| (B) each hospital with which the facility has a transfer
agreement in accordance with paragraph (10) of this subsection;
(C) the trauma service area regional advisory council
that serves the geographic area in which the facility is located;
and
(D) each applicable local emergency management agency.
(6) A facility shall provide annual training to facility
staff on the facility's emergency preparedness and contingency operations
plan required by paragraph (2) of this subsection.
(7) A facility shall annually contact a local and state
disaster management representative, an emergency operations center,
and a trauma service area regional advisory council to:
(A) request comments on whether the emergency preparedness
and contingency plan adopted by the facility under paragraph (2) of
this subsection should be modified; and
(B) ensure that local agencies, regional agencies,
state agencies, and hospitals are aware of the facility, the facility's
policy on provision of life saving treatment, the facility's patient
population and potential transportation needs, and the anticipated
number of patients affected.
(8) A facility shall have a functional plan to access
the community emergency medical services.
(9) A facility shall have personnel qualified to operate
emergency equipment and to provide emergency care to patients on site
and available during all treatment times. A charge nurse qualified
to provide basic cardiopulmonary life support (BCLS) shall be on site
and available to the treatment area whenever patients are present.
All direct care staff members shall maintain current certification
and competency in BCLS.
(10) A facility shall have a transfer agreement with
one or more hospitals which provide acute dialysis service for the
provision of inpatient care and other hospital services to the facility's
patients. The facility shall have documentation from the hospital
to the effect that patients from the facility shall be accepted and
treated in emergencies. There shall be reasonable assurances that:
(A) the transfer or referral of patients will be effected
between the hospital and the facility whenever such transfer or referral
is determined as medically appropriate by the attending physician,
with timely acceptance and admission;
(B) the interchange of medical and other information
necessary or useful in the care and treatment of the patient transferred
shall occur within one working day; and
(C) security and accountability shall be assured for
the transferred patient's personal effects.
(11) A facility shall post a telephone number listing
specific to the facility equipment and locale to assist staff in contacting
mechanical and technical support in the event of an emergency.
(12) The facility shall maintain information on the
HHSC approved reporting system to be updated online monthly.
(c) Medication storage and administration.
(1) Pharmaceutical and therapeutic items shall be provided
in accordance with accepted professional principles and federal and
state laws and regulations.
(2) Medications shall be administered only if such
medication is ordered by the patient's physician or an attending physician.
Medication shall be administered as ordered.
(3) All verbal or telephone physician orders shall
be documented and authenticated or countersigned by the physician
not more than 15 calendar days from the date the order was given.
(4) Medications maintained in the facility shall be
properly stored and safeguarded in enclosures of sufficient size which
are not accessible to unauthorized persons. Refrigerators used for
storage of medications shall be maintained with documentation of the
appropriate temperatures for such storage.
(5) A facility shall maintain emergency medications,
as specified by the medical director, to treat the emergency needs
of patients.
(6) Medications shall not be prepared for administration
in the patient's immediate treatment area. The medication preparation
area shall be located in such a manner as to prevent contamination
of medicines being prepared for administration and shall include a
work counter and a sink.
(7) Medication vials shall not be taken to a patient
station. Intravenous medication vials labeled for single-use shall
not be punctured more than once.
(8) Medications not given immediately shall be labeled
with the patient's name, the name of the medication, the dosage prepared,
and the initials of the person preparing the medication, and shall
be protected to prevent contamination and casual access of the prepared
medications to unauthorized persons. All medications shall be administered
by the individual who prepared the medication.
(9) All medications shall be administered by licensed
nurses, physician assistants, or physicians except that intravenous
normal saline, intravenous heparin, subcutaneous lidocaine, and oxygen
may be administered as part of a routine hemodialysis treatment by
dialysis technicians qualified according to §117.62 of this title
(relating to Training Curricula and Instructors) and §117.63
of this title (relating to Competency Evaluation). Such administration
by dialysis technicians shall be in compliance with Chapter 157 of
the Occupations Code concerning the delegation of medical acts by
a licensed physician in the State of Texas.
(d) Nursing services.
(1) Nursing services shall be provided to prevent or
reduce complications, to maximize the patient's functional status,
and to educate the ESRD patient, the patient's family, patient's caregiver,
or significant other.
(2) A full-time supervising nurse shall be employed
to supervise and manage the provision of safe patient care. A contract
staff person shall not be considered an employee, and shall not be
considered for the full-time supervising nurse.
(3) A registered nurse shall:
(A) be in the facility when patients are present in
the facility;
(B) conduct admission nursing assessments;
(C) conduct assessments of a patient when indicated
by a question relating to a change in the patient's status, extended
or frequent hospitalizations, or at the patient's request;
(D) participate in the interdisciplinary team review
of a patient's progress;
(E) recommend changes in treatment based on the patient's
current needs;
(F) facilitate communication between the patient, patient's
family or significant other, and other interdisciplinary members to
ensure needed care is delivered;
(G) provide oversight and direction to dialysis technicians
and licensed vocational nurses; and
(H) participate in the facility's QAPI activities.
(4) A registered nurse functioning in the charge role
shall be present during all dialysis treatments.
(5) If pediatric dialysis is provided, a registered
nurse with experience or training in pediatric dialysis shall be available
to provide care for pediatric dialysis patients smaller than 35 kilograms
in weight.
(6) Sufficient direct care staff, as defined in §117.2(25)
of this title (relating to Definitions), shall be on site to meet
the needs of the patients, and at least one licensed nurse shall be
available on site for every twelve patients or portion thereof.
(A) During treatment of seven or fewer patients, direct
care staff shall consist of one registered nurse and one direct care
staff as demonstrated in Table 1 of §117.106 of this title (relating
to Tables).
(B) During treatment of eight but not more than twelve
patients, the registered nurse functioning as charge nurse shall not
be assigned as direct care staff as demonstrated in Table 1 of §117.106
of this title.
(C) For pediatric dialysis patients, one licensed nurse
shall be provided on site for each patient weighing less than ten
kilograms and one licensed nurse provided on site for every two patients
weighing from ten to 20 kilograms.
(7) A facility shall ensure that patients are in view
of staff during hemodialysis treatments, and shall visualize the patient,
their access site, and their bloodline connections during the dialysis
treatment.
(8) A licensed nurse or dialysis technician shall collect
and document objective and subjective data for each patient before
and after treatment according to facility policy and the staff member's
level of training. There shall be written policies and procedures
specific to the facility to guide actions to be taken by the nursing
staff in the event a patient's condition deteriorates during treatment,
to identify parameters which would require a patient be referred to
a nurse for evaluation. A registered nurse shall conduct a patient
assessment when indicated by a question relating to a change in the
patient's status or at the patient's request.
Cont'd... |
