| (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
(D) the provider's status as a student, intern, trainee,
or resident, if applicable.
(g) Infection control. The hospital shall provide a
sanitary environment to avoid sources and transmission of infections
and communicable diseases. There shall be an active program for the
prevention, control, and surveillance of infections and communicable
diseases.
(1) Organization and policies. A person shall be designated
as infection control professional. The hospital shall ensure that
policies governing prevention, control and surveillance of infections
and communicable diseases are developed, implemented and enforced.
(A) There shall be a system for identifying, reporting,
investigating, and controlling health care associated infections and
communicable diseases between patients and personnel.
(B) The infection control professional shall maintain
a log of all reportable diseases and health care associated infections
designated as epidemiologically significant according to the hospital's
infection control policies.
(C) A written policy shall be adopted, implemented
and enforced for reporting all reportable diseases to the local health
authority and the Infectious Disease Surveillance and Epidemiology
Branch, Department of State Health Services, Mail Code 2822, P.O.
Box 149347, Austin, Texas 78714-9347, in accordance with Chapter 97
of this title (relating to Communicable Diseases), and Health and
Safety Code, §§98.103, 98.104, and 98.1045 (relating to
Reportable Infections, Alternative for Reportable Surgical Site Infections,
and Reporting of Preventable Adverse Events).
(D) The infection control program shall include active
participation by the pharmacist.
(2) Responsibilities of the chief executive officer
(CEO), medical staff, and chief nursing officer (CNO). The CEO, the
medical staff, and the CNO shall be responsible for the following.
(A) The hospital-wide quality assessment and performance
improvement program and training programs shall address problems identified
by the infection control professional.
(B) Successful corrective action plans in affected
problem areas shall be implemented.
(3) Universal precautions. The hospital shall adopt,
implement, and enforce a written policy to monitor compliance of the
hospital and its personnel and medical staff with universal precautions
in accordance with HSC Chapter 85, Acquired Immune Deficiency Syndrome
and Human Immunodeficiency Virus Infection.
(h) Laboratory services. The hospital shall maintain
directly, or have available adequate laboratory services to meet the
needs of its patients.
(1) Hospital laboratory services. A hospital that provides
laboratory services shall comply with the Clinical Laboratory Improvement
Amendments of 1988 (CLIA 1988), in accordance with the requirements
specified in 42 Code of Federal Regulations (CFR), §§493.1
- 493.1780. CLIA 1988 applies to all hospitals with laboratories that
examine human specimens for the diagnosis, prevention, or treatment
of any disease or impairment of, or the assessment of the health of,
human beings.
(2) Contracted laboratory services. The hospital shall
ensure that all laboratory services provided to its patients through
a contractual agreement are performed in a facility certified in the
appropriate specialties and subspecialties of service in accordance
with the requirements specified in 42 CFR Part 493 to comply with
CLIA 1988.
(3) Adequacy of laboratory services. The hospital shall
ensure the following.
(A) Emergency laboratory services shall be available
24 hours a day.
(B) A written description of services provided shall
be available to the medical staff.
(C) The laboratory shall make provision for proper
receipt and reporting of tissue specimens.
(D) The medical staff and a pathologist shall determine
which tissue specimens require a macroscopic (gross) examination and
which require both macroscopic and microscopic examination.
Cont'd... |
