Definitions, Nursing Staff Requirements, Healthcare Admission Screening, Tuberculosis (TB) Control and Screening, Health-Related History, Comprehensive Physical Assessment (CPA), Routine Consent - Authority for Evaluation and Treatment (AET), ...
DEPARTMENT OF JUVENILE JUSTICE
RULE NOS.:RULE TITLES:
63M-2.002Definitions
63M-2.0033Nursing Staff Requirements
63M-2.0041Healthcare Admission Screening
63M-2.0044Tuberculosis (TB) Control and Screening
63M-2.0047Health-Related History
63M-2.0048Comprehensive Physical Assessment (CPA)
63M-2.0051Routine Consent - Authority for Evaluation and Treatment (AET)
63M-2.0052Special Consent
63M-2.006Sick Call
63M-2.009Episodic Care
63M-2.010Girls Gender Responsive Medical Services
63M-2.022Verification and Procurement of Medications Prescribed Prior to Admission
63M-2.023Transfer of Youth's Medications
63M-2.027Disposal of Medications
63M-2.032Youth Refusal of Medication
63M-2.033Youth Hoarding of Medication and Swallowing Difficulties
63M-2.036Adverse Drug Events and Medication Errors
63M-2.040Environmental and Exercise Precautions
63M-2.050Infection Control - Regulations and Training
63M-2.051Needle Stick Injuries / Exposure
63M-2.054Methicillin Resistant Staphylococcus Aureas (MRSA)
63M-2.055Health Department Reporting of Infectious Disease
63M-2.061Record Documentation, Development and Maintenance
63M-2.070Health Education
63M-2.081Youth Release to the Community
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 39, No. 231, November 27, 2013 issue of the Florida Administrative Register.
63M-2.002 Definitions.
(1) through (8) No change.
(9) Constant supervision: The continuous and uninterrupted observation of a youth by a staff member assigned to monitor the youth who has a clear and unobstructed view of the youth, and unobstructed sound monitoring of the youth at all times.
(10) through (13) renumbered (9) through (12) No change.
(13)(14) Detention Center: a temporary hardware-secure holding state-operated, county or municipal facility for juveniles, which compares to a jail in the adult system.
(15) through (16) renumbered (14) through (15) No change.
(16) Facility Management System (FMS): The computer based system used by state-operated juvenile detention centers as the primary source of documentation and reporting for facility operations. Forms and reports generated by FMS are considered to be both the official and original documentation for the area concerned.
(17) through (18) No change.
(19) First Aid: any one-time treatment, and follow-up visit for the purpose of observation, of minor injuries such as cuts, scratches, first degree burns and splinters. Ointments, salves, antiseptics, and dressings to minor injuries are considered to be first aid. (OSHA, 30 CFR § 50.20-3)
(20) through (24) No change.
(25) Juvenile Justice Information System (JJIS): The department’s electronic information system used to gather and store information on youths having contact with the department.
(25) through (26) renumbered (26) through (27) No change.
(28)(27) Medical Grade: One of five (5) categories or grades that can be assigned to a youth as part of the medical classification system. The specific Medical Grades are defined as follows:
(a) Medical Grade 1:
1. Youth has no identified chronic health conditions; and
2. Youth has no serious, chronic infectious, communicable disease; and
3. Youth has no periodic monitoring requirements.; and
(b) Medical Grade 2:
1. Youth has only one chronic condition, which has not required medical/nursing intervention within the last 12 months (except for routine periodic evaluations at the intervals required in this rule); and
2. Youth has no serious, chronic, infectious communicable disease (youth may or may not be prescribed oral medications); and
3. Youth being treated with prescription medication greater than 30 days.
(c) through (d) No change.
(e) Medical Grade 5:
1. Youth is prescribed any medication for diagnosed mental and/or emotional disorders.
(28) through (40) renumbered (29) through (41) No change.
(42)(41) Sharp: Any object routinely used in medical procedures,. including Including but not limited to, hypodermic needles, scalpels, blades, broken glass, broken capillary tubes, breakable culture dish, and exposed ends of dental wires.
(42) through (45) renumbered (43) through (46) No change.
(47)(46) Working Inventory: Inventory that is permitted to be kept in an area outside of regular stock for immediate access by nursing staff, including but not limited to, syringes, needles, phlebotomy equipment, suture kits, and all other potentially dangerous sharps and other devices that are kept in the area where they are to be used.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0033 Nursing Staff Requirements.
(1) through (2) No change.
(3) The licensed healthcare professional that is providing the direction to the LPN is responsible for reviewing all medical cases daily with the LPN, and be available on-call for consultation. and, when necessary, provides Based upon the results of this clinical consultation, on-site assessment and management of medical cases must be provided by the licensed healthcare professional.
(4) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0041 Healthcare Admission Screening.
(1) Each facility shall screen every youth upon admission to determine if the youth has an acute injury, illness, chronic medical condition, physical impairment (e.g., speech, hearing, visual), mental disability, or developmental disability that requires medical or mental health evaluation and treatment, and/or medication needs to be met.
(2) through (4) redesignated (a) through (c) No change.
(d)(5) In detention facilities, a the Medical and Mental Health Admission Screening must be conducted and documented in the Facility document found on the Facilities Management System (FMS) shall be utilized.
(6) through (7) redesignated (e) through (f) No change.
(8) through (9) renumbered (2) through (3) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0044 Tuberculosis (TB) Control and Screening.
(1) All facilities shall implement routine screening for all youth for latent and active tuberculosis within 72 hours of admission, as well as environmental controls in the case of a youth with active Tuberculosis, in accordance with the Centers for Disease Control and Prevention recommendations and OSHA Occupational Safety and Health Standards.
(2) through (4) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0047 Health-Related History (HRH).
(1) The Health Related History (HS 014) shall be completed no later than seven (7) calendar days following the date of admission and prior to the youth engaging in strenuous exercise or being subjected to extreme outdoor weather conditions including, but not limited to, high heat indices and frigid temperatures environmental stressors. The Health Related History (HS 014, August 2009) is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.
(2) through (4) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0048 Comprehensive Physical Assessment (CPA).
(1) The Comprehensive Physical Assessment (HS 007) shall be completed no later than seven (7) calendar days following the date of admission and prior to the youth engaging in strenuous exercise or being subjected to extreme outdoor weather conditions including, but not limited to, high heat indices and frigid temperatures environmental stressors. For youth with a Comprehensive Physical Assessment completed prior to admission, see subsection 63M-2.0048(8), F.A.C.
(2) through (9) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0051 Routine Consent – Authority for Evaluation and Treatment (AET).
(1) Because a signed AET is essential to providing routine health services to youth, the following procedure shall be employed to obtain this critical authorization:
(a) through (e)1. No change.
2. Where a signed AET has not been obtained, and the person with the power to consent to examination or treatment cannot be contacted after a diligent search, and has not expressly objected to consent, the Detention Facility Superintendent or Assistant Facility Superintendent may consent to ordinary and necessary medical treatment, including immunizations, and dental examination and treatment as set forth in Section 743.0645, F.S. The assigned JPO shall conduct the diligent search as set forth in the form Affidavit of Diligent Effort (HS 056, January 2012), which is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The assigned JPO shall complete the Affidavit of Diligent Effort and attach to the youth’s Limited Consent for Evaluation and Treatment (HS 057, December 2013 January 2012), which is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The Facility Superintendent providing the consent for the youth shall sign the Limited Consent for Evaluation and Treatment.
3. Where the youth is in the dependency system and is served by the Department of Children and Families, the following process applies:
a. Where the youth has not been removed from the parent’s home, the JPO shall obtain the parent’s consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).
b. Where parental rights have not been terminated and the youth is in out-of-home care, such as a foster home, group home, or unlicensed caregiver, the JPO shall contact the Department of Children and Families or its contracted service provider to locate the parent to consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013). Parental consent is not required where the court order placing the youth in out-of-home care specifically gives authority to consent to ordinary medical treatment to the Department of Children and Families or the out-of-home caregiver. Where these circumstances exist, either the Department of Children and Families or the out-of-home caregiver may consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).
c. Where parental rights have been terminated and the youth is in the custody of the Department of Children and Families, the Department of Children and Families or its contracted service provider may consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).
a. Where parental rights have been terminated, consent for ordinary and necessary medical care and treatment may be obtained through the DCF case worker to sign the Limited Consent for Evaluation and Treatment according to Rule 65C-28.003, F.A.C.
b. Where parental rights have not been terminated, and the youth is in licensed placement, such as a foster home or group home, the JPO will contact the DCF case worker to locate the parent and obtain a signed AET. If unsuccessful, then the JPO shall seek limited consent from the case worker using the Limited Consent for Evaluation and Treatment (HS 057, January 2012).
c. Where parental rights have not been terminated, and the youth is placed with an unlicensed caregiver, the JPO will contact the DCF case worker to locate the parent and obtain a signed AET. If unsuccessful, then the JPO shall seek limited consent from the unlicensed caregiver or, failing this, the case worker, using the Limited Consent for Evaluation and Treatment (HS 057, January 2012).
(f) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.0052 Special Consent.
(1) Additional consent is required in special circumstances through the Parental Notification of Health Related Care: General (HS 020, January 2014 February 2010) and is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. Informed consent is required for the following:
(a) through (b) No change.
(c) Dental services other than evaluations or routine prophylaxis;
(d) through (f) No change.
(2) New medications, or a significant change to medications, excluding psychotropic medications, require parental consent through the Parental Notification of Health Related Care: Medications (HS 021 January 2014 February 2010) and is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.;
(3) New Vaccinations and Immunizations require parental consent through the Parental Notification of Health Related Care: Vaccinations/Immunizations (HS 022, February 2010) which and is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.
(4) through (5) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.006 Sick Call.
(1) through (3) No change.
(4) Review and triage of Sick Call requests shall be conducted as follows:
(a) A licensed nurse, or higher licensure level, shall review, triage promptly, and screen for urgency all Sick Call requests such that emergency conditions are not inappropriately delayed for the next regularly scheduled sick call session.
(b) When a licensed health care professional is not on site, the shift supervisor shall review all sick call requests as soon as possible, within four (4) hours after the request is submitted. Issues for issues requiring immediate attention prior to the next scheduled Sick Call shall be addressed as per Rule 63M-2.009, F.A.C.
1. A Registered Nurse, or higher licensure level health care staff, after review of the Sick Call requests, shall make an assessment while conducting Sick Call, and determine whether a nursing or medical intervention is appropriate.
2. If a facility utilizes a Licensed Practical Nurse (LPN) without the presence of a Registered Nurse, then the LPN shall conduct the Sick Call. The LPN shall review all sick call requests daily (either telephonically or in person) with someone at the level of a Registered Nurse or a higher licensure level.
(5) After appropriate evaluation of the Sick Call requests has been completed:
(a) No change.
(b) For detention facilities, the staff shall utilize JJIS and/FMS to enter the Sick Call requests generated by the youth. This entry must then generate a notice to the nurse for his/her timely review. Every facility shall have a backup method for notification to the nurse in situations where the computerized system is unavailable.
(6) No change.
(7) A youth who that has received medical evaluation and treatment by the ARNP or P.A. more than once repeatedly for the same complaint that has demonstrated no improvement after two medical evaluations shall be referred immediately to a physician (on-site, off-site or Emergency Room).
(8) through (9) No change.
(10) The Sick Call documentation shall be as follows:
(a) through (d) No change.
(e) Detention facilities shall utilize the established Facility Facilities Management System (FMS) and the /Juvenile Justice Information System (JJIS) (FMS/JJIS) to coordinate and document Sick Call. A copy of the completed electronic Sick Call Request form shall be placed in the youth’s Individual Health Care Record.
(f) through (g) No change.
(11) through (12) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.009 Episodic Care.
(1) through (2) No change.
(3) Non-licensed staff shall immediately report any youth who appears incapacitated to their supervisor and/or the onsite health care staff.
(4) through (13) No change.
(14) A list of emergency telephone numbers and cell-phone numbers must be posted or located accessible to all staff, on all shifts and be, inaccessible to youth.
(15) through (16) No change.
(17) All episodic care provided shall be documented on the Episodic Care (First Aid/Emergency) Care Log (HS 009, October 2006). The Episodic Care (First Aid/Emergency) Care Log is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice as long as the form includes all information required on the Episodic Care (First Aid/Emergency) Care Log that is incorporated by reference into Chapter 63M-2, F.A.C.
(18) through (19) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.010 Girls Gender Responsive Medical Services.
(1) The Designated Health Authority or physician designee, PA or ARNP shall be responsible for appropriate gender responsive and age-related health care and services in addition to routine medical care and services.
(2) Gender responsive medical care shall include all of the following conditions:
(a) through (e) No change.
(f) Anorexia, Bulimia, and/or additional specialized female adolescent complex medical conditions;
(g) through (i) No change.
(3) through (12) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.022 Verification and Procurement of Medications Prescribed Prior to Admission.
(1) through (4) No change.
(5) Only medications from a licensed pharmacy, with a current, patient-specific label intact on the original medication container may be accepted into a Department facility.
(6) Medications may not be administered unless all of the following have been met:
(a) The youth reports that he or she is taking a prescribed oral medication an oral prescribed medication;
(b) through (d) No change.
(6) through (13) renumbered (7) through (14) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.023 Transfer of Youth’s Medications.
(1) No change.
(2) When nursing staff are not on site, medication verification shall be completed by trained non-licensed staff for those youth who arrive from home for transport. This shall be completed by review of medication labels, determining last dose(s) provided, (by verifying with the parent/guardian when available), and determining if medication is scheduled to be taken necessary during the transport of the youth. The Non-Licensed Staff Medication Record (HS 054, September 2010) shall be utilized to document when the non-licensed staff delivers medication to the youth. The Non-Licensed Staff Medication Record (HS 054, September 2010) is incorporated into this rule and is available electronically at “(HYPERLINK)” or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.
(3) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.027 Disposal of Medications.
(1) No change.
(2) Each facility must perform the following:
(a) Inventory Accountability;
(b) Monitoring pharmaceutical expiration dates;,
(c) Quarantine of unusable medication;, and
(d) Disposal of medications.
1. through 3. No change.
4. Controlled medications shall be disposed of by a three-party witness, and must be destroyed beyond reclamation, per 64B16, F.A.C, by a Pharmacist, Nursing staff, and administrator or designee.
5. All medication disposals shall be documented, and the documentation retained Disposal of all medications shall be documented and maintained.
(3) through (6) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.032 Youth Refusal of Medication.
(1) through (3) No change.
(4) A youth’s refusal of prescribed injectable medications requires immediate notification to the DHA, or physician designee or and the prescribing psychiatric practitioner.
(5) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.033 Youth Hoarding of Medication and Swallowing Difficulties.
(1) through (2) No change.
(3) A practitioner’s order or general authorization must be provided by the Designated Health Authority or physician designee in order for a youth’s medications to be that may be appropriately crushed and sprinkled or mixed with food.
(4) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.036 Adverse Drug Events and Medication Errors.
(1) through (2) No change.
(3) Licensed health care professional staff shall monitor each youth daily, prior to administering medications, for potential medication side effects. For instances where licensed health care professional staff are not on-site and non-licensed staff members assist youth with medication administration, see paragraph 63M-2.031(8)(h), F.A.C.
(4) Licensed health care professional staff, at a minimum, shall document weekly side effect monitoring on the MAR on at least a weekly basis.
(5) No change.
(6) The Designated Health Authority or physician designee, and the facility superintendent or Program Director shall review the medication error reports at least, at a minimum, every two weeks., These findings shall be reviewed and summarized quarterly during the quarterly Pharmacy and Therapeutics Committee CQI meetings per as per Rule 64B-16-27.300, F.A.C.
(7) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.040 Environmental and Exercise Precautions.
(1) through (2) No change.
(3) The Designated Health Authority or physician designee, PA or ARNP shall determine whether the facility’s full exercise regimen is appropriate for a youth with a chronic medical condition is appropriate for a facility’s full exercise regimen.
(4) through (10) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.050 Infection Control – Regulations and Training.
(1) All facilities shall conduct surveillance, screening and management of specific illnesses or potential infectious conditions in accordance with state and federal regulations, established Occupational Safety and Health Administration (OSHA) (1910 Subpart I: 29CFR 1910.1030; 29CFR 1910.1200; App. A; and 29CFR 1910.1020), and the Centers for Disease Control (CDC).
(2) Each facility must develop and administer a comprehensive program of education and prevention regarding comply with federal and state legislation concerning blood borne pathogens. A comprehensive program of education and prevention shall be administered at each facility.
(3) An Exposure Control Plan shall be written in accordance with OSHA standards.
(4) through (7) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.051 Needle Stick Injuries/Exposure.
(1) No change.
(2) If an exposure meets criteria for post-exposure treatment, the post-exposure chemoprophylaxis (PEP) must be offered and initiated immediately after the exposure in accordance with CDC regulations.
(3) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.054 Methicillin Resistant Staphylococcus Aureus (MRSA).
(1) through (4) No change.
(5) The DHA At a minimum, the DHA shall re-evaluate a youth at least one week after completion of antibiotic therapy for recurrent skin lesions and/or wound assessment to determine the need for further re-culture and treatment.
(6) through (8) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.055 Health Department Reporting of Infectious Disease.
(1) Any infectious disease outbreak shall be investigated and reported to the local County Health Department in accordance with CDC reporting requirements. The index case (youth) shall be interviewed as a part of the investigation.
(2) through (3) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.061 Record Documentation, Development and Maintenance.
(1) No change.
(2) The Individual Health Care Record consists of two sections:
(a) Section 1: Core Health Profile, and
(b) Section 2: Interdisciplinary Health Record. The Interdisciplinary Health Record contains the additional subsections of the Individual Health Care Record that include the current Practitioners orders and Chronological Progress Notes, historical medical documentation, and treatment records and documents of ancillary care.
(3) through (12) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.070 Health Education.
(1) Health education programs shall pertain to health issues of adolescents. These topics shall include, at a minimum, the following:
(a) through (b) No change.
(c) HIV/AIDS as per CDC recommendations;
(d) through (o) No change.
(2) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
63M-2.081 Youth Release to the Community.
(1) through (15) No change.
(16) When required, a DNA specimen shall be obtained as per Section 943.325, F.S., using the FDLE kit prior to the youth’s release into the community.
(17) through (19) No change.
Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New__________.
