TAC §97.405(p) contains specific guidance about physician orders.

HCSSAs providing home dialysis services must properly obtain and document medical orders for client dialysis in an acceptable manner and timeframe.

Additionally, HCSSAs providing home dialysis services must ensure that staff have appropriate medical orders that address each required element of dialysis care.

If physician's orders are received verbally, they must be confirmed in writing within a reasonable time frame. An agency must adopt and enforce a policy on the time frame for the countersignature of a physician's verbal orders. Medical orders for home staff-assisted dialysis must be revised as necessary but reviewed and updated at least every six months.

The initial orders for home staff-assisted dialysis must be received prior to the first treatment and must cover all pertinent diagnoses, including mental status, prognosis, functional limitations, activities permitted, nutritional requirements, medications and treatments, and any safety measures to protect against injury.

Orders for home staff-assisted dialysis must include frequency and length of treatment, target weight, type of dialyzer, dialysate, dialysate flow rate, heparin dosage, and blood flow rate, and must specify the level of preparation required for the caregiver, such as a licensed vocational nurse or registered nurse.

Source: 40 TAC §97.405(p)