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I.EXECUTIVE ORDERS - page 216 / 359

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1.individualized training or assistance with the activities of daily living (toileting, grooming, ambulation, etc.);
2.health and nutrition counseling;
3.an individualized, daily exercise program;
4.an individualized, goal-directed recreation program;
5.daily health education;
6.one nutritionally-balanced hot meal and two snacks served each day;
7.nursing services that include the following individualized health services:
a.monitoring vital signs appropriate to the diagnosis and medication regimen of each participant no less frequently than monthly;
b.administering medications and treatments in accordance with physician's orders;
c.initiating and developing a self administration of medication plan for the ADHC center which is individualized for each participant for whom it is indicated; and
8.transportation to and from the center.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and 40:2120.41-46.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:2185 (October 2008).

§4245.Transportation Requirements

A.The center will provide transportation to and from the ADHC center at the beginning and end of the program day. The center must comply with the following requirements governing transportation.

1.The center shall have liability insurance coverage and have proof of such coverage.
2.The center must conform to all state laws and regulations pertaining to drivers, vehicles and insurance.

B.The driver shall hold a valid chauffeur's license or commercial driver license (CDL) with passenger endorsement.

1.The driver shall meet personal and health qualifications of other staff.

C.The number of occupants allowed in a car, bus, station wagon, van, or any other type of transportation shall not exceed the number for which the vehicle is designed.

D.Provisions shall be made to accommodate participants who use assistive devices for ambulation.

E.The vehicle shall be maintained in good repair.

F.In a center-owned transportation vehicle, there shall be at least one staff member in the vehicle who is trained in first-aid and cardio pulmonary resuscitation (CPR).

G.If the center contracts with a commercial proprietor for transportation, it shall select one with a good reputation and reliable drivers. All rules established for transportation furnished by the center shall be observed.

H.If the center develops a policy that establishes a limited mileage radius for transporting participants, that policy must be submitted to DHH for review and approval prior to the center being allowed to limit transportation for participants.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and 40:2120.41-46.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:2186 (October 2008).

Subchapter E.Participant Care

§4249.Medical Services

A.Medical services shall be provided by the participant’s physician of choice.

B.The center shall have a listing of available medical services for referral. When referrals are made, the center shall follow-up to see that the participant is receiving services.

C.Appropriate staff shall immediately notify the participant's physician and the legal or personal representative of any emergency, change in condition or injury to the participant that occurs at the center.

1.In areas where 911 services are not available, the center shall have means to transport participants for medical emergencies.
2.In cities or communities that have a city or community wide ambulance service (fire department or other emergency medical service), a statement in the center files regarding available emergency transportation services and the method of contact for the service will be acceptable.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and 40:2120.41-46.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:2186 (October 2008).

§4251.Nursing Services

A.All nursing services furnished in the ADHC center shall be provided in accordance with acceptable nursing professional practice standards.

B.A registered nurse (RN) shall serve on the Interdisciplinary (ID) team and shall monitor the overall health needs of the participants. The RN serves as a liaison between the participant and medical resources, including the treating physician.

1.The RN's responsibilities include medication review for each participant at least monthly and when there is a change in the medication regime to:
a.determine the appropriateness of the medication regime;
b.evaluate contraindications;
c.evaluate the need for lab monitoring;
d.make referrals to the primary care physician for needed monitoring tests;
e.report the efficacy of the medications prescribed; and
f.determine if medications are properly being administered in the center.

C.The RN shall supervise the method of medication administration to participants (both self-administration and staff administration).

D.The RN shall approve the method of medication storage and record-keeping.

E.The staff nurse shall document the receipt of all prescribed medications for each participant with a legible signature and will comply with all Louisiana laws and rules regarding medication control and disbursement.

F.The RN shall give in-service training to both staff and participants on health related matters.

G.The RN shall ensure that diagnoses are compiled into a central location in the participant's record and updated when there is a change.

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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