016.04.4-33. Detoxification Services (DS)

AR ADC 016.04.4-33Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 04. Division of Behavioral Health
Rule 4. Licensure Standards for Alcohol and Other Drug Abuse Treatment Programs (Refs & Annos)
Ark. Admin. Code 016.04.4-33
016.04.4-33. Detoxification Services (DS)
Currentness
Programs funded by OADAP to provide Detoxifications Services shall in addition to the General Standards meet the requirements of the standards listed in Detoxification Services.
DS1 The Regional Alcohol and Drug Detoxification Program will not admit any client under 18 years of age.
DS2 While a client is in observation detoxification (with or without medical supervision), Medical Doctor(s), registered or licensed practical nurse or Regional Detoxification Specialists (RDS), must be present and specifically assigned to monitor the client on a twenty-four (24) hour basis.
DS3 Clients in detoxification services will receive three (3) meals per day, with no more than fourteen (14) hours between any two (2) meals. Their meals will be served separately from other residential clients. If eating in a common area, they will receive their meal prior to or after other clients have vacated the area.
DS4 Only an RDS, Medical Doctor, registered or licensed nurse are authorized to document progress notes, vital signs, fluid/food intake, withdrawal risk assessments and stabilization plans. All documentation is to include the authorized persons' signature and credentials.
DS5 An RDS must hold current certifications in the following;
a. Cardiopulmonary Resuscitation (CPR);
b. First Aid;
c. Nonviolent Physical Crisis Intervention (NPCI); and
d. Regional Alcohol and Drug Detoxification (RADD Training)
DS6 All staff assigned to monitor detoxification clients shall know the signs and symptoms of withdrawal, the implication of those signs and symptoms; and emergency procedures, as defined in facility policy and procedure manual.
DS7 Clients in detoxification services will have their vital signs taken upon admission and documented; and at least every two (2) hours thereafter, until within normal limits for eight (8) consecutive hours.
Exception: Once vital signs are within normal limits for eight (8) consecutive hours, they will be taken no less than every six hours. At this time, blood pressure, temperature and pulse may be omitted one (1) time per twenty-four (24) hour period; observation will continue as evidenced by documentation of reason for vital sign omission, client behavior observed and respiration count. (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.);
DS8 Observation detoxification, with or without medical supervision, will include:
a. Gender separate sleeping areas with:
(1) One-level bed (no bunk beds);
(2) Individual storage for clothing and personal items;
(3) Window coverings to allow for privacy; and
(4) Sufficient clean linen
b. Gender separate bathroom/shower areas with:
(1) Sufficient lighting so as to avoid injury;
(2) Plumbing in working condition so as to avoid any threat to health; and
(3) Sufficient clean linen supply
DS9 A complete set of vital signs will include blood pressure reading (systolic and diastolic), temperature, pulse and respirations.
DS10 Once vital signs are within normal limits for eight (8) hours, they will be taken no less than every six (6) hours. There will be documentation in the client's case record verifying each vital sign taken during the client's stay in detoxification.
DS11 Oral fluids and food shall be easily accessible to clients.
DS12 There will be documentation of meals offered, consumed and/or refused; and the amount consumed or refused, every two (2) hours.
DS13 There will be documentation of consumption of oral fluids indicating amount offered, consumed, or refused, every (2) hours.
DS14 There will be documentation of reason for not offering nutrition. (e.g. client absent during meal time to see personal physician).
DS15 Medication that is prescribed to an individual for withdrawal must be documented in the withdrawal risk assessment, stabilization plan and progress notes.
DS16 A file will be maintained for each client, per admission; it will contain:
a. Proof of client identity;
b. A signed Voluntary Admission Agreement; or,
c. Involuntary Admission Agreement, as appropriate;
d. Consent to Treat Agreement signed prior to admission;
(1) Must obtain signed, dated and timed consent, even if client is impaired by substance; and,
(2) Must obtain another signed, dated and timed consent once said substance no longer impairs client.
e. The withdrawal risk assessment will be initiated on admission, completed and filed in the client record within four (4) hours of admission. 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;
f. Qualified staff member(s) (physicians, registered and/or licensed practical nurses or Regional Detoxification Specialists) will perform withdrawal risk assessment; it will include:
(1) Substance Use History;
(2) Current Detoxification Level Determination;
(3) Past psychiatric treatment;
(4) Past chemical dependency treatment;
(5) Significant medical history;
(6) Current health status;
(7) Current medications;
(8) Known food allergies;
(9) Known drug allergies;
(10) Current living situation;
(11) Current employment situation; and,
(12) Current emotional state and behavioral functioning.
g. Completed and signed authorization(s) to release confidential information, as appropriate;
h. Medication records, as appropriate (In programs utilizing MD's, LPN, LPTN and/or RNs); Clients must provide all previously prescribed prescription medications during admission. All previously prescribed prescription medications must be documented in client file including: type of medication, amount/dosage, route in which medication is administered, how often medication is taken, medical condition for prescription, prescribing physician and count of medication provided at admission.
i. Personal Property Inventory, signed by staff or authorized agent, and client;
j. Confirmation of client receiving and understanding of handbook;
k. Confirmation of client receiving notice of Federal Confidentiality Regulations; to be signed when client is capable of rational communication;
l. 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 (stabilization plan):
(1) An RDS, LPN, LPTN, RN or MD will sign the plan;
(2) The client will sign the detoxification plan, unless medically contraindicated; staff will explain the circumstances in the client record and obtain the signature as soon as possible;
(3) The completed and signed detoxification plan will be filed in the client record within eight (8) hours of admission;
(4) The program will review and, if necessary, revise the detoxification plan (stabilization plan) every twenty-four (24) hours or more often, should client need(s) change significantly;
(5) The program will implement the detoxification plan (stabilization plan) and document the client's response to interventions in the progress notes.
m. Progress notes in detoxification will be documented every two (2) hours until stable for eight (8) hours (additional notes will be documented as appropriate) and will include:
(1) The client's physical condition observed by staff (signs);
(2) Client statements about the client's condition (symptoms);
(3) Client statements about their needs;
(4) The client's mood and behavior;
(5) Any medications that have been prescribed by the program's Medical Director (for programs utilizing medical staff), and
(6) Information about the client's progress or lack of progress in relation to detoxification (stabilization) goals.

Credits

Adopted Dec. 26, 2010.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.04.4-33, AR ADC 016.04.4-33
End of Document