Section 22-B3207. PHYSICIAN SERVICES AND MEDICAL SUPERVISION OF RESIDENTS

 

3207.1The Medical Director shall assume full responsibility for the overall supervision of the medical care provided in the facility. If the Medical Director is absent, he or she shall delegate the continuity and supervision of resident care to a qualified physician.

 

3207.2The Medical Director shall:

 

(a)Coordinate medical care in the facility;

 

(b)Implement resident care policies;

 

(c)Develop written medical bylaws and medical policies;

 

(d)Serve as liaison with attending physicians to ensure the prompt issuance and implementation of orders;

 

(e)Review incidents and accidents that occur on the premises to identify hazards to health and safety;

 

(f)Ensure that medical components of resident care policies are followed;

 

(g)Assist the Administrator in arranging twenty-four (24) hours of continuous physician services a day for medical emergencies and in developing procedures for emergency medical care;

 

(h)Ensure that attending medical professionals who treat residents in the facility have current District of Columbia licenses and U.S. Drug Enforcement Agency and District of Columbia Controlled Substances registrations on file in the facility, along with initial and annual certifications of their freedom from communicable disease; and

 

(i)Ensure that each resident is seen by a physician within seventy-two (72) hours after admission and that the physician has included in the record information identified in subsection 3231.12.

 

3207.3Except as specified in subsection 3207.5 of this section, a physician may delegate tasks to a licensed physician assistant or licensed nurse practitioner who:

 

(a)Meets the applicable definition in section 3299 of this Chapter; and

 

(b)Is acting within the scope of practice as defined by District of Columbia law.

 

3207.4A physician's assistant shall be supervised by a physician.

 

3207.5A physician may not delegate a task when regulations specify that the physician shall perform it personally, or when the delegation is prohibited under District law or by the facility's own policies.

 

3207.6The physician shall prescribe a planned regimen of medical care which includes the following:

 

(a)Medications and treatment;

 

(b)Rehabilitative services;

 

(c)Diet;

 

(d)Special procedures and contraindications for the health and safety of the resident;

 

(e)Resident therapeutic activities; and

 

(f)Plans for continuing care and discharge in accordance with section 3234.

 

3207.7A facility shall have available for each resident vaccines currently recommended by the U.S. Health Advisory Committee on Immunization Practices (ACIP) as appropriate for age, occupation, lifestyle, environmental situation, documented evidence of prior vaccine, if available, or immunity and current medical status.

 

3207.8Each physician shall adhere to the written policies and regulations that govern the health services provided in the facility.

 

3207.9The Medical Director shall make arrangements for the provision of medical care twenty-four (24) hours a day.

 

3207.10Dated orders and dated progress notes in the resident's medical record shall be used to document medical supervision at the time of each visit and shall be signed and dated by the resident's physician or the resident's nurse practitioner or physician assistant, with countersignature by the resident's physician.

 

3207.11Each resident shall have a comprehensive medical examination and evaluation of his or her health status at least every twelve (12) months, and documented in the resident's medical record.

 

3207.12A schedule with the names and telephone numbers of each physician and days he or she is on call shall be kept at each nursing station.

 

3207.13There shall be available at each nursing station written procedures on emergency care, including care of residents, persons to be notified and reports to be prepared.

 

 

3207.14The facility shall make contact information of each resident’s attending physician available to facility staff as well as to each resident and his or her family, including the family designee, or legal representative upon request.

 

3207.15Each facility shall obtain a medical order from a resident’s attending physician, the facility’s medical director, an on-staff physician, or an advance practice registered nurse prior to calling 911 for emergency medical assistance, except that a prior medical order shall not be required if it is determined that there is a situation that requires an immediate transfer to a hospital.

 

3207.16If a nursing facility does not obtain a required medical order prior to calling 911, the facility shall document in the resident’s medical record why obtaining a medical order was not practicable.

 

authority

The Director of the Department of Health, pursuant to the authority set forth in section 5(a) of the Health-Care and Community Residence Facility, Hospice, and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48, D.C. Official Code § 44-504(a)(2011 Supp.)) (hereinafter the Act), and in accordance with Mayor’s Order 98-137, dated August 20, 1998.

source

Notice of Final Rulemaking published at 49 DCR 473 (January 18, 2002); as amended by Notice of Final Rulemaking published at 58 DCR 10619, 10620 (December 16, 2011).