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PDFWAC 246-341-1104

Secure withdrawal management and stabilization servicesAdults.

Secure withdrawal management and stabilization services are provided to an individual to assist in the process of withdrawal from psychoactive substances in a safe and effective manner, or medically stabilize an individual after acute intoxication, in accordance with ASAM criteria and chapters 71.05 and 71.34 RCW.
(1) In addition to meeting the behavioral health agency licensure, certification, administration, personnel, and clinical requirements in WAC 246-341-0300 through 246-341-0650, an agency must:
(a) Meet the requirements for withdrawal management services in WAC 246-341-1100; and
(b) Designate a physician or chemical dependency professional as the professional person as defined in RCW 71.05.020 in charge of clinical services at that facility.
(2) An agency certified to provide secure withdrawal management and stabilization services must have the following policies and procedures:
(a) Policies to ensure that services are provided in a secure environment. "Secure" means having:
(i) All doors and windows leading to the outside locked at all times;
(ii) Visual monitoring, either by line of sight or camera as appropriate to the individual;
(iii) Adequate space to segregate violent or potentially violent persons from others;
(iv) The means to contact law enforcement immediately in the event of an elopement from the facility; and
(v) Adequate numbers of staff present at all times that are trained in facility security measures.
(b) Policies to ensure compliance with WAC 246-337-110 regarding seclusion and restraint;
(c) Procedures for admitting individuals needing secure withdrawal management and stabilization services seven days a week, twenty-four hours a day;
(d) Procedures to ensure that once an individual has been admitted, if a medical condition develops that is beyond the facility's ability to safely manage, the individual will be transported to the nearest hospital for emergency medical treatment;
(e) Procedures to assure access to necessary medical treatment, including emergency life-sustaining treatment and medication;
(f) Procedures to assure at least daily contact between each in-voluntary individual and a chemical dependency professional or a trained professional person for the purpose of:
(i) Observation;
(ii) Evaluation;
(iii) Release from involuntary commitment to accept treatment on a voluntary basis; and
(iv) Discharge from the facility to accept voluntary treatment upon referral.
(g) Procedures to assure the protection of individual and family rights as described in WAC 246-341-1122, rights related to antipsychotic medication in WAC 246-341-1124, and rights as described in chapters 71.05 and 71.34 RCW;
(h) Procedures to inventory and safeguard the personal property of the individual being detained, including a process to limit inspection of the inventory list by responsible relatives or other persons designated by the detained individual;
(i) Procedures to assure that a chemical dependency professional and licensed physician, physician assistant, or advanced registered nurse practitioner (ARNP) are available for consultation and communication with the direct patient care staff twenty-four hours a day, seven days a week;
(j) Procedures to warn an identified person and law enforcement when an adult has made a threat against an identified victim as explained in RCW 70.02.050 and in compliance with 42 C.F.R. Part 2;
(k) Procedures to ensure that individuals detained for up to fourteen, ninety, or one hundred eighty additional days of treatment are evaluated by the professional staff of the facility in order to be prepared to testify that the individual's condition is caused by a substance use disorder and either results in likelihood of serious harm or the individual being gravely disabled.
(3) An agency providing secure withdrawal management and stabilization services must document that each individual has received evaluations to determine the nature of the disorder and the treatment necessary, including:
(a) A telephone screening reviewed by a nurse, as defined in chapter 18.79 RCW, or medical practitioner prior to admission that includes current level of intoxication, available medical history, and known medical risks;
(b) An evaluation by a chemical dependency professional within seventy-two hours of admission to the facility; and
(c) An assessment for substance use disorder and additional mental health disorders or conditions, using the global appraisal of individual needs - Short screener (GAIN-SS) or its successor.
(4) For individuals admitted to the secure withdrawal management and stabilization facility, the clinical record must contain:
(a) A statement of the circumstances under which the person was brought to the unit;
(b) The admission date and time;
(c) The date and time when the involuntary detention period ends;
(d) A determination of whether to refer to a designated crisis responder to initiate civil commitment proceedings;
(e) If an individual is admitted voluntarily and appears to meet the criteria for initial detention, documentation that an evaluation was performed by a designated crisis responder within the time period required in RCW 71.05.050, the results of the evaluation, and the disposition;
(f) Review of the client's current crisis plan, if applicable and available; and
(g) Review of the admission diagnosis and what information the determination was based upon.
(5) An agency certified to provide secure withdrawal management and stabilization services must ensure the treatment plan includes all of the following:
(a) A protocol for safe and effective withdrawal management, including medications as appropriate;
(b) Discharge assistance provided by chemical dependency professionals, including facilitating transitions to appropriate voluntary or involuntary inpatient services or to less restrictive alternatives as appropriate for the individual.
(6) An agency certified to provide secure withdrawal management and stabilization services must ensure that each staff member providing withdrawal management services to an individual, with the exception of licensed staff members and CDPs, completes a minimum of forty hours of documented training before being assigned individual care duties. This personnel training must include the following topics:
(a) Substance use disorders;
(b) Infectious diseases, to include hepatitis and tuberculosis (TB); and
(c) Withdrawal screening, admission, and signs of trauma.
[Statutory Authority: 2018 c 201 and 2018 c 291. WSR 19-09-062, § 246-341-1104, filed 4/16/19, effective 5/17/19.]
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