HIGHLIGHTS OF THE MICHIGAN PUBLIC HEALTH CODE

ADMINISTRATIVE MANGAMENT OF FACILITIES

-Employees must be in good health and free from communicable disease

-Employees must have TB skin test upon hire and annually thereafter
-If test is positive, report to local health department and get chest x-ray
-Students and volunteers must not have signs of infection and must be trained on this

-Must have MD recommendation or referral to admit a resident

-Resident must have attending physician before admission
-Must have MDCH permission to admit anyone <15 years old

-Accidents and life threatening changes must be reported to MD and family

-Immediate investigation must be initiated when accidents happen
-Communicable diseases, poisoning, etc., must be reported to local health department

-MD and family to be notified when patient dies; a record of these contacts must be kept

-Facility must communicate to residents in a way so they are able to understand

-If resident cannot understand anything, then the above rule would apply to family
-If resident refuses treatment, MD must determine if this prevents facility from giving
appropriate care. MD documentation must be kept in the chart
-Facility rules and regulations are to be publicly posted
-They also have to be given to all residents

-If provider requires cash payment from a Medicare or Medicaid resident, it’s illegal
-Payment to be returned with compound interest (along with penalties from State)

PATIENT CARE

-Must respect feelings and attitudes of residents at all times

-Must have a patient care policy committee (MD, DON, NHA, others as needed)
-Must have policy on O2 use
-Can only give O2 if trained and if ordered by a MD or it’s an emergency
-Blood transfusion to be given by MD or RN
-IV fluids must have MD order and started/monitored by MD or RN
-Residents must have TB skin test and chest x-ray upon admission
-Must have infection control policies and an infection control committee
-Virtually any interested party must be allowed to review patient care policies
-“Buddy system” cannot be used as the only method for training nurse aides
 PHYSICIAN SERVICES

-All residents must have a MD

-MD phone numbers must be at the nurse’s station
-MD to evaluate and document such 5 days prior to admit or 48 hours afterwards
-Can wait 72 hours if resident is admitted on Friday
-Residents must be seen at least every 60 days
-If MD documents appropriate justification, can be seen every 6 months instead
-PA can alternate visits with MD

NURSING SERVICES

-DON is a RN with training or experience in gerontology

-Must have a charge nurse (LPN or RN) on every shift
-Must have <30 beds for the DON to also serve as charge nurse
-Must be 17 to work in a nursing home (18 if on night shift)
-Cannot work night shift if worked somewhere else in the past 8 hours
-Exemption: Can temporarily work if no one else is available
-A nurse is not on duty unless awake and fully dressed
-Must have <50 beds for NHA to also serve as DON
-Must work 2+ continuous hours to be included as a FTE
-Must keep time cards for 2 years
-Must submit quarterly staffing reports to MDCH
-Ward clerks/secretaries are not considered nursing staff, just RN, LPN, NA
-Oral care to be provided daily
-Hands to be washed before and after meals
-Vital signs to be recorded at least monthly
-Shoes if ambulatory, socks if not
-Nursing assessment must be done within 24 hours of admission
-Must have care plan meeting every 90 days; must include discharge planning
-Bed must be 3’x6’ with a 5” thick mattress
-Sheets to be changed 2x/week if bedfast and 1x/week if ambulatory
-Must provide diversional activities 7 days per week
-Must allow formation of resident and/or family councils

DIETARY SERVICES

-Must be overseen by RD, CDM, or dietetic technician

-If not a RD, must have RD consultant 4 hours every 60 days
-Cannot go over 14 hours between dinner and breakfast
-Can increase to 14.75 hours if an evening snack is served
-Weekly menus must be posted and then retained for 3 months
-Must change menus if there is a variance with the food actually served
-A meal census must be maintained for 3 months
-Must keep a food intake log for the first 14 days following admission
-Must keep a food intake log for 14 days after a diet change
-Must keep a food intake log as ordered by MD

PHARMACEUTICAL SERVICES

-Must maintain an emergency medication kit

-Controlled substances and refrigerated substances must be double locked
-Facility must maintain a list of approved abbreviations for charting
-Must have MD order for resident self-administration of meds
-Charge nurse, MD, and RPh must be promptly notified of medication errors
-MD, NHA, DON, or RPh must initiate corrective action
-Must have policy on automatic stop orders
-Must dispose of outdated or unused medications
-Must have MD order to send resident home with medications when discharged

OTHER SERVICES

-Diagnostic tests must have a MD order

-NHA is responsible for arranging transportation to/from outside diagnostic tests
-Reports of diagnostic tests must be on the chart within 1 week
-Dental services and social services shall be provided

RECORDS

-Chest x-ray must be obtained on each resident within 90 days of admission

-Records must be fully processed within 30 days of discharge
-Records must be kept for 6 years after discharge
-Pediatric records must be kept for 3 years following the age of majority
-If there are medical records problems, get a RHIA/RHIT consult for 4 hours/6 months
-A patient register must be maintained and shall include disposition after discharge
-Must maintain accident/incident records to include corrective measures taken
-Daily work schedules shall be completed and retained for 3 months
-Facility must have at least 1 medical audit conducted per year
-UR and QAA is to be conducted per federal standards
 BUILDING AND GROUNDS

-Narrative plans are to be submitted before blueprints

-Ramps, steps, and porches must have adequate lighting
-An exterior stair or ramp must have handrails on both sides
-Porches must have a railing on open sides
-Bedrooms must have windows that = 10% of floor space
-45% of the window must be openable unless there is air conditioning
-Must have dayroom, activities, dining space = 30 square feet per bed
-Ceilings must be higher than 7’6” (8’ in bedrooms)
-No bedrooms in the basement
-Toilet rooms must be at least 3’ wide
-Elevators must be at least 5 X 7’6”
-Must have 20’ of unobstructed vision space from a window
-Emergency power supply must provide 4 hours of service at normal load
-Bedroom square footage: 100 if private, 80 per person if shared
-5 square feet per bed for wardrobe and storage
-Flameproof cubicle curtains are required if not in a private room
-At least 2 duplex electrical outlets per room, 1 which must be near head of bed
-No more than 4 beds per room
-Must have a 3’ clearance between beds
-An isolation room must be available in the facility
-Bedrooms must be located within 120’ of a nursing station
-Nurses’ stations must have a telephone connected to an outside line
-There must be 1 bathing area for every 20 beds, per floor
-1:5 bathing facilities must accommodate wheelchairs, at least 1 per floor
-Restrooms and bathing/shower rooms cannot be used for storage or housekeeping
-Plumbing systems must eliminate the possibility of backflow
-Facilities with well water must have the water tested every 3 months
-Hot water must be maintained between 105-120 degrees
-Biohazardous waste must be incinerated
-Rooms must have a temperature of 72 degrees measured 3 feet above the floor
-Each refrigerator and freezer must have a thermometer
-There must be 10 feet of storage space per bed
-There must be an examination and treatment room in the facility
-The use of common towels for hand-drying is prohibited