| (a) Anesthesia services. If the hospital furnishes
anesthesia services, these services shall be provided in a well-organized
manner under the direction of a qualified physician in accordance
with the Medical Practice Act and the Nursing Practice Act. The hospital
is responsible for and shall document all anesthesia services administered
in the hospital.
(1) Organization and staffing. The organization of
anesthesia services shall be appropriate to the scope of the services
offered. Only personnel who have been approved by the facility to
provide anesthesia services shall administer anesthesia. All approvals
or delegations of anesthesia services as authorized by law shall be
documented and include the training, experience, and qualifications
of the person who provided the service.
(2) Delivery of services. Anesthesia services shall
be consistent with needs and resources. Policies on anesthesia procedure
shall include the delineation of pre-anesthesia and post-anesthesia
responsibilities. The policies shall ensure that the following are
provided for each patient.
(A) A pre-anesthesia evaluation by an individual qualified
to administer anesthesia under paragraph (1) of this subsection shall
be performed within 48 hours prior to surgery.
(B) An intraoperative anesthesia record shall be provided.
The record shall include any complications or problems occurring during
the anesthesia including time, description of symptoms, review of
affected systems, and treatments rendered. The record shall correlate
with the controlled substance administration record.
(C) A post-anesthesia follow-up report shall be written
by the person administering the anesthesia before transferring the
patient from the post-anesthesia care unit and shall include evaluation
for recovery from anesthesia, level of activity, respiration, blood
pressure, level of consciousness, and patient's oxygen saturation
level.
(i) With respect to inpatients, a post-anesthesia evaluation
for proper anesthesia recovery shall be performed after transfer from
the post-anesthesia care unit and within 48 hours after surgery by
the person administering the anesthesia, registered nurse (RN), or
physician in accordance with policies and procedures approved by the
medical staff and using criteria written in the medical staff bylaws
for postoperative monitoring of anesthesia.
(ii) With respect to outpatients, immediately prior
to discharge, a post-anesthesia evaluation for proper anesthesia recovery
shall be performed by the person administering the anesthesia, RN,
or physician in accordance with policies and procedures approved by
the medical staff and using criteria written in the medical staff
bylaws for postoperative monitoring of anesthesia.
(b) Chemical dependency services.
(1) Chemical dependency unit. A hospital may not admit
patients to a chemical dependency services unit unless the unit is
approved by the Department of State Health Services (department) as
meeting the requirements of §133.163(q) of this title (relating
to Spatial Requirements for New Construction).
(2) Admission criteria. A hospital providing chemical
dependency services shall have written admission criteria that are
applied uniformly to all patients who are admitted to the chemical
dependency unit.
(A) The hospital's admission criteria shall include
procedures to prevent the admission of minors for a condition which
is not generally recognized as responsive to treatment in an inpatient
setting for chemical dependency services.
(i) The following conditions are not generally recognized
as responsive to treatment in a treatment facility for chemical dependency
unless the minor to be admitted is qualified because of other disabilities,
such as:
(I) cognitive disabilities due to intellectual disability;
(II) learning disabilities; or
(III) psychiatric disorders.
(ii) A minor may be qualified for admission based on
other disabilities which would be responsive to chemical dependency
services.
(iii) A minor patient shall be separated from adult
patients.
(B) The hospital shall have a preadmission examination
procedure under which each patient's condition and medical history
are reviewed by a member of the medical staff to determine whether
the patient is likely to benefit significantly from an intensive inpatient
program or assessment.
(C) A voluntarily admitted patient shall sign an admission
consent form prior to admission to a chemical dependency unit which
includes verification that the patient has been informed of the services
to be provided and the estimated charges.
(3) Compliance. A hospital providing chemical dependency
services in an identifiable unit within the hospital shall comply
with Chapter 448, Subchapter B of this title (relating to Standard
of Care Applicable to All Providers).
(c) Comprehensive medical rehabilitation services.
(1) Rehabilitation units. A hospital may not admit
patients to a comprehensive medical rehabilitation services unit unless
the unit is approved by the department as meeting the requirements
of §133.163(z) of this title.
(2) Equipment and space. The hospital shall have the
necessary equipment and sufficient space to implement the treatment
plan described in paragraph (7)(C) of this subsection and allow for
adequate care. Necessary equipment is all equipment necessary to comply
with all parts of the written treatment plan. The equipment shall
be on-site or available through an arrangement with another provider.
Sufficient space is the physical area of a hospital which in the aggregate,
constitutes the total amount of the space necessary to comply with
the written treatment plan.
(3) Emergency requirements. Emergency personnel, equipment,
supplies and medications for hospitals providing comprehensive medical
rehabilitation services shall be as follows.
(A) A hospital that provides comprehensive medical
rehabilitation services shall have emergency equipment, supplies,
medications, and designated personnel assigned for providing emergency
care to patients and visitors.
(B) The emergency equipment, supplies, and medications
shall be properly maintained and immediately accessible to all areas
of the hospital. The emergency equipment shall be periodically tested
according to the policy adopted, implemented and enforced by the hospital.
(C) At a minimum, the emergency equipment and supplies
shall include those specified in subsection (e)(4) of this section.
(D) The personnel providing emergency care in accordance
with this subsection shall be staffed for 24-hour coverage and accessible
to all patients receiving comprehensive medical rehabilitation services.
At least one person who is qualified by training to perform advanced
cardiac life support and administer emergency drugs shall be on duty
each shift.
(E) All direct patient care licensed personnel shall
maintain current certification in cardiopulmonary resuscitation (CPR).
(4) Medications. A rehabilitation hospital's governing
body shall adopt, implement and enforce policies and procedures that
require all medications to be administered by licensed nurses, physicians,
or other licensed professionals authorized by law to administer medications.
(5) Organization and Staffing.
(A) A hospital providing comprehensive medical rehabilitation
services shall be organized and staffed to ensure the health and safety
of the patients.
(i) All provided services shall be consistent with
accepted professional standards and practice.
(ii) The organization of the services shall be appropriate
to the scope of the services offered.
(iii) The hospital shall adopt, implement and enforce
written patient care policies that govern the services it furnishes.
(B) The provision of comprehensive medical rehabilitation
services in a hospital shall be under the medical supervision of a
physician who is on duty and available, or who is on-call 24 hours
each day.
(C) A hospital providing comprehensive medical rehabilitation
services shall have a medical director or clinical director who supervises
and administers the provision of comprehensive medical rehabilitation
services.
(i) The medical director or clinical director shall
be a physician who is board certified or eligible for board certification
in physical medicine and rehabilitation, orthopedics, neurology, neurosurgery,
internal medicine, or rheumatology as appropriate for the rehabilitation
program.
(ii) The medical director or clinical director shall
be qualified by training or at least two years training and experience
to serve as medical director or clinical director. A person is qualified
under this subsection if the person has training and experience in
the treatment of rehabilitation patients in a rehabilitation setting.
(6) Admission criteria. A hospital providing comprehensive
medical rehabilitation services shall have written admission criteria
that are applied uniformly to all patients who are admitted to the
comprehensive medical rehabilitation unit.
(A) The hospital's admission criteria shall include
procedures to prevent the admission of a minor for a condition which
is not generally recognized as responsive to treatment in an inpatient
setting for comprehensive medical rehabilitation services.
(i) The following conditions are not generally recognized
as responsive to treatment in an inpatient setting for comprehensive
medical rehabilitation services unless the minor to be admitted is
qualified because of other disabilities, such as:
(I) cognitive disabilities due to intellectual disability;
(II) learning disabilities; or
(III) psychiatric disorders.
(ii) A minor may be qualified for admission based on
other disabilities which would be responsive to comprehensive medical
rehabilitation services.
(B) The hospital shall have a preadmission examination
procedure under which each patient's condition and medical history
are reviewed by a member of the medical staff to determine whether
the patient is likely to benefit significantly from an intensive inpatient
program or assessment.
(7) Care and services.
(A) A hospital providing comprehensive medical rehabilitation
services shall use a coordinated interdisciplinary team which is directed
by a physician and which works in collaboration to develop and implement
the patient's treatment plan.
(i) The interdisciplinary team for comprehensive medical
rehabilitation services shall have available to it, at the hospital
at which the services are provided or by contract, members of the
following professions as necessary to meet the treatment needs of
the patient:
(I) physical therapy;
(II) occupational therapy;
(III) speech-language pathology;
(IV) therapeutic recreation;
(V) social services and case management;
(VI) dietetics;
(VII) psychology;
(VIII) respiratory therapy;
(IX) rehabilitative nursing;
(X) certified orthotics;
(XI) certified prosthetics;
(XII) pharmaceutical care; and
(XIII) in the case of a minor patient, persons who
have specialized education and training in emotional, mental health,
or chemical dependency problems, as well as the treatment of minors.
(ii) The coordinated interdisciplinary team approach
used in the rehabilitation of each patient shall be documented by
periodic entries made in the patient's medical record to denote:
(I) the patient's status in relationship to goal attainment;
and
(II) that team conferences are held at least every
two weeks to determine the appropriateness of treatment.
(B) An initial assessment and preliminary treatment
plan shall be performed or established by the physician within 24
hours of admission.
(C) The physician in coordination with the interdisciplinary
team shall establish a written treatment plan for the patient within
seven working days of the date of admission.
(i) Comprehensive medical rehabilitation services shall
be provided in accordance with the written treatment plan.
(ii) The treatment provided under the written treatment
plan shall be provided by staff who are qualified to provide services
under state law. The hospital shall establish written qualifications
for services provided by each discipline for which there is no applicable
state statute for professional licensure or certification.
(iii) Services provided under the written treatment
plan shall be given in accordance with the orders of physicians, dentists,
podiatrists or practitioners who are authorized by the governing body,
hospital administration, and medical staff to order the services,
and the orders shall be incorporated in the patient's record.
(iv) The written treatment plan shall delineate anticipated
goals and specify the type, amount, frequency, and anticipated duration
of service to be provided.
Cont'd... |
