| (-e-) review, assessment, and response by the committee
to staffing concerns expressed to the committee;
(-f-) a process for providing feedback during the committee
meeting on how concerns are addressed by the committee established
under subparagraph (F) of this paragraph; and
(-g-) use of the nurse safe harbor peer review process
pursuant to Occupations Code, §303.005;
(VIII) include policies and procedures that require:
(-a-) orientation of nurses and other personnel who
provide nursing care to all patient care units to which they are assigned
on either a temporary or permanent basis;
(-b-) that the orientation of nurses and other personnel
and the competency to perform nursing services is documented in accordance
with hospital policy;
(-c-) that nursing assignments be congruent with documented
competency; and
(IX) be used by the hospital as a component in setting
the nurse staffing budget and guiding the hospital in assigning nurses
hospital wide.
(iii) The hospital shall make readily available to
nurses on each patient care unit at the beginning of each shift the
official nurse services staffing plan levels and current staffing
levels for that unit and that shift.
(iv) There shall be a semiannual evaluation by the
staffing committee of the effectiveness of the official nurse services
staffing plan and variations between the staffing plan and actual
staffing. The evaluation shall consider the outcomes and nursing-sensitive
indicators as set out in clause (ii)(VI) of this subparagraph, patient
needs, nurse satisfaction measures collected by the hospital, and
evidence based nurse staffing standards. This evaluation shall be
documented in the minutes of the committee established under subparagraph
(F) of this paragraph and presented to the hospital's governing body.
Hospitals may determine whether this evaluation is done on a unit
or facility level basis. To assist the committee with the semiannual
evaluation, the hospital shall report to the committee the variations
between the staffing plan and actual staffing. This report of variations
shall be confidential and not subject to disclosure under Government
Code, Chapter 552 and not subject to disclosure, discovery, subpoena
or other means of legal compulsion for their release.
(v) The staffing plan shall be retained for a period
of two years.
(H) Nonemployee licensed nurses who are working in
the hospital shall adhere to the policies and procedures of the hospital.
The CNO shall provide for the adequate orientation, supervision, and
evaluation of the clinical activities of nonemployee nursing personnel
which occur within the responsibility of the nursing services.
(I) The hospital shall annually report to the department
on:
(i) whether the hospital's governing body has adopted
a nurse staffing policy;
(ii) whether the hospital has established a nurse staffing
committee that meets the membership requirements of subparagraph (F)
of this paragraph;
(iii) whether the nurse staffing committee has evaluated
the hospital's official nurse services staffing plan and has reported
the results of the evaluation to the hospital's governing body; and
(iv) the nurse-sensitive outcome measures the committee
adopted for use in evaluating the hospital's official nurse services
staffing plan.
(3) Mandatory overtime. The hospital shall adopt, implement
and enforce policies on use of mandatory overtime.
(A) As used in this subsection:
(i) "on-call time" means time spent by a nurse who
is not working but who is compensated for availability; and
(ii) "mandatory overtime" means a requirement that
a nurse work hours or days that are in addition to the hours or days
scheduled, regardless of the length of a scheduled shift or the number
of scheduled shifts each week. Mandatory overtime does not include
prescheduled on-call time or time immediately before or after a scheduled
shift necessary to document or communicate patient status to ensure
patient safety.
(B) A hospital may not require a nurse to work mandatory
overtime, and a nurse may refuse to work mandatory overtime.
(C) This section does not prohibit a nurse from volunteering
to work overtime.
(D) A hospital may not use on-call time as a substitute
for mandatory overtime.
(E) The prohibitions on mandatory overtime do not apply
if:
(i) a health care disaster, such as a natural or other
type of disaster that increases the need for health care personnel,
unexpectedly affects the county in which the nurse is employed or
affects a contiguous county;
(ii) a federal, state, or county declaration of emergency
is in effect in the county in which the nurse is employed or is in
effect in a contiguous county;
(iii) there is an emergency or unforeseen event of
a kind that:
(I) does not regularly occur;
(II) increases the need for health care personnel at
the hospital to provide safe patient care; and
(III) could not prudently be anticipated by the hospital;
or
(iv) the nurse is actively engaged in an ongoing medical
or surgical procedure and the continued presence of the nurse through
the completion of the procedure is necessary to ensure the health
and safety of the patient. The nurse staffing committee shall ensure
that scheduling a nurse for a procedure that could be anticipated
to require the nurse to stay beyond the end of his or her scheduled
shift does not constitute mandatory overtime.
(F) If a hospital determines that an exception exists
under subparagraph (E) of this paragraph, the hospital shall, to the
extent possible, make and document a good faith effort to meet the
staffing need through voluntary overtime, including calling per diems
and agency nurses, assigning floats, or requesting an additional day
of work from off-duty employees.
(G) A hospital may not suspend, terminate, or otherwise
discipline or discriminate against a nurse who refuses to work mandatory
overtime.
(4) Drugs and biologicals. Drugs and biologicals shall
be prepared and administered in accordance with federal and state
laws, the orders of the individuals granted privileges by the medical
staff, and accepted standards of practice.
(A) All drugs and biologicals shall be administered
by, or under supervision of, nursing or other personnel in accordance
with federal and state laws and regulations, including applicable
licensing rules, and in accordance with the approved medical staff
policies and procedures.
(B) All orders for drugs and biologicals shall be in
writing, dated, timed, and signed by the individual responsible for
the care of the patient as specified under subsection (f)(6)(A) of
this section. When telephone or verbal orders must be used, they shall
be:
(i) accepted only by personnel who are authorized to
do so by the medical staff policies and procedures, consistent with
federal and state laws;
(ii) dated, timed, and authenticated within 96 hours
by the prescriber or another practitioner who is responsible for the
care of the patient and has been credentialed by the medical staff
and granted privileges which are consistent with the written orders;
and
(iii) used infrequently.
(C) There shall be a hospital procedure for immediately
reporting transfusion reactions, adverse drug reactions, and errors
in administration of drugs to the attending physician and, if appropriate,
to the hospital-wide quality assessment and performance improvement
program.
(5) Blood transfusions.
(A) Transfusions shall be prescribed in accordance
with hospital policy and administered in accordance with a written
protocol for the administration of blood and blood components and
the use of infusion devices and ancillary equipment.
(B) Personnel administering blood transfusions and
intravenous medications shall have special training for this duty
according to written, adopted, implemented and enforced hospital policy.
(C) Blood and blood components shall be transfused
through a sterile, pyrogen-free transfusion set that has a filter
designed to retain particles potentially harmful to the recipient.
(D) The patient must be observed during the transfusion
and for an appropriate time thereafter for suspected adverse reactions.
(E) Pretransfusion and posttransfusion vital signs
shall be recorded.
(F) When warming of blood is indicated, this shall
be accomplished during its passage through the transfusion set. The
warming system shall be equipped with a visible thermometer and may
have an audible warning system. Blood shall not be warmed above 42
degrees Celsius.
Cont'd... |
