<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".18" citation="COMAR 10.07.05.18" title_num="10" subtitle_num="07" chapter_num="05" heading="Special Requirements for the Provision of Ventilator Services.">
  <paragraph num="A.">
    <text>A provider of ventilator services shall meet the requirements of this regulation in addition to meeting the requirements of Regulations .01—.16 of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>This regulation applies to ventilator services provided in the home, including:</text>
    <paragraph num="(1)">
      <text>Volume ventilation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Pressure ventilation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Emergency back-up power systems;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Alarms and troubleshooting equipment;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Emergency resuscitation; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>All related medical equipment used with the provision of ventilator services, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Nebulizers;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Suction equipment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Oxygen.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Education and Training. When an agency provides ventilator services, the agency shall:</text>
    <paragraph num="(1)">
      <text>Use either a licensed registered nurse or a licensed respiratory care practitioner to supervise the provision of education and training and written instruction to the client, client representative, or individual caring for the client; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide retraining and review on a monthly basis, and as frequently as necessary.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Client Record. For a client receiving ventilator services, the agency shall maintain a clinical record, in addition to the documents required to be maintained in accordance with the provisions set forth in Regulations .14 and .15 of this chapter, that includes the following:</text>
    <paragraph num="(1)">
      <text>An evaluation of use of the ventilator and all related medical equipment by the client, client representative, or individual caring for the client that includes:</text>
      <paragraph num="(a)">
        <text>Training at least monthly on the provision of ventilator services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Retraining, more frequently as needed, on the provision of ventilator services;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A prescription that includes the mode, frequency, and ventilator settings;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Respiratory and all specialized services, including the results, complications, and outcomes;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Physician orders and pharmacy-dispensed respiratory medications;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Evidence that the client, client representative, or individual caring for the client was instructed that medications are to be obtained from a licensed pharmacy; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A discharge summary when a client is no longer receiving ventilator-related services.</text>
    </paragraph>
  </paragraph>
</regulation>