1. (a) Programs funded by the Office of Alcohol and Drug Abuse Prevention to provide detoxification services shall, in addition to the General Standards, meet the requirements of the standards listed in this section.
2. (b) The Regional Alcohol and Drug Detoxification Program will not admit any client under eighteen (18) years of age.
3. (c) While a client is in observation detoxification, with or without medical supervision, a doctor or doctors of medicine, registered or licensed practical nurses, or regional detoxification specialists must be present and specifically assigned to monitor the client on a twenty-four-hour basis.

4. (d)

   1. (1) Clients in detoxification services will receive three (3) meals per day, with no more than fourteen (14) hours between any two (2) meals.

   2. (2)

      1. (A) Their meals will be served separately from other residential clients.
      2. (B) If eating in a common area, they will receive their meal prior to or after other clients have vacated the area.

5. (e)

   1. (1) Only a regional detoxification specialist, doctor of medicine, or registered or licensed nurse is authorized to document:

      1. (A) Progress notes;
      2. (B) Vital signs;
      3. (C) Fluid and food intake;
      4. (D) Withdrawal risk assessments; and
      5. (E) Stabilization plans.
   2. (2) All documentation is to include the authorized person’s signature and credentials.

6. (f) A regional detoxification specialist must hold current certifications in the following:

   1. (1) Cardiopulmonary resuscitation (CPR);
   2. (2) First aid;
   3. (3) Nonviolent physical crisis intervention (NPCI); and
   4. (4) Regional alcohol and drug detoxification (RADD) training.

7. (g) All staff assigned to monitor detoxification clients shall know:

   1. (1) The signs and symptoms of withdrawal;
   2. (2) The implication of those signs and symptoms; and
   3. (3) Emergency procedures as defined in facility policy and procedure manual.

8. (h)

   1. (1) Clients in detoxification services will have their vital signs taken upon admission and documented at least every two (2) hours thereafter, until within normal limits for eight (8) consecutive hours.

   2. (2) Exception.

      1. (A) Once vital signs are within normal limits for eight (8) consecutive hours, they will be taken no less than every six (6) hours.
      2. (B)

9. (i) At this time, blood pressure, temperature, and pulse may be omitted one (1) time per twenty-four-hour period.

   1. (ii)

10. (a) (a) Observation will continue as evidenced by documentation of:

    1. (1) (1) Reason for vital sign omission;
    2. (2) (2) Client behavior observed; and
    3. (3) (3) Respiration count.

11. (b) (b) E.g., vital signs completed at 10:00 p.m., description of behavior client exhibiting at midnight, and resume vital signs at 2:00 a.m.

    1. (i) Observation detoxification, with or without medical supervision, will include:

    2. (1) Gender-separate sleeping areas with:

       1. (A) One-level bed, i.e., no bunk beds;
       2. (B) Individual storage for clothing and personal items;
       3. (C) Window coverings to allow for privacy; and
       4. (D) Sufficient clean linen; and

    3. (2) Gender-separate bathroom/shower areas with:

       1. (A) Sufficient lighting so as to avoid injury;
       2. (B) Plumbing in working condition so as to avoid any threat to health; and
       3. (C) Sufficient clean linen supply.

12. (j)

    1. (1) A complete set of vital signs will include:

       1. (A) Blood pressure reading, systolic and diastolic;
       2. (B) Temperature;
       3. (C) Pulse; and
       4. (D) Respirations.

    2. (2)

       1. (A) Once vital signs are within normal limits for eight (8) hours, they will be taken no less than every six (6) hours.
       2. (B) There will be documentation in the client's case record verifying each vital sign taken during the client's stay in detoxification.

13. (k)

    1. (1) Oral fluids and food shall be easily accessible to clients.
    2. (2) There will be documentation of meals offered, consumed and/or refused, and the amount consumed or refused, every two (2) hours.
    3. (3) There will be documentation of consumption of oral fluids indicating amount offered, consumed, or refused every (2) hours.

    4. (4) There will be documentation of reason for not offering nutrition, e.g. client absent during meal time to see personal physician.

       1. (l) Medication that is prescribed to an individual for withdrawal must be documented in the:
    5. (1) Withdrawal risk assessment;
    6. (2) Stabilization plan; and

    7. (3) Progress notes.

       1. (m)
    8. (1) A file will be maintained for each client, per admission.

    9. (2) It will contain:

       1. (A) Proof of client identity;
       2. (B) A signed voluntary admission agreement, or involuntary admission agreement, as appropriate;

       3. (C) Consent to treat agreement signed prior to admission:

          1. (i) Must obtain signed, dated, and timed consent, even if client is impaired by substance; and
          2. (ii) Must obtain another signed, dated, and timed consent once said substance no longer impairs client;

       4. (D)

          1. (i) The withdrawal risk assessment will be initiated on admission, completed, and filed in the client record within four (4) hours of admission.
          2. (ii) If an emergency of the client's physical condition prevents documentation within four (4) hours, staff will explain the circumstances in the client record and obtain the information as soon as possible.
          3. (iii)
14. (a) (a) Qualified staff member or members, such as physicians, registered and/or licensed practical nurses, or regional detoxification specialists, will perform the withdrawal risk assessment.

15. (b) (b) It will include:

    1. (1) (1) Substance use history;
    2. (2) (2) Current detoxification level determination;
    3. (3) (3) Past psychiatric treatment;
    4. (4) (4) Past chemical dependency treatment;
    5. (5) (5) Significant medical history;
    6. (6) (6) Current health status;
    7. (7) (7) Current medications;
    8. (8) (8) Known food allergies;
    9. (9) (9) Known drug allergies;
    10. (10) (10) Current living situation;
    11. (11) (11) Current employment situation; and

    12. (12) (12) Current emotional state and behavioral functioning;

        1. (E) Completed and signed authorization or authorizations to release confidential information, as appropriate;

        2. (F)

           1. (i) Medication records, as appropriate, in programs utilizing:
16. (a) (a) MDs;

17. (b) (b) LPNs;

    1. (c) (c) LPTNs ; and/or

       1. (d) (d) RNs.

          1. (ii)
18. (a) (a) Clients must provide all previously prescribed prescription medications during admission.

19. (b) (b) All previously prescribed prescription medications must be documented in the client file including:

    1. (1) (1) Type of medication;
    2. (2) (2) Amount and dosage;
    3. (3) (3) Route in which medication is administered;
    4. (4) (4) How often medication is taken;
    5. (5) (5) Medical condition for prescription;
    6. (6) (6) Prescribing physician; and

    7. (7) (7) Count of medication provided at admission;

       1. (G) Personal property inventory, signed by staff or authorized agent and client;
       2. (H) Confirmation of client receiving and understanding of handbook; and
       3. (I) Confirmation of client receiving notice of federal confidentiality regulations, to be signed when client is capable of rational communication.

20. (n)

    1. (1) A staff person authorized by the program will identify the client's short-term needs based on the withdrawal risk assessment and medical history, and develop an appropriate detoxification plan, i.e. stabilization plan.
    2. (2) A regional detoxification specialist, licensed practical nurse, licensed psychiatric technician nurse, registered nurse, or doctor of medicine will sign the plan.
    3. (3) The client will sign the detoxification plan, unless medically contraindicated, and staff will explain the circumstances in the client record and obtain the signature as soon as possible.
    4. (4) The completed and signed detoxification plan will be filed in the client record within eight (8) hours of admission.
    5. (5) The program will review and, if necessary, revise the detoxification plan(stabilization plan) every twenty-four (24) hours, or more often should client needs change significantly.

    6. (6)

       1. (A) The program will implement the detoxification plan (stabilization plan) and document the client's response to interventions in the progress notes.

       2. (B) Progress notes in detoxification will be documented every two (2) hours until stable for eight (8) hours, with additional notes documented as appropriate, and will include:

          1. (i) The client's physical condition observed by staff (signs);
          2. (ii) Client statements about the client's condition (symptoms);
          3. (iii) Client statements about their needs;
          4. (iv) The client's mood and behavior;
          5. (v) Any medications that have been prescribed by the program’s Medical Director (for programs utilizing medical staff); and
          6. (vi) Information about the client's progress or lack of progress in relation to detoxification (stabilization) goals.

Codification Notes: "MD" means medical doctor. "LPN" means licensed practical nurse. "LPTN" means licensed psychiatric technician nurse. "RN" means registered nurse.