Provision of Medical Services and Equipment by a Hospice

While a client is under hospice care, a hospice must provide medical supplies and appliances, durable medical equipment, and drugs and biologicals related to the palliation and management of the terminal illness and related conditions, as identified in the hospice plan of care.

Click on the +/- to learn more about each item related to medical services and equipment. It is the responsibility of the license applicant to read this information in its entirety.

A hospice must ensure that the IDT confers with a person with education and training in drug management, as defined in hospice policies and procedures and state law, who is an employee of or under contract with the hospice to ensure that drugs and biologicals meet a client's needs. The hospice must be able to demonstrate that the person has specific education and training in drug management. Persons with education and training in drug management include:

  • a licensed pharmacist, a physician who is board certified in palliative medicine, or an RN who is certified in palliative care; or
  • a physician, an RN, or an advanced practice nurse who completes a specific hospice or palliative care drug management course.

 

Source: Section 558.860

A hospice that provides inpatient care directly in its own inpatient unit must provide pharmaceutical services under the direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The services provided by the pharmacist must include evaluation of a client's response to medication therapy, identification of potential adverse drug reactions, and recommended appropriate corrective action.

 

Source: Section 558.860

Only a physician or an advanced practice nurse, in accordance with the plan of care, may order drugs for a client.

If the drug order is verbal or given by or through electronic transmission:

  • it must be given only to a licensed nurse, pharmacist, or physician; and
  • the person receiving the order must record and sign it immediately and have the prescribing person sign it in accordance with the agency's policies and applicable state and federal regulations.

 

Source: Section 558.860

A hospice must obtain drugs and biologicals from community or institutional pharmacists or stock drugs and biologicals itself. A hospice that dispenses, stores, and transports drugs must do so in accordance with federal, state and local laws and regulations, as well as the hospice’s own policies and procedures. A hospice that operates its own pharmacy must comply with the Texas Occupations Code, Subtitle J, relating to Pharmacy and Pharmacists.

A hospice that provides inpatient care directly in its own inpatient unit must:

  • have a written policy in place that promotes dispensing accuracy; and
  • maintain current and accurate records of the receipt and disposition of all controlled drugs.

 

Source: Section 558.860

The IDT, as part of the review of the plan of care, must determine the ability of the client or the client's family to safely administer drugs and biologicals to the client in his or her home.


Source: Section 558.860

Clients receiving care in a hospice inpatient unit may only be administered medications by the following persons:

  • a licensed nurse, physician, or other health care professional in accordance with their scope of practice and state law;
  • a home health medication aide; and
  • a client, upon approval by the IDT.

 

Source: Section 558.860

Drugs and biologicals must be labeled in accordance with currently accepted professional practice and must include appropriate usage and cautionary instructions, as well as an expiration date, if applicable.

 

Source: Section 558.861

A hospice must have written policies and procedures for the management and disposal of controlled drugs in a client's home. The policies and procedures must address the safe use and disposal of controlled drugs in a client's home, including:

  • at the time when controlled drugs are first ordered;
  • when controlled drugs are discontinued;
  • when a new controlled drug is ordered;
  • when the client dies; and
  • the manner for disposing and documenting disposal of controlled drugs in the client's home.

 

Source: Section 558.860

At the time when controlled drugs are first ordered for use in a client's home, the hospice must:

  • provide a copy of the hospice's written policies and procedures on the management and disposal of controlled drugs in a client's home to the client or client representative and family;
  • discuss the hospice policies and procedures for managing the safe use and disposal of controlled drugs with the client or legally authorized representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs in the client's home; and
  • document in the client record that the hospice provided and discussed its written policies and procedures for managing the safe use and disposal of controlled drugs in the client's home.

A hospice that provides inpatient care directly in its own inpatient unit must dispose of controlled drugs in compliance with the hospice's policy and in accordance with state and federal requirements, including the Texas Health and Safety Code, Chapter 481, Texas Controlled Substances Act.

The hospice must maintain current and accurate records of the receipt and disposition of all controlled drugs.


Source: Section 558.861(j)

A hospice that provides inpatient care directly in its own inpatient unit must comply with the following additional requirements related to controlled drugs.

All drugs and biologicals must be stored in secure areas. All controlled drugs listed in Schedules II, III, IV, and V of the Comprehensive Drug Abuse Prevention and Control Act of 1976 must be stored in locked compartments within such secure storage areas. Only personnel authorized to administer controlled drugs may have access to the locked compartments.

Discrepancies in the acquisition, storage, dispensing, administration, disposal, or return of controlled drugs must be investigated immediately by the pharmacist and hospice administrator and reported to the Director of Controlled Substances Registration in accordance with 37 TAC Chapter 13 (relating to Controlled Substances). A hospice must maintain a written account of its investigation and make it available to state and federal officials if requested.


Source: Section 558.860

A hospice must ensure that manufacturer recommendations for performing routine and preventive maintenance on durable medical equipment are followed. The equipment must be safe and work as intended for use in the client's environment.

Where a manufacturer recommendation for a piece of equipment does not exist, the hospice must ensure that repair and routine maintenance policies are developed. The hospice may use persons under contract to ensure the maintenance and repair of durable medical equipment.


Source: Section 558.860

A hospice must ensure that a client, where appropriate, as well as the family or other caregivers, receive instruction in the safe use of durable medical equipment and supplies. The hospice may use persons under contract to ensure client and family instruction. The client, family, or caregiver must be able to demonstrate the appropriate use of durable medical equipment to the satisfaction of the hospice staff.

A hospice may only contract for durable medical equipment services with a durable medical equipment supplier that meets the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Supplier Quality and Accreditation Standards at 42 CFR Section 424.57.


Source: Section 558.860