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file:///C:/Users/Roewe/Downloads/Orientation%20Manual%20(3).pdf Medication Administratio n By Unlicensed Personnel Medication Administration Unlicensed personnel may give medication if they have been trained, passed a multiple choice test with the grade of 100 and the task is delegated and super...

file:///C:/Users/Roewe/Downloads/Orientation%20Manual%20(3).pdf Medication Administratio n By Unlicensed Personnel Medication Administration Unlicensed personnel may give medication if they have been trained, passed a multiple choice test with the grade of 100 and the task is delegated and supervised by an RN. Note: Training must be documented and kept in the staff personnel file. Medications should be kept safe from access by others with identifying information on the container and the pill box. Dose is the amount of medication that should be taken each time, i.e., 20 mgs, 1 tablet (tab), 3ccs, 2gtts (drops), 2 capsules. Frequency is how often the medication should be given, i.e., 2 times a day (bid), daily, HS (hours of sleep/bedtime). Route is the way the medication is delivered into the body, i.e., oral (by mouth); rectal; sublingual (under the tongue), by injection, eye drops, eardrops. You will be instructed on the following prior to giving a patient/client their medications: 1. Important things to know about each patient/client and their medication 2. Potential side effects of the medication and when to contact the supervisor, special instructions regarding how and when you give the meds (i.e., with meals, on an empty stomach, at bedtime, 2 hours after a meal, etc.) Medication Administration Safety Procedures When medications are given by anyone, certain safety rules must be followed. The Five Rights of Medication Administration Right Patient/Client Right Medication Right Dose Right Route Right Time Administration of Medications from a Pill Box 1. The nurse or a family member may place the prescribed medication in the pill box. 2. The unlicensed personnel may give the medications, using the 5 Rights. 3. IF IT LOOKS LIKE THE PILLS HAVE BEEN MIXED UP OR ARE MISSING, NOTIFY THE SUPERVISOR IMMEDIATELY. DO NOT GIVE ANY MEDICATIONS !!!!!!!!! 4. If you spill or drop the medication on the floor, do not give or take out of another days dose. Call the office. Documentation 1. Document the medication on appropriate form each time given with the following information: Medication name Strength, dose, amount received, route Time given 2. Remember if you do not document, you did not give the medication in the eyes of the law! Disposal of Medication 1. Medications that are dropped or become unuseable must be disposed of by the RN/Supervisor. She/he will document the disposal. 2. The unlicensed person should never throw away medication! 3. Keep unusable medication in a safe place so it can be disposed of properly. Always contact the RN/Supervisor with any questions even if you think it is “dumb.” A “dumb” question could save a person’s life! THINK You can do harm to the Patient/Client if his or her medication is not given properly or is missed. You are responsible !!!! HCL / Med Admin Orient Booklet RN Delegation Rvd. 080116 Page 4 of 4 MEDICATION ADMINISTRATION EXAM Name: Date: Determine if the statement is True or False. Place a check mark in the appropriate box. 1. The unlicensed person may give medications to a client/patient, if the unlicensed person has been trained, passes a test and the task is delegated and supervised by an RN. T F 2. The Five Rights of Medication Administration are Right Person, Right Medication, Right Dose, Right Route, Right Time. T F 3. “Dose” is the way the medication is delivered into the body i.e., Oral; Rectal; Sublingual (under the tongue). T F 4. “Frequency” is how often the medication should be given. T F 5. “Route” is the way the medication is delivered into the body. T F 6. The unlicensed person does not have to document or notify the RN or the office when the patient refuses or does not take their medication. T F 7. Medications should be kept safe from access by others and have identifying information on the container or the pill box. T F 8. The unlicensed person is not responsible if they make an error when giving medication. T F 9. If you spill or drop the medication on the floor, you may take the pills out of another days dose. It is not necessary to contact the RN or office. T F 10. The RN should always instruct and document important things to know about each patient and their medication. T F 11. If it looks like the pills have been mixed up or are missing, notify the RN or office immediately. Do not give any medications T F 12. The unlicensed person may fill the pill box for the patient. F 13. The unlicensed person should be aware of the potential side effects of the medication and when to contact the RN or office. T F 14. Some medications may need to be given with meals or on an empty stomach. T F 15. You may save a patient’s life with a “dumb” question for the RN or office. T F Graded by: HCL / Medication Administration Exam RN Delegation Rvd. 080116 T Date: INSULIN ADMINISTRATION BY UNLICENSED PERSONNEL With proper training, Unlicensed Personnel (UP) may administer insulin under the direct supervision of a Registered Nurse or physician. This inservice is designed to begin the training you’ll need in order to perform this task. You’ll learn • What diabetes is, • • • • How it’s treated, How to give insulin shots (injections), How to document the injections you give and What to report to the RN or physician. After you’ve successfully completed this training, you may be assigned the task for certain patients/clients. As with all assigned tasks, you are allowed to perform insulin administration only on the patient/client assigned by the RN or physician. If you’re assigned to administer insulin to more than one patient/client, the RN or physician must train you with EACH patient/client. In other words, the training can’t be transferred to other patients/clients. DIABETES All body cells must have sugar (glucose) to survive. Glucose is produced by the food we eat and is stored in the blood stream. Insulin, one of the hormones produced by the pancreas, works to “unlock” the cells, allowing the glucose to feed the cells. Without glucose, the cells can’t perform their functions to keep the body healthy. People with diabetes either don’t produce enough insulin to meet their needs or don’t have the ability to use the insulin they do produce to meet their needs. Untreated or poorly treated diabetes can cause kidney failure, blindness, heart disease and even death. TREATMENT OF DIABETES Diabetes is treated several ways. Sometimes, if the person with diabetes loses weight and reduces the number of cells in the body, the diabetic condition may be controlled by a diet that doesn’t include “concentrated” sugars. Concentrated sugars are the foods that have high sugar content - candy, cake, regular soft drinks. Exercise helps control diabetes by “burning up” the sugar that’s in the body. Exercise is also helpful in weight control. There are medications that are taken in pill or tablet form that stimulate the pancreas to produce more insulin. These medications, along with a diet that doesn’t include concentrated sugars, may control the diabetes. HCL / UP Insulin Admin RN Delegation Rvd. 080116 Sometimes, however, regardless of diet and weight loss, the diabetes remains out of control. The patient’s/client’s blood sugar remains at a level that isn’t healthy and, if it continues at high levels, the patient/client will develop complications and may even die. INSULIN Insulin can only be given by injection. It can’t be taken in a pill or tablet because the fluids in the stomach break it down and make it unuseable by the body. The most common, and easiest, way to give it is“subcutaneously” - just under the skin. The medical abbreviation for this is “SQ” and sometimes it’s referred to as “sub-q.” This is the only way you will give insulin. The needles that are used are very short and very fine. While no one likes to get a “shot,” most people who receive insulin say that the injections aren’t very painful. There are different types of insulin used to control diabetes. The physician determines which type each patient/client needs and how much is needed as well as the times it will be given. The doctor is the only one who can order insulin. Right Time Insulin must be given at approximately the same time every day. You will be given directions for the time your patient/client must receive his or her insulin. If the assignment is to give it at 7:00 A.M., you must give it within a 30-minute “window” of 7:00 AM—no earlier than 6:45 A.M. and no later than 7:15 A.M.. If you aren’t able to give it within that “window,” you must immediately call the RN and inform him or her so that arrangements can be made for the patient/client. Right Dose Insulin must be given in the right dose. It’s measured in “units” and each patient’s/client’s dose is prescribed specifically for that patient/client. The amount of insulin in the syringe must be checked EVERY time before it’s given to assure that the correct dose is administered. You’ll have documentation on what the dose is. If there’s more or less than what is prescribed for the patient/client in the syringe, DO NOT give the insulin. Call the RN or physician and receive instructions on what to do. If the patient/client or a family member tells you the dose has been changed, you must notify the RN before administering any insulin. The RN is the only one who can accept changes in orders. Right Location Insulin injections must be given in different sites. If it’s given in the same place every day, the patient/client will develop tissue problems. It’s very important to document the site of each injection and to determine which site was used last HCL / UP Insulin Admin RN Delegation Rvd. 080116 so that you can alternate the sites. For instance, if the insulin was given in the right thigh on Wednesday, it will need to be given in another site on Thursday. Common sites for injections include the thighs, the upper arms and the abdomen. Exact documentation is essential to avoid complications. Right Route Because the needles are very short, the insulin is delivered to the subcutaneous level of the skin. The skin is first cleansed, usually with an alcohol pad, and allowed to dry. The needle is injected quickly and straight into the skin, the way you would use a dart. Once the needle has pierced the skin, pull back slightly on the plunger of the syringe. This determines if the needle has entered a blood vessel. If blood comes into the syringe, do NOT inject the insulin. Instead, remove the syringe and discard it into a special container that is used for contaminated needles. Notify the RN who will probably direct you to select another syringe and another site to inject the insulin. This is a very rare occurrence. After making sure the needle isn’t in a blood vessel, push the plunger of the syringe, injecting ALL of the insulin in the syringe. Remove the syringe by pulling it straight out. Do NOT put the cap back on the needle. Instead, dispose of it in the container used for contaminated needles. Recapping the needle exposes you to needle sticks. It isn’t unusual for a small amount of blood to escape the skin when the needle is removed. Use a clean tissue or paper towel to wipe the blood. An alcohol pad can be used but remember that alcohol burns broken skin. GLUCOSE METERS As part of your training with the patient/client you’re assigned to care for, the RN will teach you how to perform a procedure to test the patient’s/client’s blood sugar level using a machine called a glucose meter. Because there are many different types of glucose meters, your training will be with the specific machine the patient/client has. The procedure includes sticking the patient’s/client’s skin to obtain a drop of blood and then using the machine to give you the blood sugar level. The RN or physician will also tell you what blood sugar levels that must be reported to an RN or physician. It’s very important that you know what levels to report because monitoring the blood sugar is an important part of the management of diabetes. HCL / UP Insulin Admin RN Delegation Rvd. 080116 DOCUMENTING INSULIN ADMINISTRATION Documenting insulin administration is very important. Always remember that “if it wasn’t documented, it wasn’t done.” Make it a routine to document the injection as soon as it’s given. That way, you’re less likely to forget. Documentation will include the date, the time, the amount, the type of insulin, the location, the patient/client and the one who gave the insulin. You will be given instructions on how to complete the correct forms. Your documentation is very important and becomes a part of the clinical record. If under RN delegation, the RN assigned to supervise you will make visits to the patient’s/client’s home every week. At that time, the RN will assure that you’re following the care plan and that the patient/client wants to continue having you administer the insulin. The RN will also fill the insulin syringes for you to use the next week. This supervision is very important to help the agency and the RN to remain in compliance with Medicare regulations and the nurse’s practice act. Under physician delegation supervision will be determined and documented on the delegated task assignment form. RISKS OF INSULIN There are risks involved with insulin administration and it’s essential that you understand what the risks are in order to help your assigned patients/clients avoid any complications. The production of insulin in the body of someone who doesn’t have diabetes is controlled by how much that person needs to transport the glucose from the blood into the cells. If the non-diabetic eats a lot of sugar, his body produces more insulin. The pancreas also produces another hormone, glucagon, that’s used to increase the blood sugar. If the non-diabetic goes without eating for a long time, his body produces glucagon to increase his glucose to prevent loss of consciousness and even death. As you learned earlier, people who have diabetes don’t produce enough insulin or can’t use the insulin they do produce. Oftentimes, they don’t produce glucagon either. Because the insulin they receive is given in the form of an injection, it can’t be regulated as well as if it were produced by the body. If they don’t eat, the insulin continues to lower the blood sugar and there’s no glucagon being produced to raise it to prevent the loss of consciousness. Because of this, the person with diabetes must eat at regular times throughout the day. HCL / UP Insulin Admin RN Delegation Rvd. 080116 If the patient/client is nauseated or is vomiting and can’t eat, you must notify the RN so the doctor can be called to adjust the insulin. You cannot “hold” the insulin without directions to do so by the RN or physician. When the blood sugar is too low, the person will have an “insulin reaction.” He may feel shaky or hungry, may be irritable and complain of a headache, and may be sweating. If your patient/client experiences any of these signs or symptoms, notify the RN or physician through the office immediately. If the patient/client is conscious, offer fruit juice or milk only as directed by the RN or physician. If you aren’t able to reach the RN immediately, you may give the conscious patient/client juice or milk. Do NOT give the insulin until the RN or physician directs you to do so. In extreme cases, the patient/client may lose consciousness. If this happens, call 911. NEVER attempt to make an unconscious person drink anything. Regardless of how the patient/client feels after drinking something, you must still let the RN or physician through the office know what happened. When a person with diabetes develops an infection, his insulin needs may change. If your patient/client tells you he has unusual aches and pains, has run a fever or has burning with urination, notify the RN or physician through the office. An infection usually makes the blood sugar increase and the RN will call the doctor to determine if the insulin dosage needs to be adjusted. Again, only the physician can order the amount of insulin. Diabetes is a serious disease that causes many complications leading to death every year. While insulin is not a cure but only a treatment for the disease, the proper administration of the drug is instrumental in controlling your patient’s/client’s outcome. Remember that any time you notice a change in your patient/client, call the RN or physician through the office. Your observations of the patient/client and your careful administration of insulin will help the doctor and the RN develop a plan to avoid the complications of diabetes. You are an important part in the patient’s/client’s well-being. HCL / UP Insulin Admin RN Delegation Rvd. 080116 EXAM FOR INSULIN ADMINISTRATION BY UNLICENSED Employee: Date: The employee must make 100 percent to pass this exam 1. Diabetes can cause: A. B. C. D. 2. Insulin can be given by: A. B. C. 3. The patient/client; The RN; The physician; The Unlicensed Personnel (UP). If the patient/client or a family member tells you the doctor changed the insulin order, you should: A. B. C. D. 6. True False The amount and type of insulin a patient/client takes can be determined by: A. B. C. D. 5. Pill; Injection; A and B. When someone with diabetes takes insulin, he can eat anything he wants because the insulin will take care of him. A. B. 4. Heart disease; Kidney failure; Blindness; All of the above. Call the RN; Change the amount as the patient/client or the family member says; Leave the home immediately; Pay no attention to what the patient/client or family member says. The location of the insulin injections should: A. B. C. Be the same every time; Be rotated; Not be of any concern to the UP; 7. When the needle is inserted into the skin, the plunger is pulled back. If blood comes into the syringe, you should: A. B. C. 8. After injecting the insulin: A. B. C. D. 9. True False Insulin must be given: A. B. C. D. 13. The time given; The date given; The location of the injection; The person who gave the injection; All of the above. Once you’ve been trained to give insulin with one of your patients/client, you may then give it to any patient/client. A. B. 12. Call 911; Notify the RN; Notify a family member; Use a clean tissue, paper towel or an alcohol pad to wipe the blood off. Documentation of the injection includes: A. B. C. D. E. 11. Discard the syringe without recapping it in a special container; Carefully recap the syringe and put it in a special container; Carefully recap the syringe and save it to be used again; Throw the syringe in the patient’s/client’s garbage can. If a small amount of blood comes out of the skin when the needle is removed, you should: A. B. C. D. 10. Remove the syringe and discard it in a special container and notify the RN; Quickly inject the insulin without letting the patient/client know because it may alarm him; Think nothing of it because this happens often. Within a one hour “window” of the ordered time; Within a 30 minute “window” of the ordered time; At exactly the same time everyday; Whenever the UP gets around to it. If the patient/client says he doesn’t feel like eating because he has nausea and has been vomiting, you should: A. B. C. D. Ignore him because he probably just wants attention; Notify the RN: Call 911; Don’t give the insulin and don’t complete a note for that day. 14. You should document the injection of insulin: A. B. C. D. 15. If the patient/client says he feels shaky and is sweating and complains of a headache, you should: A. B. C. D. 16. Give him double his usual insulin dose; Call 911; Ignore him because he may be developing senility; Notify the RN. Foods with concentrated sugars include: A. B. C. D. E. 20. True False If the patient/client says he’s had a fever and complains of aches and pains that are unusual for him, you should: A. B. C. D. 19. Call 911; Force some sugar or juice into his mouth; Notify a family member; Notify the RN. Insulin is a cure for diabetes. A. B. 18. Give the insulin immediately; Call the RN and give the insulin while waiting for a reply; Give the patient/client some candy and give the insulin; Call the RN and do not give the insulin until you are instructed to do so. If your patient/client loses consciousness, you should first; A. B. C. D. 17. At the end of the week before you turn in your notes; At the end of the day after you’ve gone home; As soon as you’ve attended to the patient/client and discarded the syringe; This is a trick question — UP can’t document insulin administration. Regular soft drinks; Candy; Steak; A and B; All of the above. A person with diabetes should never exercise because it causes too much of a strain on his body. A. B. True False Graded by: Date: (Name and Title) INSTRUCTIONS FOR WOUND CARE NOTE General Use of the Wound Care Note This form is intended for documentation by Unlicensed Personnel (UP) for documentation of delegated wound care. It may be used to document wound care for multiple wounds, two per page. Form Completion Patient Name, MR#: Enter the patient’s name as it appears in the chart and the medical record number. Wound #: Each wound should be given a number when it is first identified and the number should remain consistent for that wound throughout the episode of care, even if the wound heals. Location: Enter a description of the anatomical location of the wound and also write the wound number on the corresponding location on the graphic of the body. Observations or Changes: Check any that are present. This, or any other complications, would also require RN notification. Wound Care: Document the details of the wound care. Repeat assessment and wound care documentation for each wound. Signature: Sign with full name and title and date and time of wound care. HCL / Wound Care Instructions and Note RN Delegation Rvd. 080116 WOUND CARE NOTE Patient: MR#: Wound # Location: Observations, changes noted Fever No Yes Redness No Yes Swelling No Drainage: No Yes Yes Odor: No reported: No Yes Pain Yes Other: Reported to (RN Name): Wound Care: Date Time Cleaned with with Irrigated Patted dry with gauze Applied (medication) Packed with with Covered with SCTA Tongue blade Other Wrapped with Secured with Other: Wound # Location: Observations, changes noted Fever No Yes Redness No Yes Swelling No Drainage: No Yes Odor: No reported: No Yes Yes Pain Yes Other: Reported to (RN Name): Wound Care: Date Time Cleaned with with Applied (medication) Covered with Irrigated Patted dry with gauze with SCTA Packed with Tongue blade Other Wrapped with Secured with Other: Signature and Title: HCL / Wound Care Instructions and Note RN Delegation Rvd. 080116 Date: Time: AM CAPSTONE HOMECARE, LLC - 1982342903 PM Admit Pack (Spanish Forms are located after the English Forms) PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE H R.1 Page PAGE 1 of 3 PURPOSE To establish policy and procedures for a drug-free workplace. DEFINITIONS: I. Controlled Substance: The term "controlled substance" means a controlled substance in schedules I through V of section 202 of the Comprehensive Drug Abuse Prevention and Control Act of 1970 II. Conviction: A finding of guilt (including a plea of nolo contendere), an imposition of sentence, or both, by a judicial body charged with the responsibility to determine violations of Federal or State criminal drug statutes. POLICY I. Drug Free Workplace: Addendums titled HR.1A describe the instances of when the agency will conduct drug testing. II. Drug Free Workplace: Addendums titled HR.1B describe the source of drug testing the Agency uses to conduct drug tests. III. The Agency and its employees must be alert, responsive and able to perform work in a safe and productive manner. Working "under the influence" of drugs or alcohol creates a risk to the safety and well being of the individual and patients/clients. IV. Per Federal Law 41 U.S. Code 8102 and the Drug-Free Workplace Act of 1988 employees are informed of the following: A. All employees are prohibited from the unlawful or unauthorized manufacture, distribution, dispensing, possession or use of a controlled substance, narcotics or other illegal drugs, alcohol, or prescription medication without a prescription while on company or client premises or on Agency paid time. B. Violation of this policy can result in disciplinary action, up to and including termination of employment. HCL / HR.1 Rvd. 020120 PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE H R.1 V. Page PAGE 1 of 3 The Agency will provide a copy of the policy to anyone applying for services from the Agency, employees on hire and any person who requests the information. PROCEDURE I. The Agency educates all employees during orientation and patients/clients upon admission regarding the drug testing policy. II. Employees must sign an acknowledgment of receipt of the policy. A signed statement will be maintained in the employees’ personnel files. III. All employees are responsible for reporting instances of possible abuse. Reported instances of abuse will be thoroughly and confidentially investigated. Violations may result in disciplinary action up to and including termination depending on the results of the investigation. IV. Agency employees are provided the following information: A. There are substantial dangers of drug and alcohol abuse in the workplace. B. It is the Agency policy to maintain a workplace free of illegally used drugs and abuse of alcohol. C. Management and the Human Resources Department are prepared to advise what counseling and rehabilitation programs are available to employees. D. The Agency may at its sole discretion, require an employee to participate in an appropriate counseling and rehabilitation program as the result of substance abuse violations. 1. E. HCL / HR.1 Rvd. 020120 Refusal to participate in such a program and to submit to “for cause” (reasonable-suspicion) testing during the course of treatment for a reasonable period of time may result in disciplinary action up to and including termination. Employees taking legally prescribed or over-the-counter drugs that might impair mental or physical functions must notify management prior to PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE H R.1 Page PAGE 1 of reporting to work and/or prior to taking the drug after the start of3work. A doctor's note may be required. F. Employees must notify management of drug convictions within five days of such conviction. Management will notify Human Resources immediately. G. If the employee is performing services under a government contract, the Agency will notify the government contracting officer within ten days of the Agency's receipt of a notice of conviction. H. Within 30 days after receiving notice from an employee of a conviction, the Agency will take appropriate personnel action against the employee, up to and including termination. I. The Agency may also require an employee to submit to drug and/or alcohol screening when required by state or federal law, regulation or contractual obligation not otherwise anticipated by this policy. HCL / HR.1 Rvd. 020120 MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS H R.1 Página PAGE 1 de 3 PROPÓSITO Establecer la política y los procedimientos para un lugar de trabajo libre de drogas. DEFINICIONES: I. Sustancia controlada: El término “sustancia controlada” significa una sustancia controlada en los anexos I a V de la sección 202 de la Ley Integral de Prevención y Control del Abuso de Drogas de 1970. II. Condena: Una declaración de culpabilidad (incluida una declaración de nolo contendere), una imposición de sentencia, o ambas, por parte de un organismo judicial encargado de determinar las violaciones de los estatutos penales federales o estatales sobre drogas. POLÍTICA I. Lugar de trabajo libre de drogas: Adendas tituladas HR. 1A describe los casos en que la agencia realizará pruebas de drogas. II. Lugar de trabajo libre de drogas: Adendas tituladas HR. 1B describe la fuente de pruebas de drogas que la Agencia utiliza para realizar pruebas de drogas. III. La Agencia y sus empleados deben estar alertas, receptivos y ser capaces de realizar el trabajo de una manera segura y productiva. Trabajar “bajo la influencia” de las drogas o el alcohol crea un riesgo para la seguridad y el bienestar de la persona y el paciente. IV. Según la Ley Federal 41 del Código 8102 de EE. UU., y la Ley de Lugar de Trabajo Libre de Drogas de 1988, se informa a los empleados lo siguiente: A. HCL / HR.1 Rvd. 020120 Se prohíbe a todos los empleados la fabricación, distribución, dispensación, posesión o uso ilegal o no autorizado de una sustancia controlada, narcóticos u otras drogas ilegales, alcohol o medicamentos recetados sin una receta mientras se encuentren en las instalaciones de la compañía o de un cliente o en tiempo laboral pagado por la Agencia. MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS H R.1 B. V. Página PAGE 1 de 3 El incumplimiento con esta política puede derivar en una acción disciplinaria, hasta e incluyendo el despido. La Agencia proporcionará una copia de la política de Lugar de Trabajo Libre de Drogas a los empleados contratados y a cualquiera que solicite la política. PROCEDIMIENTO I. Durante la orientación, todos los empleados recibirán educación sobre la política de pruebas de drogas de la Agencia. II. Los empleados deben firmar un acuse de recibo de esta política. Una declaración firmada se mantendrá en el expediente personal de los empleados. III. Todos los empleados son responsables de reportar los casos de posible abuso. Los casos de abuso reportados se investigarán a fondo y de forma confidencial. Los incumplimientos pueden derivar en medidas disciplinarias que pueden incluir el despido, dependiendo de los resultados de la investigación. IV. Los empleados de la Agencia reciben la siguiente información: A. Si hay peligros sustanciales de abuso de drogas y alcohol en el lugar de trabajo. B. Es la política de la Agencia mantener un lugar de trabajo libre de drogas usadas ilegalmente y del abuso de alcohol. C. La gerencia y el Departamento de Recursos Humanos están preparados para informar sobre los programas de asesoría y rehabilitación disponibles. D. La Agencia puede, a su exclusiva discreción, requerir que un empleado participe en un programa apropiado de asesoría y rehabilitación como resultado de incumplimientos con el abuso de sustancias. 1. HCL / HR.1 Rvd. 020120 La negativa a participar en un programa de este tipo y de someterse a una prueba “por causa” (sospecha razonable) durante el curso del tratamiento por un período de tiempo razonable puede derivar en una acción disciplinaria, hasta e incluyendo el despido. MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS H R.1 E. Página PAGE 1 de 3 Los empleados que tomaron legalmente medicamentos de venta libre o recetados que podrían afectar las funciones mentales o físicas, deben notificar a la gerencia antes de presentarse a trabajar y/o antes de tomar el medicamento después del inicio de trabajo. Se podría requerir una nota del médico. F. Los empleados deben notificar a la gerencia de las condenas por drogas dentro de los cinco días naturales posteriores a tal condena. La gerencia notificará a Recursos Humanos inmediatamente. G. Si el empleado está realizando servicios en virtud de un contrato con el gobierno, la Agencia notificará al oficial de contrataciones del gobierno dentro de los diez días posteriores a la recepción en la Agencia de una notificación de la condena. H. Dentro de los 30 días posteriores a la recepción de la notificación por parte de un empleado sobre una condena, la Agencia tomará las medidas apropiadas contra el empleado, hasta e incluyendo el despido. I. La Agencia también puede requerir que un empleado se someta a pruebas de drogas y/o alcohol cuando sea requerido por cualquier ley estatal o federal, regulación u obligación contractual no prevista de otra manera en esta política. HCL / HR.1 Rvd. 020120 PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE - FOR CAUSE ADDENDUM HR.1A The Agency conducts drug testing for cause. Staff who have direct contact with patients/clients will be subject to “for cause” (reasonable suspicion) testing when the Agency or its patient/client has reason to believe that drug or alcohol use or a violation of the policy has occurred. HCL / HR.1A For Cause Rvd. 010118 MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS APÉNDICE DE POR CAUSA HR.1A La Agencia realiza pruebas de drogas por causa. El personal que tenga contacto directo con pacientes/clientes estará sujeto a pruebas “por causa” (sospecha razonable) cuando la Agencia o su paciente/cliente tenga motivos para creer que ha ocurrido el uso de drogas o alcohol o un incumplimiento con la política. HCL / HR.1A For Cause Rvd. 010118 PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE - POST ACCIDENT ADDENDUM HR.1A The Agency conducts post-accident drug testing. Staff who have direct contact with patients/clients will be subject to testing if involved in an on-the-job accident, near-miss accident, or an incident where injury or property damage did occur or might have occurred. HCL / HR.1A Post Accident Rvd. 010118 MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS APÉNDICE DE POST ACCIDENTE HR.1A El personal que tenga contacto directo con los pacientes/clientes estará sujeto a las pruebas si se involucra en un accidente, un cuasi-incidente o un incidente en el trabajo en el que ocurrió o pudo haber ocurrido una lesión o daño a la propiedad. HCL / HR.1A Post Accident Rvd. 010118 PAS POLICY MANUAL HOME CARE DRUG FREE WORKPLACE - URINE SAMPLE METHOD ADDENDUM The Agency may use a urine sample as the method/type of drug testing. HCL / HR.1B Urine Rvd. 070118 HR.1B MANUAL DE POLÍTICA PAS ATENCIÓN EN EL HOGAR LUGAR DE TRABAJO LIBRE DE DROGAS APÉNDICE DE MÉTODO DE MUESTRA DE ORINA La Agencia mayo una muestra de orina como método/tipo de prueba de drogas. HCL / HR.1B Urine Rvd. 070118 HR.1B Patient/Client Information - Patient/Client Bill of Rights Patient/Client/Agency Responsibilities Patient/Client Rights A patient/client has the following rights: 1. To be informed in advance about the care to be furnished, the plan of care, expected outcomes, barriers to treatment, and any changes in the care to be furnished. The agency must ensure that written informed consent that specifies the type of care and services that may be provided by the agency has been obtained for every patient/client, either from the patient/client or their legal representative. The patient/client or the legal representative must sign or mark the consent form. 2. To participate in the planning of the care or treatment and in planning changes in the care or treatment. • • • An agency must advise or consult with the patient/client or legal representative in advance of any change in the plan of care. A patient/client has the right to refuse care and services. A patient/client has the right to be informed, before care is initiated, of the extent to which payment may be expected from the patient/client, third-party payers, and any other source of funding known to the agency. 3. To have assistance in understanding and exercising his or her rights. The agency must maintain documentation showing that it has complied with the requirements of this paragraph and that the patient/client demonstrates understanding of rights. 4. To exercise his or her rights as a patient/client of the agency. 5. To have his or her person and property treated with consideration, respect, and full recognition of his or her individuality and personal needs. 6. To be free from abuse, neglect, and exploitation by an agency employee, volunteer, or contractor. 7. To confidential treatment of his or her personal and medical records. 8. To voice grievances regarding treatment or care that is or fails to be furnished, or regarding the lack of respect for property by anyone who is furnishing services on behalf of the agency and must not be subjected to discrimination or reprisal for doing so. HCL / Patient/Client Information - Bill of Rights PAS Rvd. 060118 1 of 3 Patient/Client Information - Patient/Client Bill of Rights Patient/Client/Agency Responsibilities 9. In the case of a patient/client adjudged incompetent, the rights of the patient/client are exercised by the person appointed by law to act on the patient’s/client’s behalf. 10. In the case of a patient/client who has not been adjudged incompetent, any legal representative may exercise the patient’s/client’s rights to the extent permitted by law. Attendant Responsibilities Per Service Plan Bathing and Hygiene Hair and Nail Care Assist with Ambulation and Transfers Dressing Assist with elimination Linen Change Range of Motion Light Meal Preparation Transportation Sitter/companion Light housekeeping pertaining to the patient/client If uncovered services are needed, please notify the Agency or the Nurse so an attempt can be made to assist with this need. Patient/Client Responsibilities Patient/client responsibilities include the following: 1. To provide medical and personal information necessary to plan and carry out care, including information on advanced directives. 2. To follow instructions agreed upon by you and the Agency and to inform the Agency when instructions are not followed. 3. To provide information and releases when required for billing purposes. 4. To allow the Agency to act on your behalf in filing appeals of denied payments of service and to the fullest extent possible in such appeals. 5. To be available to the staff for home visits at reasonable times. 6. To notify the Agency if you are going to be unavailable for a visit. HCL / Patient/Client Information - Bill of Rights PAS Rvd. 060118 2 of 3 Patient/Client Information - Patient/Client Bill of Rights Patient/Client/Agency Responsibilities 7. To provide a safe working environment for the home health staff. 8. To notify the Agency of any changes in treatment made. 9. To inform the Agency of any dissatisfaction with service or care. 10. To participate with the Agency staff in developing a patient/client and family Emergency Preparedness and Response Plan. Agency Responsibilities 1. To be available to respond to the patient/client in a timely manner. 2. To follow the Individualized Service Plan as agreed upon by the patient/client and the agency. 3. To provide patient/client with amount of assistance requested to complete registration process for evacuation assistance of 2-1-1. 4. To triage patients/clients during an emergency/disaster, offering assistance according to triage level and need. 5. To re-evaluate patients/clients following an emergency/disaster and providing care according to need. NonDiscrimination The Agency complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, marital status, religion, or source of payment. HCL / Patient/Client Information - Bill of Rights PAS Rvd. 060118 3 of 3 PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 1 of 13 PURPOSE To identify suspected or alleged victims of abuse, neglect, and exploitation (ANE) and establish appropriate protocols for reporting and/or referring abuse, neglect, and/or exploitation of a patient/client to the appropriate state agency. DEFINITIONS I. "Agency" means an entity licensed under Chapter 142, Health and Safety Code. II. "Employee" means an individual who: A. Is directly employed by the Agency, a contractor, or a volunteer B. Provides personal care services, active treatment, or any other personal services to a patient/client receiving Agency services C. Is not licensed by the state to perform the services the person performs for the Agency. III. “Report” means a report that alleged or suspected abuse or neglect of a patient/client has occurred or may occur. IV. “Adult Abuse" is defined as: A. The negligent or wilful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to an elderly or disabled person by the person's caretaker, family member, or other individual who has an ongoing relationship with the person; or B. Sexual abuse of an elderly or disabled person, including any involuntary or nonconsensual sexual conduct that would constitute an offense under Section 21.08, Penal Code (indecent exposure) or Chapter 22, Penal Code (assaultive offenses), committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person. HCL / PC.3 Rvd. 120120 PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION V. C.3 Page PAGE 1 of 13 “Adult Exploitation" means the illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with the elderly or disabled person using the resources of an elderly or disabled person for monetary or personal benefit, profit, or gain without the informed consent of the elderly or disabled person. VI. "Adult Neglect" means the failure to provide for one's self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide such goods or services. VII. ”Child Abuse” includes the following acts or omissions by a person: A. Mental or emotional injury to a child that results in an observable and material impairment in the child's growth, development, or psychological functioning; B. Causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results in an observable and material impairment in the child's growth, development, or psychological functioning; C. Physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm; D. Failure to make a reasonable effort to prevent an action by another person that results in substantial harm to the child; E. Sexual conduct harmful to the child's mental, emotional, or physical welfare, including conduct that constitutes the offense of continuous sexual abuse of young child or children under Section 21.02, Penal Code; indecency with a child under Section 21.11, Penal Code; sexual assault under Section 22.011, Penal Code; or aggravated sexual assault under Section 22.021, Penal Code; HCL / PC.3 Rvd. 120120 P PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION F. VIII. C.3 Page PAGE 1 of 13 Failure to make a reasonable effort to prevent sexual conduct harmful to a child; G. Compelling or encouraging the child to engage in sexual conduct as defined by Section 43.01, Penal Code, including conduct that constitutes an offense of trafficking of persons under Section 20A.02(a)(7) or (8), Penal Code, prostitution under Section 43.02(a)(2), Penal Code, or compelling prostitution under Section 43.05 (a)(2), Penal Code; H. Causing, permitting, encouraging, engaging in, or allowing the photographing, filming, or depicting of the child if the person knew or should have known that the resulting photograph, film, or depiction of the child is obscene as defined by Section 43.21, Penal Code, or pornographic; I. The current use by a person of a controlled substance as defined by Chapter 481, Health and Safety Code, in a manner or to the extent that the use results in physical, mental, or emotional injury to a child; J. Causing, expressly permitting, or encouraging a child to use a controlled substance as defined by Chapter 481, Health and Safety Code; K. Causing, permitting, encouraging, engaging in, or allowing a sexual performance by a child as defined by Section 43.25, Penal Code; or, L. Knowingly causing, permitting, encouraging, engaging in, or allowing a child to be trafficked in a manner punishable as an offense under Section 20A.02(a)(5), (6), (7), or (8), Penal Code, or the failure to make a reasonable effort to prevent a child from being trafficked in a manner punishable as an offense under any of those sections. “Child Neglect” includes the following acts or omissions by a person: A. HCL / PC.3 Rvd. 120120 The leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child; P PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 1 of 13 B. IX. The following acts or omissions by a person: 1. Placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child; 2. Failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a substantial risk of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child; 3. The failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused; 4. Placing a child in or failing to remove the child from a situation in which the child would be exposed to a substantial risk of sexual conduct harmful to the child; C. Placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse under Family Code Chapter 261 Subdivision (1) (E), (F), (G), or (K) committed against another child. D. The failure by the person responsible for a child's care, custody, or welfare to permit the child to return to the child's home without arranging for the necessary care for the child after the child has been absent from the home for any reason, including having been in residential placement or having run away. “Child Exploitation” means the illegal or improper use of a child or of the resources of a child for monetary or personal benefit, profit, or gain by an employee, volunteer, or other individual working under the auspices of the Agency or program as further described by rule or policy. HCL / PC.3 Rvd. 120120 PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION X. C.3 Page PAGE 1 of 13 “Cause to believe” means that an Agency or individual knows or suspects, or receives allegation regarding abuse, neglect, or exploitation. POLICY I. At hire and annually thereafter, Agency employees, contractors, and volunteers will be educated on signs and symptoms to be aware of indicating possible abuse, neglect, and/or exploitation. II. All Agency employees, contractors, and volunteers are required, and have the legal obligation, to report suspected abuse, neglect, and/or exploitation to the Texas Department of Family and Protective Services (DFPS), the Texas Health and Human Services (HHS) and Agency management. III. The patients/clients will be informed of and educated on this policy, verbally and in writing, during the admission process. If the Agency contracts with HHS for Community Services, the patient/client and their representative will be informed of and educated on this policy, verbally and in writing, during the admission process and at least once every twelve (12) months thereafter. PROCEDURE I. Agency staff, contractor, or representative will: A. Immediately report assessment of the patient’s/client's condition that might indicate abuse, neglect, or exploitation to the Agency supervisor. Signs and symptoms that may indicate a need for further investigation include the following: 1. HCL / PC.3 Rvd. 120120 Signs of physical abuse: a. Injuries to the trunk of the body that indicate intentional rather than accidental harm b. Injury with a patterned appearance to it, i.e., marks from a belt or a ring c. Bruised skin from a grasp, black eyes P PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 1 of 13 2. 3. 4. d. Swelling, cuts, burns, welts, or scratches e. The patient/client reports an abusive incident Signs of emotional/psychological abuse: a. Being emotionally upset or agitated b. Eating issues, increased worry c. Being extremely withdrawn and non-communicative or non-responsive d. Unusual behavior usually attributed to dementia e. Anxiety or depression f. An individual’s report of being verbally or emotionally mistreated Signs of sexual abuse: a. Difficulty walking and/or sitting b. Torn, stained, or bloody clothing c. Genital pain or itching d. External genitalia bruising/bleeding, bruising around breasts e. Dramatic changes in behavior f. An individual’s report of being sexually assaulted or raped Signs of neglect: a. HCL / PC.3 Rvd. 120120 Lack of necessities-food, clothing, shelter PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 1 of 13 5. b. Lack of supervision c. Dehydration, malnutrition, untreated bed sores, poor personal hygiene d. Lack of medical care e. Unsanitary living conditions f. Unsafe living conditions g. An individual’s report of being neglected Signs of exploitation: a. Unpaid bills or unusual activity in bank account b. Frequent expensive gifts to a caregiver c. Unexplained disappearance of funds or valuable possessions d. Care givers refuse to spend money on those they are caring for e. Frequent checks made out to “cash” f. Signatures on documents that don’t match a patient/clients handwriting g. An individuals report of financial exploitation B. When appropriate, acquire input from other disciplines providing care regarding concerns. C. Be knowledgeable of methods to prevent occurrences of abuse, neglect and exploitation, such as: HCL / PC.3 Rvd. 120120 PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 1 of 13 II. 1. Know the signs and symptoms of abuse 2. Ask questions when abuse, neglect, or exploitation is suspected 3. Listen, affirm, and reassure the person that it is never their fault 4. Follow the process to report suspected or reported abuse, neglect or exploitation 5. Refer the person to, or contact, professionals or organizations that have experience in assisting and supporting victims of abuse, neglect and exploitation Agency Management will: A. Initiate an investigation of known or alleged acts of ANE immediately upon witnessing the act or upon receipt of the allegation or upon having cause to believe ANE occurred. B. Report findings and the Agency’s intentions to report the suspected abuse, neglect, or exploitation to the appropriate entities to the patient’s/client's attending physician. Medical Social Services may be ordered by the physician, as appropriate. C. Report if there is cause to believe abuse, neglect, or exploitation of the patient/client has occurred by a staff member, representative, volunteer or contractor immediately, meaning within 24 hours to: D. HCL / PC.3 Rvd. 120120 1. Texas Department of Family and Protective Services at 1-800-252-5400, or through the DFPS secure website at www.txabusehotline.org, and 2. Health and Human Services (HHS) at 1-800-458-9858 The Agency will send a written report, using the Provider Investigation Report form, of the investigation to HHS Complaint Intake Unit no later than the tenth (10) day after reporting the act, verbally or online, to DFPS and HHS. Documentation will be kept confidential by the Agency to the extent required by state law. PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION 1. E. C.3 Page PAGE 1 of 13 The Provider Investigation Report form will include the following: a. Incident date b. The alleged victim c. The alleged perpetrator d. Any witnesses e. The allegation f. Any injury or adverse affect g. Any assessments made h. Any treatment required i. The investigation summary j. Any action taken The Agency will immediately suspend any Agency employee or contractor suspected of abuse, neglect, or exploitation while an investigation is being conducted by the Agency and State agency. If the investigation validates the claim, the employee or contractor will be terminated and the incident(s) reported to appropriate state department, state licensing board, or law enforcement official. III. The Agency will complete the investigation and documentation within thirty (30) days after the Agency received a complaint or report of abuse, neglect, and exploitation, unless the Agency has and documents reasonable cause for delay. IV. The Agency will file a report of child abuse, child neglect, or child exploitation immediately, meaning within 24 hours, with DFPS, local or state law enforcement agency, the state agency that operates, licenses, certifies, or registers the agency in which alleged abuse occurs or other agency designated by the court to be responsible for the protection of children. HCL / PC.3 Rvd. 120120 P PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 10 of 13 A. V. Identify the following, if known in the Child Abuse report: 1. Name and address of child; 2. The name and address of person responsible for the care, custody, or welfare of the child; 3. Any other pertinent information concerning the alleged suspected abuse, neglect, or exploitation. B. Report any incidents of family violence to a local law enforcement agency. C. Track and keep copies of reports filed with the state or local law enforcement. If the Agency contracts with HHS for Community Services, the following requirements will apply, also. A. Agency staff will be trained before assuming job responsibilities and at least annually thereafter, and be knowledgeable of the following: 1. Acts that constitute abuse, neglect, and exploitation include but not limited to the following: a. 2. Yelling, habitual blaming, isolation, infliction of pain or injury to patient/client, unreasonable confinement, misuse of patient/client money, disappearance of patient/client money and/or valuable possession/property, stealing, poor hygiene, patient/client lack of glasses, hearing aids, dentures, prosthetics, etc, lack of food or water, malnutrition, dehydration, untreated skin disorders/rashes, untreated injuries or medical problems, unsanitary living conditions, medication not being given properly. Signs and symptoms of abuse, neglect and exploitation (see section I) 3. HCL / PC.3 Rvd. 120120 Methods to prevent the occurrence of abuse, neglect, exploitation, include but not limited to: PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 10 of 13 B. C. Recognizing signs and symptoms b. Know actions to take when abuse, neglect or exploitation suspected, reported or alleged c. Be aware of those who may be vulnerable and limit their isolation, encourage them to stay in contact with others d. Educate others of signs and symptoms of abuse, neglect, and exploitation and actions to take if suspected, reported or alleged e. Encourage patient/client to avoid sharing their personal information like social security number, date of birth, banking information, etc. f. Assist patient/client in forming support group with friends and family g. Encourage open communication with patient/client At the time of admission and at least every twelve (12) months thereafter, the patient/client and the representative will be instructed verbally and in writing on the following: 1. How to report allegations of abuse, neglect, or exploitation to DFPS and provided with the Abuse Hotline toll-free number, 1-800-252-5400, in writing, and 2. Education about protecting the individual from abuse, neglect, and exploitation. The Agency will take necessary actions to secure the safety of the patient/client if there is suspected abuse, neglect, or exploitation and notify the patient/client as soon as possible, but no later than 24 hours, after the Agency reports or is notified of the allegation the following: 1. HCL / PC.3 Rvd. 120120 a. The allegation report PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION 2. C.3 Page PAGE 10 of 13 The actions the Agency has taken or will take based on the allegation, the condition of the patient/client, and the nature and severity of any harm to the patient/client. . D. If abuse, neglect, or exploitation is confirmed by the investigative authority and the Agency is notified of the confirmation, the Agency will take appropriate action to prevent the reoccurrence of abuse, neglect or exploitation, including, when warranted, disciplinary action against the employee, subcontractor, or volunteer confirmed to have committed abuse, neglect, and/or exploitation. E. The Agency will review reports of confirmed abuse, neglect, or exploitation of which it has been notified, and all final investigative reports received from Texas Health and Human Commission (HHSC) for investigations, at least annually and will identify program process improvements that will prevent the reoccurrence of such incidents, thus improving service delivery. F. In addition to not taking retaliatory action against the patient/client if he or she alleges abuse, neglect, or exploitation that did not occur, the Agency will not take retaliatory action against an employee, subcontractor, volunteer, or any other person who files a complaint, presents a grievance, or otherwise provides good faith information relating to possible abuse, neglect, or exploitation against him or her. G. The Agency will not take retaliatory action against the patient/client if someone on his or her behalf files a complaint, presents a grievance, or otherwise provides good faith information relating to possible abuse, neglect, or exploitation of the patient/client. HCL / PC.3 Rvd. 120120 P PAS POLICY MANUAL HOME CARE ABUSE, NEGLECT, AND EXPLOITATION P C.3 Page PAGE 10 of 13 REFERENCES Texas Administrative Code (TAC) Title 22, Part 11, Chapter 217, Rule §217.11 Texas Administrative Code (TAC) Title 40, Part 1, Chapter 47, Subchapter H, Rule §47.101 Texas Administrative Code (TAC) Title 26, Part 1, Chapter 558, Subchapter C, Rule §558.250 Section 301.402 of the Nursing Practice Act Nursing Practice Act in Texas Occupations Code Chapter 301, Subchapter I HCL / PC.3 Rvd. 120120 Rights of the Elderly Section 102.001 Definitions (1) “Convalescent and nur