North Carolina Administrative Code

10A NCAC 28D .0106 CONSENT (a) Consents required in Sections .0200, .0300 and .0400 in this Subchapter shall be obtained in writing or verbally over the telephone. (b) Written consent of the client or his legally responsible person shall be obtained whenever possible. Information…

section .0200 – protections regarding certain procedures 10A ncac 28D .0201 least restrictive alternative and PROHIBITED PROCEDURES (a) Each facility shall provide services/supports that promote a safe and respectful environment. These include: (1) using the least restrictive and…

10A NCAC 28D .0202 ELECTROCONVULSIVE THERAPY (a) The treatment/habilitation team may recommend the use of electroconvulsive therapy. (b) Before electroconvulsive therapy can be utilized two licensed physicians, one of whom shall be clinically privileged to perform electroconvulsi…

10A ncac 28D .0203 GENERAL POLICIES REGARDING INTERVENTIVE PROCEDURES (a) This Rule governs the policies and requirements regarding the use of the following interventions: (1) seclusion; (2) physical restraint including: (A) mechanical restraint; or (B) manual restraint; (3) isol…

10A ncac 28D .0204 INDICATIONS FOR USE OF SECLUSION AND ISOLATION TIME-OUT Seclusion and isolation time-out shall be used only: (1) in those situations specified in G.S. 122C-60; (2) after less restrictive measures have been attempted and have proven ineffective. Less restrictive…

10A ncac 28D .0205 INDICATIONS FOR USE OF PHYSICAL RESTRAINTS Physical restraints shall be used only: (1) in those situations specified in G.S. 122C-60; (2) after consideration of the client's physical and psychological well-being as specified in Rule .0203(b) of this Section; an…

10A ncac 28D .0206 PROCEDURES: SECLUSION, physical RESTRAINTS, OR ISOLATION TIME OUT (a) This Rule delineates the procedures to be followed for use of seclusion, physical restraint or isolation time-out in addition to the procedures specified in Rule .0203 of this Section. (b) Th…

10A ncac 28D .0207 PROTECTIVE DEVICES (a) Whenever protective devices that cannot be removed at will by the client are utilized, the state facility shall: (1) assure that the protective device shall be used only to promote the client's physical safety; (2) assure that the factors…

10A NCAC 28D .0208 INTERVENTIONS REQUIRING ADDITIONAL SAFEGUARDS (a) The interventions specified in this Rule present a significant risk to the client and therefore require additional safeguards. These procedures shall be followed in addition to the procedures specified in Rule .…

10A ncac 28D .0209 TRAINING: EMPHASIS ON ALTERNATIVES TO RESTRICTIVE INTERVENTIONS (a) Facilities shall implement policies and practices that emphasize the use of alternatives to seclusion, physical restraint and isolation time-out. (b) Prior to providing services to people with …

10A ncac 28D .0210 training in seclusion, physical restraint and isolation time-out (a) Seclusion, physical restraint and isolation time-out may be employed only by staff who have been trained and have demonstrated competence in the proper use of and alternatives to these procedu…

SECTION .0300 - RIGHT TO REFUSE TREATMENT 10A NCAC 28D .0301 THERAPEUTIC AND DIAGNOSTIC PROCEDURES (a) In addition to the treatment procedures specified in G.S. 122C-57(f), other intrusive procedures which are not routine medical diagnostic or treatment procedures shall require t…

10A NCAC 28D .0302 INTRUSIVE INTERVENTIONS When a client or his legally responsible person refuses treatment or habilitation utilizing interventions specified in Section .0200 of this Subchapter in a non-emergency situation, the following process shall be followed for both volunt…

SECTION .0400 - REFUSAL OF PSYCHOTROPIC MEDICATION 10A NCAC 28D .0401 ADMINISTRATION OF MEDICATIONS IN AN EMERGENCY (a) For the purposes of the rules in this Section, "emergency" means a situation in which a client is in imminent danger of causing physical harm to self or other p…

10A NCAC 28D .0402 BEST INTEREST TEST (a) The responsible professional shall document in the client record that the administration of psychotropic medication against the client's will is in the best interest of the client. "Psychotropic medication administration is in the best in…

10A NCAC 28D .0403 REFUSAL IN STATE FACILITIES OTHER THAN MR CENTERS (a) This Rule applies to all state facilities with the exception of mental retardation centers. Mental retardation centers shall comply with Rule .0404 of this Section. (b) In the case of an emergency, procedure…

10A NCAC 28D .0404 REFUSAL IN REGIONAL MENTAL RETARDATION CENTERS (a) This Rule applies to mental retardation centers. All other state facilities shall comply with Rule .0403 of this Section. (b) In the case of an emergency, procedures specified in Rule .0401 of this Section shal…

SUBCHAPTER 28E - ADVANCE CARE DIRECTIVES FOR CLIENTS SECTION .0100 - RIGHT TO NATURAL DEATH 10A NCAC 28E .0101 SCOPE These Rules set forth the right of an individual to control decisions relating to his medical care, including the right to a peaceful and natural death, as set for…

10A NCAC 28E .0102 DEFINITIONS (a) The definitions contained in this Rule, and the terms defined in G.S. 90-321 shall apply to the rules in this Subchapter. (b) As used in these Rules, the following terms have the meanings specified: (1) "Advance care directive" means any indicat…

10A NCAC 28E .0103 ADVANCE CARE DIRECTIVES The Division shall honor advance care directives made by clients prior to admission or made by capable clients after admission. Division facilities shall decline to honor any advance care directive which does not conform with the require…

10A NCAC 28E .0104 NATURAL DEATH IN ABSENCE OF DIRECTIVE Clients in division facilities retain the right to die with dignity even where they have made no advance care directive, or have made a directive which does not comply with statutory requirements. In the absence of an advan…

SUBCHAPTER 28F – ADMISSION AND DISCHARGE SECTION .0100 - ADMISSIONS 10A NCAC 28F .0101 REGIONS FOR DIVISION INSTITUTIONAL ADMISSIONS (a) Except as otherwise provided in rules codified in this Chapter and Chapters 26 through 29 of this Title and except for State-wide programs and …

section .0200 – voluntary admisions, involuntary commitements and discharges of adults from regional psychiatric hospitals 10A NCAC 28F .0201 SCOPE The rules in this Section apply to admissions, commitments and discharges of all clients to and from the regional psychiatric hospit…

10A NCAC 28F .0202 EXPLANATION OF TERMS For the purposes of the rules in this Section the following terms shall have the meanings indicated: (1) "Area program staff" means professionals who are employees of the area authority or who contract with the area authority or are employe…

10A NCAC 28F .0203 AUTHORIZATION OF HOSPITALIZATION BY AREA PROGRAM (a) Designated area program staff shall authorize all hospitalizations for individuals residing in an area program's catchment area. (b) This authorization shall be done when the individual is evaluated by the ar…

10A NCAC 28F .0204 AUTHORIZATION OF HOSPITALIZATION WHEN INDIVIDUAL ARRIVES DIRECTLY AT HOSPITAL (a) When an individual from an area program arrives at the hospital for admission without area program authorization, the hospital shall contact designated personnel of the individual…

10A NCAC 28F .0205 WRITTEN EVALUATION BY AREA PROGRAM (a) Area program staff shall evaluate each individual prior to authorization and referral to the hospital unless G.S. 122C-262 applies. (b) The evaluation shall be in writing and shall include the following: (1) identifying in…

10A NCAC 28F .0206 ADDITIONAL INFORMATION FOR TREATMENT The following client information, if available, shall be sent with the evaluation which accompanies the individual to the hospital. If not immediately available, it shall be sent, together with any information required by Ru…

10A NCAC 28F .0207 COMMUNICATION TO AREA PROGRAM REGARDING ADMISSION/DENIAL (a) In all instances where area program staff have evaluated, authorized, and referred the individual to a hospital with a recommendation for admission, the area program staff shall call the hospital admi…

10A NCAC 28F .0208 GENERAL CRITERIA FOR ADMISSION (a) Admission staff shall evaluate the individual to determine that: (1) there is the presence of mental illness; (2) the individual is in need of treatment or further evaluation at the facility; and (3) admitting the individual t…

10A NCAC 28F .0209 COORDINATION AND CONTINUITY OF CLIENT CARE (a) Each hospital in conjunction with each area program shall develop a process to assure ongoing communication between the hospital and area program regarding clients in treatment at the hospital. This process shall i…

10A NCAC 28F .0210 NOTIFICATION OF CLIENT HEARING AND/OR DISCHARGE (a) The hospital shall give the authorizing area program 72 hours notice of planned discharge of all clients except those clients for whom unplanned discharge precludes 72 hours notice. In those cases notice shall…

10A NCAC 28F .0211 PLACEMENT OF CLIENTS OUTSIDE THEIR COUNTY OF RESIDENCE Note: Until the effective date of the repeal of Rule .0128 of this Section, this Rule shall supersede. (a) If a discharge plan proposes that a client live in a facility outside his county of residence, hosp…

10A NCAC 28F .0212 RESOLUTION OF DIFFERENCES OF OPINION (a) Differences of opinion between area authority/county program staff and hospital staff regarding admission, treatment or discharge issues shall be resolved through negotiation involving hospital and area authority/county …

10A NCAC 28F .0213 REFERRALS OF MINORS FROM A NON-SINGLE PORTAL AREA (a) In a non-single portal area, in addition to area program staff, a licensed physician or eligible psychologist may refer a minor directly to a hospital. This person shall be known as the "referring agent." (b…

SECTION .0300 - MEDICAL STAFF BYLAWS OF NORTH CAROLINA REGIONAL MENTAL HOSPITALS 10A NCAC 28F .0301 ORGANIZATION OF STAFFS The medical and dental staffs of the four psychiatric hospitals shall organize themselves in conformity with the model bylaws and rules set forth in Rule .03…

10A NCAC 28F .0302 APPLICANTS FOR MEMBERSHIP Applicants for membership on the medical staffs shall be duly licensed or authorized to practice medicine or dentistry in the State of North Carolina according to those standards set forth by the North Carolina State Board of Medical E…

10A NCAC 28F .0303 MEDICAL DIRECTOR OF HOSPITAL The medical director of a hospital shall be a member of the hospital medical staff and shall be a medical doctor duly licensed to practice medicine in the State of North Carolina with approved training and experience in the practice…

10A NCAC 28F .0304 APPLICATION PROCESS Applicants for the medical staff may be appointed or reappointed by the Director of the hospital with concurrence of the Director of Clinical Services and after consultation with the credentials committee. Appointment to the medical staff sh…

10A NCAC 28F .0305 RESTRICTION OR TERMINATION OF STAFF PRIVILEGES Should the superior of any physician or dentist recommend restriction or termination of the employment of any physician or dentist of the medical staffs for personal conduct or performance of duties issues as speci…

10A NCAC 28F .0306 EMERGENCY AND TEMPORARY PRIVILEGES The Director and Director of Clinical Services shall have the authority to grant emergency and temporary privileges to a qualified physician who is not a member of the medical staff for a period of time not to exceed 30 days. …

10A NCAC 28F .0307 DIVISIONS OF STAFF The medical staff shall be divided into honorary, visiting, active, and resident staffs. Officers, standing and special committees shall be elected and appointed with duties assigned, including meeting schedules and attendance requirements, i…

10A NCAC 28F .0308 MEDICAL STAFF BYLAWS FORM (a) Preamble (1) Recognizing that the medical and dental staff is responsible for the quality of medical care in the hospital and must take steps to assume this responsibility, and that the best interests of the patient are protected b…

SECTION .0400 - HOSPITAL BEHAVIOR THERAPY PROGRAMS 10A NCAC 28F .0401 SCOPE (a) The purpose of Rules .0401 through .0406 of this Section shall be to set forth the requirements and general framework for behavior therapy programs used in the treatment of mental illness. (b) The rul…

10A NCAC 28F .0402 DEFINITIONS For the purposes of the rules in this Section the following terms shall have the meaning indicated: (1) Behavior therapy shall be defined as the systematic application of principles of conditioning and learning for the purpose of changing or remedia…

10A NCAC 28f .0403 IDENTIFICATION OF BEHAVIOR THERAPY PROGRAMS The Director of each hospital shall be responsible for the identification of treatment programs in the hospital that qualify as behavior therapy according to the definition given in Rule .0402(1) of this Section inclu…

10A NCAC 28F .0404 REQUIRED FACILITY MANUALS The Director of each hospital shall be responsible for the development of a manual which shall establish the framework and general operating procedures for behavior therapy programs in the hospital. The manual shall not be overly const…

10A NCAC 28F .0405 REQUIRED PROGRAM MANUAL (a) The Director of each behavior therapy program of a regional psychiatric hospital shall be responsible for the development of an operations manual which shall communicate the purpose and operating procedures of the program. The manual…

10a NCAC 28F .0406 INSTITUTIONAL BEHAVIOR THERAPY COMMITTEE (a) The Director of each hospital shall establish an institutional behavior therapy committee to: (1) review, at least annually, program-wide applications of behavior therapy (e.g., Behavior Therapy Ward); (2) be availab…

SECTION .0500 - DESIGNATION OF RESEARCH FACILITIES IN REGIONAL PSYCHIATRIC HOSPITALS 10A NCAC 28F .0501 SCOPE The rules in this Section establish procedures by which a regional psychiatric hospital may be designated as a facility where adults who are not otherwise admissible as c…