| (i) a physician. This provision is not to be construed
to limit the authority of a physician to delegate tasks to other qualified
health care personnel to the extent recognized under state law or
the state's regulatory mechanism;
(ii) a dentist who is legally authorized to practice
dentistry by the state and who is acting within the scope of his or
her license; or
(iii) a podiatrist, but only with respect to functions
which he or she is legally authorized by the state to perform.
(B) patients are admitted to the hospital only by members
of the medical staff who have been granted admitting privileges;
(C) a physician is on duty or on-call at all times;
(D) specific colored condition alert wrist bands that
have been standardized for all hospitals licensed under Health and
Safety Code, Chapter 241, are used as follows:
(i) red wrist bands for allergies;
(ii) yellow wrist bands for fall risks; and
(iii) purple wrist bands for do not resuscitate status;
(E) the governing body shall consider the addition
of the following optional condition alert wrist bands. This consideration
must be documented in the minutes of the meeting of the governing
body in which the discussion was held:
(i) green wrist bands for latex allergy; and
(ii) pink wrist bands for restricted extremity; and
(F) the governing body shall adopt, implement, and
enforce a policy and procedure regarding the removal of personal wrist
bands and bracelets as well as a patient's right to refuse to wear
condition alert wrist bands; and
(G) the governing body shall adopt, implement, and
enforce policies and procedures regarding DNR orders issued in the
hospital by the attending physician that comply with Health and Safety
Code, Chapter 166, Subchapter E (relating to Health Care Facility
Do-Not-Resuscitate Orders), including policies and procedures regarding
the rights of a patient and person authorized to make treatment decisions
regarding the patient's DNR status; notice and medical record requirements
for DNR orders and revocations; and actions the attending physician
and hospital must take pursuant to Health and Safety Code §166.206
when the attending physician or hospital and the patient or person
authorized to make treatment decisions regarding the patient's DNR
status are in disagreement about the execution of, or compliance with,
a DNR order. The policies and procedures shall include that:
(i) Except in circumstances described by Health and
Safety Code §166.203(a)(2), a DNR order issued for a patient
is valid only if the patient's attending physician issues the order,
the order is dated, and the order is issued in compliance with:
(I) the written and dated directions of a patient who
was competent at the time the patient wrote the directions;
(II) the oral directions of a competent patient delivered
to or observed by two competent adult witnesses, at least one of whom
must be a person not listed under Health and Safety Code §166.003(2)(E)
or (F);
(III) the directions in an advance directive enforceable
under Health and Safety Code §166.005 or executed in accordance
with Health and Safety Code §§166.032, 166.034, or 166.035;
(IV) the directions of a patient's legal guardian or
agent under a medical power of attorney acting in accordance with
Health and Safety Code, Chapter 166, Subchapter D (relating to Medical
Power of Attorney); or
(V) a treatment decision made in accordance with Health
Safety Code §166.039.
(ii) A DNR order that is not issued in accordance with
Health and Safety Code §166.203(a)(1) is valid only if the patient's
attending physician issues the order, the order is dated, and:
(I) the order is not contrary to the directions of
a patient who was competent at the time the patient conveyed the directions;
(II) in the reasonable medical judgment of the patient's
attending physician, the patient's death is imminent, regardless of
the provision of cardiopulmonary resuscitation; and
(III) in the reasonable medical judgment of the patient's
attending physician, the DNR order is medically appropriate.
(iii) A DNR order takes effect at the time the order
is issued, as provided by Health and Safety Code §166.203(b).
(iv) Before placing in a patient's medical record a
DNR order described by Health and Safety Code §166.203(a)(2),
the physician, physician assistant, nurse, or other person acting
on behalf of the hospital shall:
(I) notify the patient of the order's issuance; or
(II) if the patient is incompetent, make a reasonably
diligent effort to contact or cause to be contacted and notify of
the order's issuance the patient's known agent under a medical power
of attorney or legal guardian or, for a patient who does not have
a known agent under a medical power of attorney or legal guardian,
a person described by Health and Safety Code §166.039(b)(1),
(2), or (3).
(v) A physician providing direct care to a patient
for whom a DNR order is issued shall revoke the patient's DNR order
if the patient, or the patient's agent under a medical power of attorney
or the patient's legal guardian if the patient is incompetent:
(I) effectively revokes an advance directive, in accordance
with Health and Safety Code §166.042, for which a DNR order is
issued under Health and Safety Code §166.203(a); or
(II) expresses to any person providing direct care
to the patient a revocation of consent to or intent to revoke a DNR
order issued under Health and Safety Code §166.203(a).
(vi) A person providing direct care to a patient under
the supervision of a physician shall notify the physician of a request
to revoke a DNR order under Health and Safety Code §166.205(a).
(vii) A patient's attending physician may at any time
revoke a DNR order executed under Health and Safety Code §166.203(a)(2).
(viii) On admission to the hospital, the hospital shall
provide to the patient or person authorized to make treatment decisions
regarding the patient's DNR status notice of the policies and procedures
adopted under this subparagraph.
(7) Services. The governing body shall be responsible
for all services furnished in the hospital, whether furnished directly
or under contract. The governing body shall ensure that services are
provided in a safe and effective manner that permits the hospital
to comply with applicable rules and standards. At hospitals that have
a mental health service unit, the governing body shall adopt, implement,
and enforce procedures for the completion of criminal background checks
on all prospective employees that would be considered for assignment
to that unit, except for persons currently licensed by this state
as health professionals.
(8) Nurse Staffing. The governing body shall adopt,
implement and enforce a written nurse staffing policy to ensure that
an adequate number and skill mix of nurses are available to meet the
level of patient care needed. The governing body policy shall require
that hospital administration adopt, implement and enforce a nurse
staffing plan and policies that:
(A) require significant consideration be given to the
nurse staffing plan recommended by the hospital's nurse staffing committee
and the committee's evaluation of any existing plan;
(B) are based on the needs of each patient care unit
and shift and on evidence relating to patient care needs;
(C) ensure that all nursing assignments consider client
safety, and are commensurate with the nurse's educational preparation,
experience, knowledge, and physical and emotional ability;
(D) require use of the official nurse services staffing
plan as a component in setting the nurse staffing budget;
(E) encourage nurses to provide input to the nurse
staffing committee relating to nurse staffing concerns;
(F) protect from retaliation nurses who provide input
to the nurse staffing committee; and
(G) comply with subsection (o) of this section.
(9) Photo identification badge. The governing body
shall adopt a policy requiring employees, physicians, contracted employees,
and individuals in training who provide direct patient care at the
hospital to wear a photo identification badge during all patient encounters,
unless precluded by adopted isolation or sterilization protocols.
The badge must be of sufficient size and worn in a manner to be visible
and must clearly state:
(A) at minimum the individual's first or last name;
(B) the department of the hospital with which the individual
is associated;
(C) the type of license held by the individual, if
applicable under Title 3, Occupations Code; and
Cont'd... |
