| (ii) A maximum of 15 hours shall not be exceeded between
the last meal of the day (i.e. supper) and the breakfast meal, unless
a substantial snack is provided. The hospital shall adopt, implement,
and enforce a policy on the definition of "substantial" to meet each
patient's varied nutritional needs.
(C) A current therapeutic diet manual approved by the
dietitian and medical staff shall be readily available to all medical,
nursing, and food service personnel. The therapeutic manual shall:
(i) be revised as needed, not to exceed 5 years;
(ii) be appropriate for the diets routinely ordered
in the hospital;
(iii) have standards in compliance with the RDA;
(iv) contain specific diets which are not in compliance
with RDA; and
(v) be used as a guide for ordering and serving diets.
(e) Emergency services. All licensed hospital locations,
including multiple-location sites, shall have an emergency suite that
complies with §133.161(a)(1)(A) of this title (relating to Requirements
for Buildings in Which Existing Licensed Hospitals are Located) or §133.163(f)
of this title, and the following.
(1) Organization. The organization of the emergency
services shall be appropriate to the scope of the services offered.
(A) The services shall be organized under the direction
of a qualified member of the medical staff who is the medical director
or clinical director.
(B) The services shall be integrated with other departments
of the hospital.
(C) The policies and procedures governing medical care
provided in the emergency suite shall be established by and shall
be a continuing responsibility of the medical staff.
(D) Medical records indicating patient identification,
complaint, physician, nurse, time admitted to the emergency suite,
treatment, time discharged, and disposition shall be maintained for
all emergency patients.
(E) Each freestanding emergency medical care facility
shall advertise as an emergency room. The facility shall display notice
that it functions as an emergency room.
(i) The notice shall explain that patients who receive
medical services will be billed according to comparable rates for
hospital emergency room services in the same region.
(ii) The notice shall be prominently and conspicuously
posted for display in a public area of the facility that is readily
available to each patient, managing conservator, or guardian. The
postings shall be easily readable and consumer-friendly. The notice
shall be in English and in a second language appropriate to the demographic
makeup of the community served.
(2) Personnel.
(A) There shall be adequate medical and nursing personnel
qualified in emergency care to meet the written emergency procedures
and needs anticipated by the hospital.
(B) Except for comprehensive medical rehabilitation
hospitals and pediatric and adolescent hospitals that generally provide
care that is not administered for or in expectation of compensation:
(i) there shall be on duty and available at all times
at least one person qualified as determined by the medical staff to
initiate immediate appropriate lifesaving measures; and
(ii) in general hospitals where the emergency treatment
area is not contiguous with other areas of the hospital that maintain
24 hour staffing by qualified staff (including but not limited to
separation by one or more floors in multiple-occupancy buildings),
qualified personnel must be physically present in the emergency treatment
area at all times.
(C) Except for comprehensive medical rehabilitation
hospitals and pediatric and adolescent hospitals that generally provide
care that is not administered for or in expectation of compensation,
the hospital shall provide that one or more physicians shall be available
at all times for emergencies, as follows.
(i) General hospitals, except for hospitals designated
as critical access hospitals (CAHs) by the Centers for Medicare &
Medicaid Services (CMS), located in counties with a population of
100,000 or more shall have a physician qualified to provide emergency
medical care on duty in the emergency treatment area at all times.
(ii) Special hospitals, hospitals designated as CAHs
by the CMS, and general hospitals located in counties with a population
of less than 100,000 shall have a physician on-call and able to respond
in person, or by radio or telephone within 30 minutes.
(D) Schedules, names, and telephone numbers of all
physicians and others on emergency call duty, including alternates,
shall be maintained. Schedules shall be retained for no less than
one year.
(3) Supplies and equipment. Adequate age appropriate
supplies and equipment shall be available and in readiness for use.
Equipment and supplies shall be available for the administration of
intravenous medications as well as facilities for the control of bleeding
and emergency splinting of fractures. Provision shall be made for
the storage of blood and blood products as needed. The emergency equipment
shall be periodically tested according to the policy adopted, implemented
and enforced by the hospital.
(4) Required emergency equipment. At a minimum, the
age appropriate emergency equipment and supplies shall include the
following:
(A) emergency call system;
(B) oxygen;
(C) mechanical ventilatory assistance equipment, including
airways, manual breathing bag, and mask;
(D) cardiac defibrillator;
(E) cardiac monitoring equipment;
(F) laryngoscopes and endotracheal tubes;
(G) suction equipment;
(H) emergency drugs and supplies specified by the medical
staff;
(I) stabilization devices for cervical injuries;
(J) blood pressure monitoring equipment; and
(K) pulse oximeter or similar medical device to measure
blood oxygenation.
(5) Participation in local emergency medical service
(EMS) system.
(A) General hospitals shall participate in the local
EMS system, based on the hospital's capabilities and capacity, and
the locale's existing EMS plan and protocols.
(B) The provisions of subparagraph (A) of this paragraph
do not apply to a comprehensive medical rehabilitation hospital or
a pediatric and adolescent hospital that generally provides care that
is not administered for or in expectation of compensation.
(6) Emergency services for sexual assault survivors.
This section does not affect the duty of a health care facility to
comply with the requirements of the federal Emergency Medical Treatment
and Active Labor Act of 1986 (42 U.S.C. §1395dd) that are applicable
to the facility. The hospital shall develop, implement, and enforce
policies and procedures to ensure that after a sexual assault survivor
presents to the hospital following a sexual assault, the hospital
shall provide the care specified under the Health and Safety Code,
Chapter 323.
(f) Governing body.
(1) Legal responsibility. There shall be a governing
body responsible for the organization, management, control, and operation
of the hospital, including appointment of the medical staff. For hospitals
owned and operated by an individual or by partners, the individual
or partners shall be considered the governing body.
(2) Organization. The governing body shall be formally
organized in accordance with a written constitution and bylaws which
clearly set forth the organizational structure and responsibilities.
(3) Meeting records. Records of governing body meetings
shall be maintained.
(4) Responsibilities relating to the medical staff.
(A) The governing body shall ensure that the medical
staff has current bylaws, rules, and regulations which are implemented
and enforced.
(B) The governing body shall approve medical staff
bylaws and other medical staff rules and regulations.
(C) In hospitals that provide obstetrical services,
the governing body shall ensure that the hospital collaborates with
physicians providing services at the hospital to develop quality initiatives,
through the adoption, implementation, and enforcement of appropriate
hospital policies and procedures, to reduce the number of elective
or nonmedically indicated induced deliveries or cesarean sections
performed at the hospital on a woman before the 39th week of gestation.
Cont'd... |
