(a) Nursing services.
(1) There shall be an organized nursing service under
the direction of a qualified registered nurse (RN). The ambulatory
surgical center (ASC) shall be staffed to assure that the nursing
needs of all patients are met.
(2) There shall be a written plan of administrative
authority for all nursing services with responsibilities and duties
of each category of nursing personnel delineated and a written job
description for each category. The scope of nursing service shall
include, but is not limited to, nursing care rendered to patients
preoperatively, intraoperatively, and postoperatively.
(A) The responsible individual for nursing services
shall be a qualified registered nurse (RN) whose responsibility and
authority for nursing service shall be clearly defined and includes
supervision of both personnel performance and patient care.
(B) There shall be a written delineation of functions,
qualifications, and patient care responsibilities for all categories
of nursing personnel.
(C) Surgical technicians and licensed vocational nurses
may be permitted to serve in the scrub nurse role under the direct
supervision of an RN; they shall not be permitted to function as circulating
nurses in the operating rooms. Licensed vocational nurses and surgical
technicians may assist in circulatory duties under the direct supervision
of a qualified RN.
(D) Nursing services shall be provided in accordance
with current recognized standards or recommended practices.
(E) The facility shall adopt, implement and enforce
policies and procedures to comply with Health and Safety Code, Chapter
259 (relating to Surgical Technologists at Health Care Facilities).
(3) There shall be an adequate number of RNs on duty
to meet the following minimum staff requirements: director of the
department (or designee), and supervisory and staff personnel for
each service area to assure the immediate availability of an RN for
emergency care or for any patient when needed.
(A) An RN shall assign the nursing care of each patient
to other nursing personnel in accordance with the patient's needs
and the preparation and qualifications of the nursing staff available.
(B) There shall be other nursing personnel in sufficient
numbers to provide nursing care not requiring the service of an RN.
(4) An RN qualified, at a minimum, with current certification
in basic cardiac life support shall be on duty and on the premises
at all times whenever patients are present in the facility.
(b) Additional staffing requirements. In addition to
meeting the requirements for nursing staff under subsection (a) of
this section, facilities shall comply with the following minimum staffing
requirements.
(1) Facilities that provide only topical anesthesia,
local anesthesia and/or minimal sedation are required to have a second
individual on duty on the premises who is trained and currently certified
in basic cardiac life support until all patients have been discharged
from the facility.
(2) Facilities that provide moderate sedation/analgesia
are required to have the following additional staff:
(A) a second individual on duty on the premises who
is trained and currently certified in basic cardiac life support until
all patients have been discharged from the facility; and
(B) an individual trained and currently certified in
advanced cardiac life support and, if surgery is performed on pediatric
patients, pediatric advanced life support shall be available until
all patients have been discharged from the postanesthesia care unit.
(3) Facilities that provide deep sedation/analgesia,
general anesthesia, and/or regional anesthesia shall have the following
additional staff:
(A) a second individual on duty on the premises who
is trained and currently certified in basic cardiac life support until
all patients have been discharged from the facility; and
(B) an individual who is trained and currently certified
in advanced cardiac life support and, if surgery is performed on pediatric
patients, pediatric advanced life support shall be on duty on the
premises and sufficiently free of other duties to enable the individual
to respond rapidly to emergency situations until all patients have
been discharged from the postanesthesia care unit.
(c) Nursing peer review committees. The facility shall
establish a nursing peer review committee to conduct nursing peer
review, as required by Texas Occupations Code, Chapter 303.
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Source Note: The provisions of this §135.15 adopted to be effective June 18, 2009, 34 TexReg 3948; amended to be effective November 25, 2010, 35 TexReg 10232; amended to be effective January 26, 2020, 45 TexReg 578 |