10.07.01.31

.31 Hospital Palliative Care Programs.

A. Acute general hospitals and special hospitals-chronic care with 50 or more beds shall establish an active hospitalwide palliative care program that provides consultation services to patients suffering from pain and symptoms due to serious illnesses or conditions.

B. The hospital shall:

(1) Promote the palliative care program;

(2) Provide information and referrals to patients and families when appropriate regarding the availability of palliative care services; and

(3) Inform patients of the patientís right to request a palliative care consultation.

C. Staffing.

(1) The hospital shall designate a qualified interdisciplinary care team with training in palliative care to staff the palliative care program.

(2) The hospital shall ensure that:

(a) A qualified health care professional coordinates the activities of the palliative care program with the palliative care patientís interdisciplinary care team;

(b) Staff is appropriately trained, credentialed, or certified in the staffís area of expertise;

(c) Staff receives continuing training and education; and

(d) Written policies and procedures for the hospital palliative care program are established, implemented, maintained, and updated periodically.

D. Palliative Care Education and Training. The hospital shall provide and document training to medical and other clinical staff as determined by the hospital regarding:

(1) Services provided by the palliative care program;

(2) Domains of palliative care; and

(3) Legal requirements for:

(a) Health care decisions; and

(b) MOLST as referenced in COMAR 10.01.21.

E. Interdisciplinary Plan of Care.

(1) The hospital shall incorporate the recommendations of the palliative care program into the palliative care patientís interdisciplinary care plan.

(2) The hospital shall review the interdisciplinary plan of care and revise it as necessary to meet the needs of the palliative care patient.

(3) The palliative care program shall conduct care conferences as appropriate to review the plan of care with:

(a) The palliative care patient;

(b) The palliative care patientís family;

(c) The health care professionals; and

(d) Other interdisciplinary team members.

(4) Contents. The hospital shall ensure that the palliative care patientís plan of care includes at a minimum:

(a) Initial assessments conducted by the interdisciplinary palliative care team;

(b) Psychological needs assessment;

(c) Treatment goals;

(d) Choice of treatment options;

(e) Preferred care setting;

(f) Availability of hospice services;

(g) Preferred site of death and after-death arrangements, as appropriate;

(h) Grief and bereavement plan, as appropriate;

(i) Assessment of cultural needs;

(j) Assessment of legal needs; and

(k) Assessment of discharge needs.

(5) Collaboration. The hospital shall document and provide palliative care services in collaboration with:

(a) The attending physician; and

(b) Any other health care provider managing the patientís care.

(6) Continuity of Care. The hospital shall coordinate services to ensure continuity of care for the palliative care patient. The hospital shall:

(a) Transfer the pertinent parts of the medical record, medical orders, and plan of care with the palliative care patient upon transfer to post-acute care;

(b) Ensure that MOLST forms are completed in accordance with COMAR 10.01.21;

(c) Convert a palliative care patientís treatment goals into medical orders, as appropriate; and

(d) Have reporting mechanisms to keep all staff informed and updated about care changes and treatment goals.

F. Palliative Care Services.

(1) The hospital or palliative care program shall counsel the palliative care patient or the patientís authorized decision maker regarding:

(a) Health options;

(b) Pain management options;

(c) Prognosis;

(d) Risks and benefits of treatment;

(e) Availability of grief and bereavement services, as appropriate;

(f) Psychological services;

(g) Availability of spiritual care counseling through the hospital or outpatient providers; and

(h) Hospice services, as appropriate.

(2) Referrals.

(a) As appropriate and upon request by the patient or authorized decision maker, the hospital may make timely referrals.

(b) The hospital shall document any referrals made to:

(i) Inpatient or outpatient bereavement providers;

(ii) Psychological services for the palliative care patient and the patientís family;

(iii) Inpatient or outpatient spiritual care services; and

(iv) Hospice.

(3) Pain and Symptom Management. The hospital shall:

(a) Conduct and document pain and symptom assessments using available standardized scales to appropriately manage a palliative care patientís symptoms;

(b) Provide adequate and appropriate dosage of analgesics and sedatives to meet the needs of the palliative care patient; and

(c) Educate the patient and the patientís family about the use of opioids during end-of-life care.

(4) Other Services. The hospital shall provide culturally and linguistically appropriate education and support about how to safely care for the patient at home or in an alternate residential setting as appropriate.

(5) Imminent Death. The palliative care program shall document and counsel the patient, the authorized decision maker, the patientís family, and the interdisciplinary care team about the active dying phase and imminent death as appropriate.

(6) MOLST. The hospital shall comply with the procedures and requirements of the Medical Orders for Life-Sustaining Treatment Form, which is incorporated by reference at COMAR 10.07.21.

(7) Interpreter Services. The hospital shall ensure interpreter services are available and accessible to the palliative care program.

G. Advance Directives.

(1) The hospital shall recognize the authority of:

(a) An advance directive established in compliance with Health-General Article, §5-602, Annotated Code of Maryland; and

(b) An authorized decision maker.

(2) The hospital shall ensure that any provided advance directive and authorized decision maker designation are in the patientís medical record, including the electronic medical record.

(3) The hospital shall promote advance care planning and the completion of advance directives through community outreach activities.

H. Ethics Committee. The hospital shall allow staff, patients, and the patientís family in the palliative care program access to an ethics committee to address ethical conflicts at the end of life.

I. Quality Improvement. The palliative care program shall take part in the hospitalís quality improvement and performance improvement activities to the extent required by State and federal statute.

J. Departmental Oversight. The Department shall have access to all data maintained through the hospitalís palliative care program to determine the hospitalís compliance with State and federal regulations.