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PDFWAC 246-341-1126

Mental health inpatient servicesPolicies and proceduresAdult.

In addition to meeting the agency licensure, certification, administration, personnel, and clinical requirements in WAC 246-341-0100 through 246-341-0650, and the applicable inpatient service requirements in WAC 246-341-1118 through 246-341-1132, an inpatient facility must implement all of the following administrative requirements:
(1) Policies to ensure that services are provided in a secure environment. "Secure" means having:
(a) All doors and windows leading to the outside locked at all times;
(b) Visual monitoring, either by line of sight or camera as appropriate to the individual;
(c) Adequate space to segregate violent or potentially violent persons from others;
(d) The means to contact law enforcement immediately in the event of an elopement from the facility; and
(e) Adequate numbers of staff present at all times that are trained in facility security measures.
(2) Designation of a professional person as defined in RCW 71.05.020 in charge of clinical services at that facility, as appropriate to the type of inpatient services.
(3) Policies to ensure compliance with WAC 246-337-110 regarding seclusion and restraint.
(4) A policy management structure that establishes:
(a) Procedures for admitting individuals needing treatment seven days a week, twenty-four hours a day, except that child long-term inpatient treatment facilities are exempted from this requirement;
(b) Procedures to assure access to necessary medical treatment, including emergency life-sustaining treatment and medication;
(c) Procedures to assure the protection of individual and family rights as described in this chapter and chapters 71.05 and 71.34 RCW;
(d) Procedures to inventory and safeguard the personal property of the individual being detained according to RCW 71.05.220;
(e) Procedures to assure that a mental health professional, chemical dependency professional, if appropriate, and physician, physician assistant, or psychiatric 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;
(f) 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; and
(g) Procedures to ensure that individuals detained for up to fourteen, ninety, or one hundred and 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 mental disorder or substance use disorder and either results in likelihood of serious harm or the individual being gravely disabled.
(5) For individuals who have been involuntarily detained, the facility must obtain a copy of the petition for initial detention stating the evidence under which the individual was detained.
(6) The facility must document that each individual has received evaluations to determine the nature of the disorder and the treatment necessary, including:
(a) A health assessment of the individual's physical condition to determine if the individual needs to be transferred to an appropriate hospital for treatment;
(b) Examination and medical evaluation within twenty-four hours of admission by a licensed physician, advanced registered nurse practitioner, or physician assistant;
(c) Development of an initial treatment plan while in the facility;
(d) Consideration of less restrictive alternative treatment at the time of admission; and
(e) The admission diagnosis and what information the determination was based upon.
(7) An individual who has been delivered to the facility by a peace officer for evaluation must be evaluated by a mental health professional within the following time frames:
(a) Three hours of an adult individual's arrival;
(b) Twelve hours of arrival for a child in an inpatient evaluation and treatment facility; or
(c) At any time for a child who has eloped from a child long-term inpatient treatment facility and is being returned to the facility.
(8) If the mental health professional or chemical dependency professional and physician, physician assistant, or psychiatric advanced registered nurse practitioner determine that the needs of an adult individual would be better served by placement in a another type of service facility then the individual must be referred to an more appropriate placement in accordance with RCW 71.05.210.
(9) The treatment plan must contain documentation of:
(a) Diagnostic and therapeutic services prescribed by the attending clinical staff;
(b) An individual service plan that meets the requirements of WAC 246-341-0620;
(c) Copies of advance directives, powers of attorney or letters of guardianship provided by the individual;
(d) A plan for discharge including a plan for follow-up where appropriate;
(e) Documentation of the course of treatment; and
(f) That a mental health professional or chemical dependency professional, as appropriate, has contact with each involuntary individual at least daily for the purpose of determining the need for continued involuntary treatment.
[Statutory Authority: 2018 c 201 and 2018 c 291. WSR 19-09-062, § 246-341-1126, filed 4/16/19, effective 5/17/19.]
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