Arkansas Administrative Code
Agency 007 - Arkansas Department of Health
Division 05 - Health Facility Services
Rule 007.05.00-003 - Addendum - Ambulatory Surgery Center - Extended Recovery Time
Universal Citation: AR Admin Rules 007.05.00-003
Current through Register Vol. 49, No. 9, September, 2024
ADDENDUM TO THE 1999 RULES AND REGULATIONS FOR HOSPITALS AND RELATED lNSTITUTlONS IN ARKANSAS PURSUANT TO ACT 414 OF 1961 AS AMENDED EXTENDED RECOVERY TIME
I. Scope/Limitations of Services
A. The extended
recovery time service shall be approved by the Health Facility Services
Division prior to implementation of the service.
B. Ambulatory Surgery Centers shall have the
capability to Provide care for post surgical patients requiring continued
nursing or medical treatment, but whose condition does not warrant acute
hospitalization. The extended recovery period shall not exceed 23 hours and 59
minutes. The extended recovery period shall be limited to:
1. Observation;
2. Control of nausea/vomiting;
3. Replacement of fluids; and
4. Pain management.
C. Patients shall be screened prior to
surgery and prior to Admission to the overnight area to ascertain that
established admission criteria is met.
D. Services shall not include intensive
nursing care, continuous monitoring due to the instability of vital signs,
administration of IV cardiac or anti-hypertensive drugs, or treatment of any
unstable underlying medical condition.
E. If a question arises as to whether or not
a patient is an appropriate candidate for extended stay, the decision shall be
made by the Medical Director or Administrator.
II. Admission Criteria
A. Physician's order shall be obtained for
transfer to extended stay;
B.
Stable vital signs and 02 saturation level;
C. Oriented to person, place, and time (a
return to preoperative mentation);
D. Presence of satisfactory airway;
E. Absence of significant bleeding;
F. Stabilized or resolution of any acute
problem;
G. Movement of extremities
following regional anesthetic;
H.
Level of consciousness which permits patient to call for nurse;
I. Recovery will require 23 hours 59 minutes
or less prior to discharge;
J. The
surgeon and anesthesia provider (or their designee of similar training and
expertise) shall be present or immediately available; and
K. Patient assessment and orientation shall
be recorded in the medical record.
III. Discharge Criteria
A. Discharge shall be done in keeping with
the same criteria established for the discharge of any patient from the
Ambulatory Surgery Center.
B. The
patient shall be discharged within 23 hours and 59 minutes of his/her admission
to extended recovery by the surgeon or anesthesiologist or his/her
designee.
C. If the patient's
condition is such that discharge is deemed inappropriate, arrangements shall be
made for hospital transfer.
D.
Postoperative prescription orders and instructions shall be given to the
patient and responsible adult with an understanding of instructions verbally by
the person(s) receiving them and a copy retained in the medical
record.
IV. Transfer Requirements to Acute Care Facility
A.
Patients who require continuous monitoring due to the instability of vital
signs;
B. Patients who require
administration of IV cardiac or anti-hypertensive drugs;
C. Patients who require treatment of any
unstable underlying medical condition;
D. Patients whose pain management or
observation requires longer than 23 hours and 59 minutes;
E. Patients who have a lowered level of
consciousness than their preoperative status; and
F. Patients who exhibit current or potential
airway complications.
V. Supervision of Extended Recovery Care
A.
Ambulator}' Surgery Centers shall provide adequate supervision of extended stay
area to assure quality patient care and safety.
B. The extended stay area shall be staffed
with a minimum of two caregivers at all times.
1. At least one of the caregivers shall be a
Registered Nurse.
2. All caregivers
shall be Basic Cardiac Life Support (BCLS) certified.
3. At least one Registered Nurse on duly at
all times shall be Advanced Cardiac Life Support (ACLS) certified.
4. The anesthesiologist (or designee) and the
surgeon (or designee) shall be present or immediately available.
VI. Emergency Procedures
A. Any emergency or
life-threatening situation shall be handled in a manner that provides the most
appropriate and rapid care to best meet the patient needs.
B. Local Emergency Medical Sendees (EMS)
shall be notified that regular hours are trying extended on the days patients
require extended recoveiy care.
C.
Appropriate drugs, supplies and equipment shall be immediately available to the
area, including a fully stocked crash cart with defibrillator and oxygen
tank.
D. Transfer agreements to a
local acute care hospital and ambulance transportation covering the Ambulatory
Surgery Center shall include the extended stay area.
VII. Medications
The Ambulatory Surgery Center shall have provisions for obtaining prescribed drugs and biologicals to meet the needs of the population served. In addition, policies and procedures shall be developed and implemented for the handling of medications brought into the facility by patients. Should it be necessary to administer a patient's own medications, a signed physician's order shall be in the medical record identifying the medication(s) along with the route and directions for use.
VIII. Medical Records
A. Ambulatory Surgery Centers shall have an
expanded medical record for patients in extended stay.
B. The same medical record rmryshall be
utilized that was initiated upon admission for surgery.
C. A discharge note shall be written upon
discharge from acute recovery care.
D. An admission note, to include a patient
assessment by a Registered Nurse, shall be included when the patient is
received in the extended care area.
E. Pertinent observations, treatments, and
medications shall be documented in the nurses' notes.
F. A closing entry or discharge summary shall
include information/observations regarding the patient's condition and the care
provided throughout the extended care.
G. Patient food allergies and
preferences-shall be documented. Meal intake and toleration of diet shall be
documented by nursing personnel in the nurses' notes.
IX. Patient Nutrition
A. If meals are prepared onsite, the Food and
Nutrition Services shall be supervised by a qualified individual on the days
the facility is open. A qualified individual shall be at a minimum a certified
dietary manager.
B. The food
preparation area shall included at a minimum:
1. Refrigerator/freezer;
2. Microwave oven;
3. Handwashing sink with towel and soap
dispensers;
4. Counter
space;
5. Garbage cans with
cover;
6. Storage area for food,
food preparation equipment and tableware; and
7. A three (3) compartment sink, if
disposables are not utilized at all times.
C. If meals are not prepared onsite, the food
served to the patient shall be obtained from a food service establishment that
operates in accordance with the Arkansas Department of Health Rules and
Regulations Pertaining to Food Service Establishments.
D. Leftover foods shall not be stored for
future patient use.
X. Physical Facilities
Extended stay may permit patient sleeping accommodations in the post-anesthesia recovery area.
XI. Staffing
A. At least one (1) registered nurse shall be
on duty at all times while the center is in operation, with supportive
personnel as needed.
B. Non-nursing
personnel, i.e., aides, housekeeping, etc. shall be assigned in sufficient
numbers and with sufficient training to meet the patient-s needs.
XII. Security Procedures
A. Measures shall be employed to ensure the
security of patients, families, physicians, and employees while at the center
after normal working hours.
B. The
parking lot shall be well-lit, with frequent checks made for light bulbs
needing replacement.
C. At least
two employees shall be present inside the facility when patients are present.
XIII. Quality Improvement/Risk Management Plan
A.
Ambulatory Surgery Centers shall assure the same QI plan is followed for
extended recovery care patients as general patients.
B. Each extended recovery patient shall
receive the same Patient Satisfaction Questionnaire as general surgical
patients upon discharge from the facility.
C. Each extended recovery care patient shall
receive a postoperative call if they are discharged to home. If they are
discharged to an alternate health care facility (i.e., rehab) a discharge
summary shall be obtained upon discharge from that facility.
D. During the first year of extended
recover)' services a quarterly report of the plan review shall be sent to the
Health Facility Services Division of the Department.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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