| (i) 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;
(ii) be based on the needs of each patient care unit
and shift and on evidence relating to patient care needs;
(iii) require use of the official nurse services staffing
plan as a component in setting the nurse staffing budget;
(iv) encourage nurses to provide input to the nurse
staffing committee relating to nurse staffing concerns;
(v) protect nurses who provide input to the nurse staffing
committee from retaliation; and
(vi) comply with this subsection.
(B) The plan shall:
(i) set minimum staffing levels for patient care units
that are:
(I) based on multiple nurse and patient considerations;
an
(II) determined by the nursing assessment and in accordance
with evidence-based safe nursing standards; and
(ii) include a method for adjusting the staffing plan
shift to shift for each patient care unit to provide staffing flexibility
to meet patient needs;
(iii) include a contingency plan when patient care
needs unexpectedly exceed direct patient care staff resources;
(iv) include how on-call time will be used;
(v) reflect current standards established by private
accreditation organizations, governmental entities, national nursing
professional associations, and other health professional organizations;
(vi) include a mechanism for evaluating the effectiveness
of the official nurse services staffing plan based on patient needs,
nursing-sensitive quality indicators, nurse satisfaction measures
collected by the hospital, and evidence based nurse staffing standards;
and
(vii) be used by the hospital as a component in setting
the nurse staffing budget and guiding the hospital in assigning nurses
hospital wide.
(C) 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.
(3) The hospital shall annually report to the department
on:
(A) whether the hospital's governing body has adopted
a nurse staffing policy;
(B) whether the hospital has established a nurse staffing
committee that meets the membership requirements of paragraph (1)
of this subsection;
(C) 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
(D) the nurse-sensitive outcome measures the committee
adopted for use in evaluating the hospital's official nurse services
staffing plan.
(4) 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.
(k) Outpatient services. If the facility provides outpatient
services within the facility, written policies and procedures describing
the operation of the services shall be adopted, implemented and enforced.
(l) Pharmacy services. The facility shall provide pharmaceutical
services that meet the needs of the patients.
(1) License. A facility that stores and dispenses prescription
drugs for administration to a patient by a person authorized by law
to administer the drug, shall be licensed, as required, by the Texas
State Board of Pharmacy.
(2) Organization. The facility shall have a pharmacy
directed by a licensed pharmacist.
(3) Medical staff. The medical staff shall be responsible
for developing policies and procedures that minimize drug errors.
This function may be delegated to the facility's organized pharmaceutical
services.
(4) Pharmacy management and administration. The pharmacy
or drug storage area shall be administered in accordance with accepted
professional principles.
(A) Standards of practice as defined by state law shall
be followed regarding the provision of pharmacy services.
(B) The pharmaceutical services shall have an adequate
number of personnel to ensure quality pharmaceutical services including
emergency services.
(i) The staff shall be sufficient in number and training
to respond to the pharmaceutical needs of the patient population being
served. There shall be an arrangement for emergency services.
(ii) Employees shall provide pharmaceutical services
within the scope of their license and education.
(C) Drugs and biologicals shall be properly stored
to ensure ventilation, light, security, and temperature controls.
(D) Records shall have sufficient detail to follow
the flow of drugs from entry through dispensation.
(E) There shall be adequate controls over all drugs
and medications including floor stock. Drug storage areas shall be
approved by the pharmacist, and floor stock lists shall be established.
(F) Inspections of drug storage areas shall be conducted
throughout the hospital under pharmacist supervision.
(G) There shall be a drug recall procedure.
(H) A full-time, part-time, or consulting pharmacist
shall be responsible for developing, supervising, and coordinating
all the activities of the pharmacy services.
(i) Direction of pharmaceutical services may not require
on premises supervision but may be accomplished through regularly
scheduled visits in accordance with state law.
(ii) A job description or other written agreement shall
clearly define the responsibilities of the pharmacist.
(I) Current and accurate records shall be kept of the
receipt and disposition of all scheduled drugs.
(i) There shall be a record system in place that provides
the information on controlled substances in a readily retrievable
manner which is separate from the patient record.
(ii) Records shall trace the movement of scheduled
drugs throughout the services, documenting utilization or wastage.
Cont'd... |
