## Requirements # 5. Requirements This section defines the functional and, where available, business and constraint requirements for the system, as derived from the provided context. All requirements are traceable to their source context blocks. --- ## 5.1 Functional Requirements ### 5.1.1 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 home nursing services and efficient operation of the stations. [KB-01a2d77c-a20a-47e5-ae19-16ab2c89e272], [KB-17ac1ec0-b2d4-4910-9884-a2e46ea25ce0] - Systems must be established to prevent abuse in home nursing, and the implementation of such abuse prevention measures is mandatory. Physical restraints and similar measures 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) in home nursing must be reviewed to ensure appropriate assessment based on the patient’s condition. [KB-17ac1ec0-b2d4-4910-9884-a2e46ea25ce0] - The requirements and evaluation system for the 24-hour response system addition (24時間対応体制加算) must be revised to consider efforts to reduce the burden on nursing staff and to review the handling of communication systems for 24-hour support. [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 appropriate provision and to update the documentation requirements for home nursing care fee claims. [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, ensuring high-quality and effective care in response to diverse user and regional needs. [KB-aeb72a17-5d44-4c8e-b3c6-e83c459da003] - Abuse prevention measures and the proper handling of physical restraints in home nursing must be institutionalized, with physical restraints generally prohibited. [KB-e14d657a-8970-4e3e-9ccb-5662af7d6525] - For initial home visits, the online qualification confirmation system must be utilized to obtain and use patient medical and medication information for planned management and provision of high-quality care. [KB-9e53203f-143a-4301-abb8-e7bd7dde87af] --- ### 5.1.2 Nursing and Physical Restraint - The requirements and evaluation for the enhancement addition for the nursing assistant system (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 encourage efforts to minimize physical restraint. [KB-05c4460e-0933-40a9-962c-fc2be422e060] --- ### 5.1.3 Dementia Medical Care - Medical institutions must establish organizational systems to minimize the use of physical restraints for dementia patients. [KB-8445364a-473a-46bc-8207-fb1f2671bde6], [KB-edc81296-4474-4138-a404-f797f293eb19] - The requirements and evaluation for the dementia care addition (認知症ケア加算) must be reviewed, including the necessity to distinguish delirium during assessment. [KB-c2bd624b-5c92-413c-be0e-30abb7e64211] --- ### 5.1.4 Medication Management and Pharmacy - Pharmacists must confirm and evaluate the medication status of patients, especially for those with malignant tumors, and provide necessary pharmaceutical management and guidance. For such cases, information must be documented and provided to medical institutions, with specific additions applied as per the following table: | Scenario | Addition Type | Points | Frequency | Source | |-------------------------------------------------------------------------------------------|-----------------------------------|--------|-------------------|------------------------------------------------------| | Pharmaceutical management for patients using narcotics | Narcotics Management Guidance | 100 | Per instance | [KB-24385190-0703-42d1-a834-6854e998b51a63], [KB-ad7d4dc3-8896-4c1b-92c7-8d969120b377], [KB-66969593-ac17-45cd-a41d-f335a2406225] | | Pharmaceutical management for patients with malignant tumors (by phone, etc.) | Specific Pharmaceutical Guidance | 100 | Monthly | [KB-b2731f14-7331-4d15-827d-89f8aed2bcb1], [KB-20775cd7-be3a-4a41-a8e2-53ac409c2538] | | Inhaler guidance for asthma or COPD patients | Inhaler Guidance Addition | 30 | Once every 3 mo. | [KB-604920cd-689f-4a10-97db-9faeb614d499], [KB-ef609548-ff37-4388-9fd5-c638d8bf6eab] | | Pediatric-specific guidance for children with disabilities | Pediatric Specific Addition | 350 | Per instance | [KB-6bb697eb-fdad-4cda-a697-9d148e072b9d], [KB-ba91d9ab-b335-4929-9779-694ba115ef39] | | Safety management for high-risk pharmaceuticals | Specific Pharmaceutical Guidance | 10 | Per instance | [KB-fde2b685-c7c4-44c8-9de7-3a7051dd9005], [KB-f271747d-fadb-4d69-9ff8-ea0f4702f4f2] | - Pharmacists must provide necessary explanations and guidance for the selection of pharmaceuticals, especially when the patient is required to choose the medication. [KB-5398730a-d7b5-4d8b-830e-5282b5bf61c8], [KB-9720cc93-fb47-4376-9506-fbb4d8f61048] - For patients with multiple medications or difficulty in self-administration, pharmacists must support medication management, including packaging by dosage time and providing necessary instructions. [KB-07f1aee1-1797-47ce-a5e9-b2462436b453], [KB-2f8bb1e8-7cd1-4808-802d-61cbf1dea96e], [KB-ff3ce6e4-b5ec-4058-afe5-c24124781336] - Pharmacists must provide medication information to medical institutions as required, with documentation, and may claim the designated points per the relevant guidelines. [KB-37919876-98a0-4f81-879a-7de2d13e4a0f], [KB-c35807e4-304e-4ba2-8e86-e1404c20a9fd], [KB-cd5ee7fe-b23b-4de0-a8e1-f8ff41e250cf] --- ### 5.1.5 Discharge Guidance - When a patient is discharged from a medical institution, the designated pharmacy pharmacist must, with the patient’s consent, provide guidance for home medication management post-discharge, and may claim 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] --- ### 5.1.6 Palliative Care and Cancer Care - For home-based terminal cancer patients, high-quality palliative care must be provided, and in emergencies, ICT should be utilized to share end-of-life care information among healthcare professionals. [KB-fa0fdacb-f933-4296-8d0b-ac501b9102a5], [KB-ef95bdaa-ef0b-4848-bf4b-a5c073be5ba9] - For non-terminal cancer patients receiving palliative care at home, new evaluation criteria must be established for guidance and management related to narcotic injections. [KB-7feb02b9-5c22-4143-be1d-bdddef349def], [KB-a37a229d-a301-4e7f-8fcb-6324bf53e88d] --- ### 5.1.7 Other Requirements - Medical institutions must review requirements and evaluation for comprehensive support additions (包括的支援加算) based on the condition of home care patients. [KB-09f32992-f81b-4576-aaa4-262f9f8d8579] - Requirements for the issuance of itemized statements (明細書) must be reviewed, including the obligation for designated home nursing providers to issue them free of charge. [KB-7b83826c-4a00-4706-aced-07ac5183c8ff] - Requirements for the use of information and communication technology (ICT) in medical management for children with developmental disorders must be reviewed, ensuring effectiveness and safety. [KB-82af478a-eb1e-461e-befc-c32755e8d262] --- ## 5.2 Business Requirements - The requirements and evaluation for the enhancement addition for the nursing assistant system must be reviewed to promote the division of work and collaboration between nursing staff and assistants. [KB-05c4460e-0933-40a9-962c-fc2be422e060] - The requirements and evaluation for the management and guidance of narcotics in pharmacies must be reviewed, including the application of additional points for appropriate pharmaceutical management and guidance. [KB-24385190-0703-42d1-a834-6854e998b51a63], [KB-ad7d4dc3-8896-4c1b-92c7-8d969120b377], [KB-66969593-ac17-45cd-a41d-f335a2406225] --- ## 5.3 Constraint Requirements - The use of physical restraints for patients, especially those with dementia, must be minimized, and organizational systems must be established to enforce this policy. [KB-8445364a-473a-46bc-8207-fb1f2671bde6], [KB-edc81296-4474-4138-a404-f797f293eb19] - Abuse prevention systems must be established and maintained in home nursing, with physical restraints generally prohibited. [KB-e14d657a-8970-4e3e-9ccb-5662af7d6525] --- If any required information is missing for a specific requirement, it is noted as follows: [GAP: Missing data for Requirements]