1. (ii) The committee shall be responsible for the following:
13. (a) (a) Serve as an advisory group to the medical staff;

14. (b) (b) Approve the policies and procedures for pharmaceutical service annually;

    1. (c) (c) Approve medication formulary annually;

       1. (d) (d) Approve floor stock annually; and

15. (e) (e) Discuss medication errors and adverse drug reactions.

    1. (5) Orders for medications.

       1. (A) All medications shall be ordered by the physician or credentialed licensed practitioner according to their scope of practice if approved by the medical staff and governing body.

       2. (B) If the medication order is verbal:

          1. (i) The physician shall give the order only to a:
16. (a) (a) Licensed nurse;

17. (b) (b) Pharmacist; or

    1. (c) (c) Another physician; and

       1. (ii)
18. (a) (a) The individual receiving the order shall record and sign immediately.

19. (b) (b) The prescribing physician shall sign in the time frame determined by hospice policy.

    1. (6) Administration of medication. Medications shall be administered only by one (1) of the following individuals:

       1. (A) Licensed personnel in accordance with their scope of practice; and

       2. (B) The patient:

          1. (i) With approval of the attending physician; and
          2. (ii) According to hospice policy.

    2. (7) Control and accountability.

       1. (A) The pharmaceutical service has procedures for control and accountability of all drugs and biologicals throughout the facility.
       2. (B) Drugs are dispensed in compliance with federal and state laws.
       3. (C) Records of receipt and disposition of all controlled drugs are maintained in sufficient detail to enable an accurate reconciliation.

       4. (D) The pharmacist determines:

          1. (i) Drug records are in order; and
          2. (ii) An account of all controlled drugs is maintained and reconciled.

    3. (8) Labeling of drugs and biologicals. The labeling of drugs and biologicals:

       1. (A) Is based on currently accepted professional principles; and
       2. (B) Includes the appropriate accessory and cautionary instructions as well as the expiration date when applicable.

    4. (9) Storage.

       1. (A) In accordance with state and federal laws:

          1. (i) All drugs and biologicals are locked and stored under proper temperature controls; and
          2. (ii) Only authorized personnel shall have access to the keys.
       2. (B) Scheduled drugs shall be maintained as required by federal and state regulations.

    5. (10) Drug disposal. Controlled substances no longer required by a patient residing in an inpatient hospice shall be disposed of by:

       1. (A) Returning unused medications; and
       2. (B) A Report of Drugs Surrendered Form to the Division of Pharmacy Services and Drug Control of the Department of Health.

20. (f) Linen.

    1. (1) The hospice has available at all times a quantity of linen essential for proper care and comfort of patients.
    2. (2) Linens are handled, stored, processed, and transported in such a manner as to prevent the spread of infection.

21. (g) Pet therapy.

    1. (1) Therapy animals (birds, cats, dogs, and other animals):

       1. (A) May be permitted to visit in the patient’s room; and
       2. (B) Shall not negatively affect the well-being of others.
    2. (2) Animals shall have appropriate vaccinations and licenses.

    3. (3) A veterinary record shall be kept on all therapy animals to:

       1. (A) Verify vaccinations; and
       2. (B) Be made readily available for review.
    4. (4) Therapy pets shall not be allowed in food preparation, food storage, dining, or service areas.
22. (h) If personal pets are allowed in the facility, the facility will have policy and procedures consistent with local ordinances.

Codification Notes: “LPN” means licensed practical nurse. "RN" means registered nurse.