(a) Modifying the environment and monitoring the patient.
A hospital shall protect a patient by taking the following measures:
(1) modifying the hospital environment based on the
patient's needs, including:
(A) providing furnishings that do not present safety
hazards to the patient;
(B) securing or removing objects that are hazardous
to the patient; and
(C) installing any necessary safety devices;
(2) monitoring the patient at the level of monitoring
most recently specified in the patient's medical record; and
(3) making roommate assignments and other decisions
affecting the interaction of the patient with other patients, based
on patient needs and vulnerabilities.
(b) Levels of monitoring. A hospital shall:
(1) define each level of monitoring in the hospital's
policies and procedures, including a description of the responsibilities
of staff members for each level of monitoring;
(2) implement the level of monitoring ordered by the
physician, or physician-delegated physician's assistant or advanced
practice registered nurse, based on the individual's needs; and
(3) document the clinical justification for any level
of monitoring.
(c) Separation of patients by age. A provider that
delivers mental health community services to children and adolescents
in group settings (e.g., residential, day programs, group therapy,
partial hospitalization, and inpatient) shall separate children and
adolescents from adults. The provider shall further separate children
from adolescents according to age and developmental needs, unless
there is a clinical or developmental justification in the medical
record.
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