(a) Purpose. This rule establishes conditions and procedures for youth to be admitted to and discharged from infirmaries in Texas Juvenile Justice Department (TJJD) facilities.
(b) General Provisions.
  (1) Nursing care will be provided in the infirmary at each institution through contract health care staff for youth who do not need hospitalization but who need increased observation or medical care. Infirmary admissions are utilized for youth who are acutely ill, injured, medically compromised due to mental health decompensation, or recovering from surgery or illness.
  (2) Juvenile correctional officers shall supervise youth admitted to the infirmary at all times.
  (3) Only nursing staff may receive medical orders from the medical provider.
(c) Infirmary Admission for Medical Diagnosis.
  (1) The medical provider or health services administrator or designee determines if a youth requires observation or treatment for a medical diagnosis or condition.
  (2) The health services administrator or registered nurse designee may admit a youth to the infirmary for a medical diagnosis or condition for up to 24 hours. Only a medical provider may authorize admission to the infirmary for 24 hours or longer.
  (3) Only a medical provider may discharge the youth if the youth:
    (A) was admitted to the infirmary for 24 hours or longer; or
    (B) was admitted by a medical provider for any length of time.
  (4) A nurse or medical provider may discharge the youth if he/she was admitted to the infirmary by a nurse.
(d) Infirmary Admission for Psychiatric Monitoring.
  (1) A psychiatrist or physician, if readily available, may admit a youth to the infirmary for close observation and/or monitoring after a psychiatric-related incident. The designated mental health professional may authorize the admission when a psychiatrist or medical provider is not readily available. The nurse will immediately notify the psychiatrist, or a physician if a psychiatrist is not available, and document the notification and any order/instructions in the electronic medical record. Psychiatrist or physician orders shall be obtained for youth admitted to the infirmary within two hours of admission.
  (2) In obtaining psychiatrist or physician orders for youth experiencing a psychiatric crisis, nursing staff provides the psychiatrist relevant medical information such as current medications, vital signs, subjective or objective data (e.g., laboratory values),observations, and assessment. The psychiatrist or physician order includes instructions regarding any observations that nursing staff must make about the youth's mental status, as well as instructions for any other type of monitoring or medications that are to be administered.
  (3) A Ph.D. level psychologist or psychologist associate (if a Ph.D. level is not available) evaluates the youth at least once a day.
  (4) Disposition (discharge or referral) is made by the psychiatrist or physician.

Source Note: The provisions of this §380.9186 adopted to be effective December 16, 1999, 24 TexReg 10372; amended to be effective August 1, 2009, 34 TexReg 4916; transferred effective June 4, 2012, as published in the Texas Register June 22, 2012, 37 TexReg 4639; amended to be effective April 15, 2015, 40 TexReg 1976