PURPOSE: This rule specifies the requirements for psychiatric services in a hospital.

1. (1) Emergency psychiatric care.

   1. (A) If the hospital does not have a psychiatric unit, written policies and procedures shall be developed to provide for the safe management of patients requiring psychiatric SENIOR SERVICES

services until they can be safely transferred to an appropriate facility.

1. (B) Written policies shall be established regarding the use of restraints or seclusion. These restraints or seclusion shall be used only on the order of a physician. In the absence of a physician, a registered professional nurse shall make the decision that the use of a physical restraint or seclusion is the least restrictive procedure appropriate at the time of the emergency situation. The physician shall be notified immediately and a physician’s order obtained as soon as possible after the occurrence of an emergency. Physicians’ orders for use of physical restraints or seclusion shall be rewritten every twenty-four

1. (24) hours. A full record of any restriction of activity for any patient shall be recorded on the nurses’ notes and shall include the reason for restriction, the type of restriction used, the time of starting and ending the restriction and regular observations of the patient while restricted.

2. (2) Acute psychiatric services. If a psychiatric unit is designed within the hospital, it shall comply with the following requirements as a minimum:

   1. (A) Psychiatric services shall be under the medical direction of a qualified physician member of the medical staff and appointed by the governing body. The director shall be responsible for implementing rules of the medical staff governing psychiatric privileges, quality and scope of care and patient safety;
   2. (B) Psychiatric services shall be supervised by a qualified registered professional nurse with relevant education, experience and demonstrated current competency;
   3. (C) The psychiatric nursing supervisor shall have the authority to implement and enforce hospital policies and procedures governing psychiatric care and shall have the responsibility for evaluating the competency of all nursing personnel assigned to psychiatric services;
   4. (D) Appropriate registered nurse staffing patterns shall be developed to meet the care needs and activity demands of each patient in the psychiatric unit;
   5. (E) New employees shall attend appropriate orientation, in-service and staff development programs prior to being considered part of the staff required to meet the minimum standards of patient care;
   6. (F) Written policies shall be established regarding the use of restraints or seclusion. These restraints or seclusion shall be used only on the order of a physician. In the absence of a physician, a registered professional nurse shall make the decision that the use of a physical restraint or seclusion is the least restrictive procedure appropriate at the time of the emergency situation. The physician shall be notified immediately and a physician’s order obtained as soon as possible after the occurrence of an emergency. Physician’s orders for use of physical restraints or seclusion shall be rewritten every twenty-four

3. (24) hours. A full record of any restriction of activity for any patient shall be recorded on the nurses’ notes and shall include the reason for restriction, the type of restriction used, the time of starting and ending the restriction and regular observations of the patient while restricted;

   1. (G) The social work services staff shall be available to participate as members of the treatment team, exchanging information and evaluations with the attending physician and other professional disciplines in order to insure a comprehensive treatment program for patients;
   2. (H) Activity therapy services shall be available with the services provided under the direction of a qualified therapist. All therapy shall be given on the written order of a physician and documented in the patients’ clinical records; and
   3. (I) There shall be a mechanism for the review and evaluation on a regular basis of the quality and appropriateness of psychiatric services provided.

AUTHORITY: sections 192.006 and 197.080, RSMo 2000 and 197.154, RSMo Supp. 2007.* This rule previously filed as 19 CSR 30-20.021(4)(H). Original rule filed June 27, 2007, effective Feb. 29, 2008.

*Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo 2004.