1. (a) Medically supervised withdrawal management shall be provided outside a medical facility, but under the direction of a licensed physician, Advanced Practice Registered Nurse, or Physician Assistant and a licensed registered nurse supervisor, for consumers who are withdrawing or are intoxicated from alcohol or other drugs. Presenting consumers shall be assessed as currently experiencing no apparent medical or neurological symptoms as a result of their substance use that would require hospitalization.

2. (b) The facility shall maintain written programmatic descriptions and operational methods addressing the following:

   1. (1) Environment: The facility shall provide for beds, food service, monitoring/documenting vital signs, food, and liquids. The facility shall provide a safe, welcoming, and culturally/age appropriate environment. If the facility provides services to consumers under the age of eighteen (18), it shall be licensed by the Oklahoma State Department of Human Services (OKDHS) as a "Residential Child Care Facility".

   2. (2) Support system:

      1. (A) A licensed physician, Advanced Practice Registered Nurse, or Physician Assistant providing supervision of withdrawal management shall be on site or on call twenty-four (24) hours per day, seven (7) days per week;
      2. (B) The facility shall maintain a written plan for emergency procedures which shall be approved by a licensed physician; and
      3. (C) The facility shall have supplies, as designated in the written emergency procedures, which shall be accessible to the staff.

   3. (3) Staff:

      1. (A) Staff members shall be knowledgeable about the physical signs of withdrawal, the taking of vital signs, the implication of those vital signs, and emergency procedures.
      2. (B) A Registered Nurse shall provide twenty-four (24) hour on-site supervision and monitoring, and statutorily approved personnel shall administer medications in accordance with physician's orders;
      3. (C) Staff shall be knowledgeable regarding facility-required education, evidenced based practices, training, and policies; and
      4. (D) The facility shall document in personnel records all education, training, and experience stated in (A), (B), and (C) above prior to staff providing direct care services.
      5. (E) The facility shall have a minimum of two (2) staff members on site twenty-four (24) hours per day, seven (7) days per week. If consumers under eighteen (18) are on site, staffing ratios shall not exceed those specified in OAC 340:110-3-153.2.

   4. (4) Treatment services:

      1. (A) Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder withdrawal management treatment services shall be provided which shall include, but are not limited to, oral intake of fluids, three (3) meals a day, taking of vital signs (temperature, pulse, respiration rate, blood pressure), documentation of fluid and food intake a minimum of one (1) time every six (6) hours or more often as indicated by the consumer's condition.
      2. (B) Medications are to be prescribed if needed during withdrawal management. The medications are to include those needed for physical health issues and mental impairment if acquired during the withdrawal process.

   5. (5) Assessment:

      1. (A) An individualized case management plan shall be developed for each consumer prior to discharge;
      2. (B) A medical assessment for appropriateness of placement shall be completed and documented by a licensed physician, Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA) during the admission process to the program. A Registered Nurse (RN) may assist with the assessment. RN signatures must be co-signed by a physician, APRN or PA at the time the assessment is completed and must include a dated signature(s) of each practitioner.
3. (C) All assessments shall be signed by a licensed physician within twenty-four (24) hours of admission, with the physician as the admitting practitioner of record.

4. (c) Compliance with 450:18-13-61 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following:

   1. (1) Licenses;
   2. (2) Policies and procedures;
   3. (3) Treatment protocols;
   4. (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, and ongoing in-service trainings;
   5. (5) Treatment records;
   6. (6) Interviews with staff; and
   7. (7) Other supporting facility documentation

Amended and renumbered from 450:18-3-61 at 23 Ok Reg 1953, eff 7-1-06

Amended at 24 Ok Reg 2580, eff 7-12-07

Amended at 27 Ok Reg 2237, eff 7-11-10

Amended at 31 Ok Reg 2004, eff 10-1-14

Amended at 34 Ok Reg 1791, eff 10-1-17

Amended at 36 Ok Reg 1256, eff 9-15-21

Amended at 42 Ok Reg, Number 20, effective 9-1-25