## Requirements # 4. Requirements This section outlines the functional and business requirements for the system, as derived strictly from the provided context. All requirements are organized according to ISO/IEC/IEEE 29148 structure and are traceable to their source. --- ## 4.1 Functional Requirements ### 4.1.1 Home Nursing (訪問看護) - The responsibilities of administrators at home nursing stations must be clarified and requirements reviewed to ensure both the quality of provided home nursing and efficient station operation. [KB-01a2d77c-a20a-47e5-ae19-16ab2c89e272] - Measures for the prevention of abuse and the proper use of physical restraints in home nursing must be institutionalized. The establishment of an organizational structure for abuse prevention is mandatory, and physical restraints are, in principle, prohibited. [KB-01a2d77c-a20a-47e5-ae19-16ab2c89e272] [KB-e14d657a-8970-4e3e-9ccb-5662af7d6525] - The requirements and evaluation for frequent visit additions (頻回訪問加算) must be reviewed to ensure appropriate assessment based on patient conditions. [KB-17ac1ec0-b2d4-4910-9884-a2e46ea25ce0] - The requirements and evaluation for the 24-hour response system addition (24時間対応体制加算) must be revised, considering initiatives to reduce nursing workload and reviewing the handling of the communication system for 24-hour response. [KB-06db46ba-7647-483b-9f38-f7fa62a24d77] - The requirements and evaluation for emergency home nursing visit additions (緊急訪問看護加算) must be reviewed to ensure proper provision of emergency designated home nursing, and the content of home nursing care fee statements must be revised. [KB-4be6a015-623d-440c-95dd-a51bf556ebbd] - The requirements and evaluation for home nursing management care fees (訪問看護管理療養費) must be reviewed to strengthen the functions of home nursing stations and ensure high-quality, effective care that meets diverse user and regional needs. [KB-aeb72a17-5d44-4c8e-b3c6-e83c459da003] - Abuse prevention measures in home nursing, including the establishment of an organizational structure and the prohibition of physical restraints, must be institutionalized. [KB-e14d657a-8970-4e3e-9ccb-5662af7d6525] - The requirements and evaluation for discharge support and guidance additions (退院支援指導加算) must be enhanced based on the user’s condition and the status of home nursing provided on the day of discharge. [KB-b375a84b-c77e-4084-a4a2-a2e0f2c22a9a] - Upon introduction of the online eligibility confirmation system (オンライン資格確認等システム), at the initial visit, the system must acquire and utilize user medical and medication information to manage the implementation of designated home nursing and provide high-quality medical care. [KB-9e53203f-143a-4301-abb8-e7bd7dde87af] ### 4.1.2 Physical Restraint Minimization - Medical institutions must establish an organizational structure to minimize the use of physical restraints and strengthen initiatives to reduce their use. [KB-8445364a-473a-46bc-8207-fb1f2671bde6] [KB-edc81296-4474-4138-a404-f797f293eb19] - The requirements and evaluation for dementia care additions (認知症ケア加算) must be reviewed, including the necessity to identify delirium in assessments. [KB-c2bd624b-5c92-413c-be0e-30abb7e64211] ### 4.1.3 Nursing Staff and Assistant Collaboration - The requirements and evaluation for the enhancement of the nursing assistant system addition (看護補助体制充実加算) must be reviewed to further promote the division and collaboration of duties between nursing staff and assistants, and to promote efforts to minimize physical restraints. [KB-05c4460e-0933-40a9-962c-fc2be422e060] ### 4.1.4 Medication Management and Guidance - When a pharmacist confirms the need, with patient consent, the pharmacist must ensure proper medication use and continue to monitor and provide necessary information to medical institutions after dispensing. [KB-0dc6dd3d-3ecc-4685-9f43-b8bcb2ab8ce4] [KB-37919876-98a0-4f81-879a-7de2d13e4a0f] - Pharmacists must provide necessary guidance and management for patients prescribed narcotics, confirming usage, storage, and side effects, and add 100 points per instance to the designated score. [KB-24385190-0703-42d1-a834-6854e998b904] [KB-66969593-ac17-45cd-a41d-f335a2406225] [KB-ad7d4dc3-8896-4c1b-92c7-8d969120b377] - For patients requiring special safety management drugs, pharmacists must confirm medication status and side effects, provide necessary management and guidance, and add the designated points per instance. [KB-f271747d-fadb-4d69-9ff8-ea0f4702f4f2] [KB-fde2b685-c7c4-44c8-9de7-3a7051dd9005] - For pediatric patients with disabilities as defined by the Child Welfare Act, pharmacists must confirm necessary information directly with the patient or family, provide required guidance on medication, and record the guidance in the patient’s notebook, adding 350 points as a pediatric specific addition. [KB-6bb697eb-fdad-4cda-a697-9d148e072b9d] [KB-ba91d9ab-b335-4929-9779-694ba115ef39] - For patients with asthma or chronic obstructive pulmonary disease (COPD) prescribed inhaled medications, pharmacists must provide necessary management and guidance using written materials and practice inhalers, and provide required information to medical institutions, adding 30 points once every three months as an inhaler guidance addition. [KB-604920cd-689f-4a10-97db-9faeb614d499] [KB-ef609548-ff37-4388-9fd5-c638d8bf6eab] - When multiple medications are prescribed, pharmacists must support medication management, including one-dose packaging and necessary guidance, and calculate scores according to the number of days of medication. [KB-07f1aee1-1797-47ce-a5e9-b2462436b453] [KB-ff3ce6e4-b5ec-4058-afe5-c24124781336] - When duplicate prescriptions are identified, pharmacists must propose solutions to the prescribing physician in writing, and the designated score can be calculated once every three months. [KB-50d4fc2a-962d-4820-a105-6ba75b15cf4c] [KB-f2bbf07b-2196-40f3-9da7-66b45e6dd128] ### 4.1.5 Discharge and Home Care Support - For patients discharged from medical institutions, if the designated pharmacy pharmacist is responsible for post-discharge home medication management guidance, with patient consent, the pharmacist must provide necessary guidance and calculate the discharge joint guidance fee (退院時共同指導料) of 600 points. [KB-061bef49-5443-4529-80cb-0067c3bedc4f] [KB-1eebb670-f513-40ab-a8bc-7127863e3404] [KB-44db8f45-e972-47c4-ba46-8ad6a816615e] - For patients with cancer, pharmacists must confirm the treatment plan in writing, provide necessary management and guidance, obtain patient consent, and, for oral or injectable anti-cancer drugs, confirm medication status and side effects by phone, and provide necessary information to medical institutions in writing. [KB-1a041fdb-9f3f-4485-887a-113bbc6d3aa7] [KB-b2731f14-7331-4d15-827d-89f8aed2bcb1] ### 4.1.6 Dementia Care - Medical institutions must strengthen efforts to minimize physical restraints for dementia patients and establish an organizational structure to this effect. [KB-8445364a-473a-46bc-8207-fb1f2671bde6] - The requirements and evaluation for dementia care additions and delirium high-risk patient care additions must be reviewed, including the necessity to identify delirium in assessments. [KB-c2bd624b-5c92-413c-be0e-30abb7e64211] --- ## 4.2 Business Requirements - Medical institutions must review administrative procedures related to facility standards notification and insurance claim submissions to improve operational efficiency and reduce administrative burden. The digitization of facility standards notification must be promoted. [KB-b952325d-d264-48ac-afd5-532c6ea95025] --- ## 4.3 Interface Requirements - When providing medical information, pharmacists must ensure that necessary information is provided in writing to medical institutions, including after dispensing, and to care managers as required. [KB-c35807e4-304e-4ca5-8e86-e1404c20a9fd] --- ## 4.4 Quality and Security Requirements - Medical institutions must review requirements and evaluation for the management of medical records, including the establishment of cybersecurity measures for emergencies, in accordance with the "Guidelines for the Safe Management of Medical Information Systems." [KB-f2add61c-f758-48b5-bf48-6956eec6aa8a] --- ## 4.5 Constraints - For certain additions (e.g., narcotics management, home care emergency guidance), calculation is limited to a specified number of times per month. [KB-473d2d4d-0a06-4fe0-990e-29bef944a7c7] [KB-95340505-f820-4879-9646-0167a0508c15] --- [GAP: Missing data for Requirements] (If any required content is not covered by the context, it is indicated as a gap above.) --- **End of Requirements Section**