(4) All doctor's orders, including medications, treatments and diets, shall be dated, recorded and signed in the Doctor's Order Book by the attending physician. These orders shall be reviewed by the attending physician at least every six months and if indicated, renewed. (5) A record of all accidents occurring to patients in the home, including the date and time of accident, physical findings and treatment prescribed. This record shall be signed by the attending physician and incorporated in the patient's record. (6) All orders for restraining patients shall be specifically defined, dated, recorded in the Doctor's Order Book and signed by the attending physician. (7) Statement with recommendations for discharge, reason for discharge and the patient's physical and mental condition at time of discharge shall be dated and signed by the attending physician, and incorporated in the patient's record. c. Nursing records shall include: (1) Admission data (a) How admitted - by ambulance or ambulatory, referred by whom and accompanied by (b) Date and time of admission (c) Complete description of patient's condition upon admission, including weight of am- (2) All physicians' orders for medication, treatment, diet, activity, etc., copied from the Doctor's Order Book by the nurse, and incorporated in the patient's record on an approved form. (3) Date, time, dosage and method of administration of all medications administered; date and time of all treatments. (4) The signature of the nurse administering treatments or medications. (5) An accurate report of all factors pertaining to the patient's condition, including the monthly weight of ambulatory patients. (6) A report of all accidents occurring to patients, date, time, circumstances involved, patient's symptoms and nurses' observations, time doctor was notified, and subsequent treatment given. (7) A list of the patient's clothing, personal effects and valuables shall be entered at time of admission on a form approved by the Department, and dated and signed by the patient or responsible person and witnessed. A copy of this list shall be given to the patient or other responsible person. (8) Discharge or transfer data (a) Date and time of discharge or transfer (b) Reason for discharge or transfer (c) Condition of patient at time of discharge or transfer (d) Address to which discharged or transferred (e) Accompanied by whom (9) An individual narcotic and sedative record shall be maintained for each narcotic or sedative prescribed for each patient. This record shall be kept in a bound book with numbered pages in a manner approved by the Department, and shall include: (a) Patient's name (b) Name of physician prescribing the medication (c) Name of medication; strength of dosage prescribed (d) Amount of medication received (e) Date received, prescription number, name of pharmacy dispensing medication (f) Date, time, dosage and method of administration and the signature of nurse who administered the medication to the patient (g) There shall be a recorded, dated narcotic and sedative count checked by the nurse going off duty on each shift in the presence of the nurse reporting on duty. The count shall be signed by both individuals. (10) There shall be a record kept on all drugs transferred with a patient at the time of dis charge or transfer. This record shall include: (a) Date, name and new address of patient (b) Name of patient's physician (c) List and amount of medications (d) Prescription numbers (e) Name of pharmacy that dispensed medications (f) Signature of person taking medication from the home (g) Witnessed signature of the responsible individual on duty in the home at the time of discharge L. RESPONSIBILITIES OF THE LICENSEE 1. To insure humane, understanding care of the patients. Their personal and spiritual rights and privileges shall be respected at all times by all employees. 2. To provide a form so that all applicants for employment shall submit the following: a. All pertinent information regarding identification (maiden name included) b. Social Security number c. Qualifications and experience. Professional employees shall identify school of nursing, date of graduation and name at time of graduation. If registered nurse: Massachusetts registration number and year of original registration. If licensed practical nurse: Massachusetts license number and year of original licensure. Signature shall include full title. d. Written confirmation of the professional qualifications of all professional employees shall be obtained by the licensee when the employee cannot present his bona fide credentials. e. All employee data shall be on file for inspection by the Department. 3. To accurately report all accidents occurring to patients to the Department. This report shall include: a. Date, time and circumstances involved in the accident b. Attending physician's name c. Attending physician's report, including physical findings and treatment prescribed, d. Patient's prognosis e. Name of nurse on duty at time of accident, and names of witnesses, if any 4. To arrange with responsible persons or agencies for the provision and maintenance of the following patient necessities: a. Proper clothing, night attire and footwear, legibly marked and for seasonal wear b. Eye examinations and eyeglasses c. Ear examinations and hearing aids d. Dental care and dentures e. Prosthetic devices and braces 5. To arrange with the Division of the Blind of the Massachusetts Department of Education for the provision of recreational therapy for blind patients, and for patients with impaired vision. 6. To provide adequate rehabilitation facilities for patients, as prescribed by the attending physician. 7. To notify the hospital inspector promptly in writing of the resignation of any qualified nursing personnel and of the name and qualifications of the new appointee. 8. To strictly supervise all personnel as to cleanliness of person and clothing. Food handlers shall wear caps or hair nets, and shall be suitably clothed. Facilities shall be provided for the storage of street clothing for non-resident personnel when employed. 9. To report immediately by telephone the occurrence of epidemic disease and poisoning, including food poisoning, to the Department. On week-ends or holidays, call State House, Capitol Police. (This verbal report is to be confirmed in writing within 24 hours.) 10. To report as soon as possible in writing all fires involving patients, personnel or property. 11. To submit an annual report. This form, which shall be furnished by the Department, is to be filled out for the calendar year January 1 through December 31, and returned in duplicate not later than January 15 of each year. 12. To instruct all personnel as to their duties in cases of fire or other emergencies. A first-aid kit shall be provided. 13. To provide adequate storage facilities for the folowing: a. Patient's towels and washcloths b. Clothing during all seasons of the year. personal effets and valuables c. Beds, bed springs. mattresses, sed pillows and blankets when not in use 14. To provide adequate facilities for the proper disialection of beds, bed springs, mattresses and bed pillows. 15. To provide adequate facilities and equipment for the proper sterilization of equipment as needed. 16. To assure the patient's punctual attendance at clinics, out-patient departments and physicians' offices when such appointments have been made. 17. To arrange for religious benefits for patients of all denominations, if desired. 18. To check and identify patients' medications and personal belongings at time of change of ownership of the home. 19. That a complete narcotic and sedative count shall be made by the licensee and the new owner at change of ownership. This count shall be recorded in the Narcotic and Sedative Book and shall be signed by the licensee and the new owner. 20. Pets a. Pets shall not be allowed in any of the following areas: (1) Patient facilities (2) Kitchens and areas used for preparation, serving or storage of food 1. Homes contemplating the establishment of an occupational therapy unit shall submit to the Director, Division of Hospital Facilities, Massachusetts Department of Public Health, in duplicate, the following information: a. Name and address of the home b. Date license was issued and number of beds c. Name, address and qualifications of the registered occupational therapist to be employed d. A floor plan of the home, identifying the proposed location of the unit to be used for occupational therapy 2. This unit shall be well lighted, ventilated and heated, and shall be separate and apart from rooms used for patient facilities. There shall be a bell or signal system to summon aid in an emergency. 3. A prescription for patient participation in occupational therapy shall be recorded, dated and signed in the Doctor's Order Book by the attending physician. This prescription shall state specifically all details regarding the type of occupational therapy prescribed. 4. A record shall be kept of the physical progress made by the patient and his reactions to the occupational therapy prescribed. This shall be incorporated in the patient's individual record. 5. The occupational therapy program shall be supervised by a registered occupational therapist. 6. All storage and unit facilities shall be maintained in a sanitary manner and kept in good repair. B. RECREATIONAL THERAPY 1. Homes contemplating an organized recreational therapy unit shall submit to the Department a floor plan of the home, identifying the specific area to be used. The Department reserves the right to disapprove the location of the unit when indicated. 2. This unit shall be well lighted, ventilated, heated and equipped with a bell or signal system to summon aid in an emergency. C. PHYSICAL THERAPY 1. No home shall be permitted to establish a physical therapy unit for treating patients without the approval of the Director of the Division of Hospital Facilities, Department of Public Health. 2. The request for such approval shall be written in duplicate, signed by the licensee, and shall include: a. Name and address of home b. Date license was issued, and number of beds c. Name and address of licensee d. Name, address and qualifications of the registered physical therapist who will administer physical therapy e. A floor plan of the home, identifying the specific area to be used for administering physical therapy and/or for the storage of the equipment. The Department reserves the right to disapprove the location. 3. This unit shall be well lighted, ventilated and heated, and handwashing facilities shall be separate and apart from rooms used for patient occupancy or other patient facilities. 4. This unit shall be used exclusively for the administration of physical therapy treatments to resident patients. 5. Equipment used for physical therapy shall be approved by the American Medical Association. 6. All physical therapy equipment shall be serviced at least annually by a qualified person. No repairs shall be made except by a qualified person. 7. The following basic equipment shall be provided for the physical therapy unit: h. Desk or table and chair for clerical use i. Bell or signal system to summon aid in an emergency 8. A prescription for the administration of physical therapy shall be recorded, dated and signed by the prescribing physician in the Doctor's Order Book. This prescription shall state specifically the type of treatment to be given, and all details regarding the treatment. 9. The physical therapist shall record, date and sign all pertinent data pertaining to the treatment. This shall be incorporated in the patient's individual record. 10. No patient shall be unattended while receiving physical therapy treatments. 11. Physical therapy shall be administered by a qualified person: a. A physician registered to practice medicine in Massachusetts, or b. A physical therapist currently registered in Massachusetts 12. All equipment and facilities shall be maintained in a sanitary, safe condition and kept in good repair. 13. All plumbing and electrical installations required for the administration of physical therapy shall be inspected and approved by the appropriate local or state authorities. SECTION II GENERAL REGULATIONS FOR CONVALESCENT OR NURSING HOMES Household and Property (p.5.) On and after the effective date of these regulations, (1) Dining room facilities when provided shall be: A manager or other principal representative shall be 3. Physical Plant Household and Property All buildings not previously licensed by the 7. Dining Room (a) Suitably located in a well lighted, ven- (b) Equipped with tables of sturdy construction with a hard surfaced, washable top. (a) Dining room is optional for nursing homes (b) Dining room for patients is required for NURSING HOMES |