<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".26" citation="COMAR 10.07.21.26" title_num="10" subtitle_num="07" chapter_num="21" heading="Inpatient Hospice Care.">
  <paragraph num="A.">
    <text>In addition to the other requirements of this chapter, when a hospice care program delivers inpatient care, the hospice care program shall provide nursing services 24 hours a day in a manner sufficient to meet the total nursing needs identified in the patient's plan of care. A registered nurse shall be on duty during each shift.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The hospice care program shall design and equip all areas for the comfort and privacy of patients and family members. Specifically, the hospice care program shall:</text>
    <paragraph num="(1)">
      <text>Provide accommodation for family members to remain with the patient throughout the night;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide an adequate supply of hot water at all times for patient use;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Have available at all times a quantity of linen sufficient for proper care and comfort of patients;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Make provisions for isolating patients with infectious diseases; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provide privacy for patient/family visitation and accommodations for the family's privacy immediately after a patient's death.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The hospice care program shall provide food services designed to meet the nutritional needs of the patients, in accordance with physician orders and the following guidelines:</text>
    <paragraph num="(1)">
      <text>At least three meals shall be served each day with not more than 14 hours between the evening meal and breakfast, unless otherwise prescribed by the patient's physician;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>All foods shall be stored, prepared, and served as required by COMAR 10.15.03; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Medically prescribed special diets shall be planned by a registered dietitian or licensed nutritionist.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>In addition to all other State and federal requirements, all medications shall be labeled, stored, and administered in accordance with the following:</text>
    <paragraph num="(1)">
      <text>All medications shall be ordered by a physician;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>All medications shall be administered by a licensed nurse or physician;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>All medications shall be labeled in accordance with Health-General Article, §21-221(a), Annotated Code of Maryland, 21 U.S.C. §§301 et seq. and 801 et seq.;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>All medications shall be stored in locked compartments under proper temperature control and all schedule II drugs shall be maintained separately from other medications and secured by use of two different locks; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>All medications no longer needed by the patient shall be destroyed in the presence of two witnesses authorized by the hospice care program.</text>
    </paragraph>
  </paragraph>
</regulation>