Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59A - Health Facility and Agency Licensing
Chapter 59A-3 - HOSPITAL LICENSURE
Section 59A-3.244 - Ambulatory, Obstetrical, and Special Care Units
Universal Citation: FL Admin Code R 59A-3.244
Current through Reg. 50, No. 187; September 24, 2024
(1) Ambulatory Care Services. Each hospital offering ambulatory care services under its hospital license shall establish policies and procedures to ensure that quality care based on the needs of the patient will be delivered at all times.
(a)
Ambulatory care services shall be under the direction of a licensed
physician(s) responsible for the clinical direction of patient care and
treatment services, and whose qualifications, authority, and responsibilities
are defined in writing as approved by the governing board.
(b) Ambulatory care services shall be staffed
with appropriately trained and qualified individuals to provide the scope of
services anticipated to meet the needs of the patients.
(c) Each patient's general medical condition
shall be managed by a member of the organized medical staff with appropriate
clinical privileges, as determined by medical staff bylaws.
(d) When any ambulatory care services are
provided by non-hospital employees, the provider shall meet all safety
requirements, abide by all pertinent rules and regulations of the hospital and
medical staff, and document the quality improvement measures to be
implemented.
(e) The provisions of
ambulatory nursing care shall be supervised by a registered nurse who is
qualified by relevant training and experience in ambulatory care.
(f) Sufficient personnel shall be on duty to
provide efficient and effective patient care services.
(g) The scope of services offered, and the
relationship of the ambulatory services program to other hospital units, as
well as all supervisory relationships within the program, shall be defined in
writing, and must be provided in accordance with the standards set by the
governing board's bylaws and the rules and regulations of the medical
staff.
(h) Written policies and
procedures to guide the operation of the ambulatory services program shall be
developed, reviewed, and revised as necessary, dated to indicate the time of
last revision, and enforced.
(i) A
medical record must be maintained on every patient who receives ambulatory care
services. Medical records shall be managed and maintained in accordance with
acceptable professional standards and practices. Confidentiality and disclosure
of patient information contained in the medical record must be maintained in
accordance with hospital policy and state and federal law. Each patient's
medical record must include the following information, and be updated as
necessary:
1. Patient
identification;
2. Relevant history
of the illness or injury and of physical findings;
3. Diagnostic and therapeutic
orders;
4. Clinical observations,
including the results of treatment;
5. Reports of procedures and tests, and their
results;
6. Diagnosis or
impression;
7. Allergies;
8. Referrals to practitioners or providers of
services internal or external to the hospital;
9. Communications to and from practitioners
or providers of service external to the hospital;
10. Growth charts for children and
adolescents as needed when the service is the source of primary care;
and
11. Immunization status of
children and adolescents and others as determined by law and/or hospital
policy.
(j) To facilitate
the ongoing provision of care, a problem list of known significant diagnoses,
conditions, procedures, drug allergies and medications shall be maintained for
each patient who receives ambulatory services. The problem list shall be
initiated no later than the third visit and include items based on any initial
medical history and physical examination, and updated on subsequent visits with
additional information as necessary. The problem list shall include the
following items:
1. Known significant medical
diagnoses and conditions;
2. Known
significant surgical and invasive procedures;
3. Known adverse and allergic reactions to
drugs; and
4. Medications known to
be prescribed for and/or used by the patient.
(2) Obstetrical Department. If provided, obstetrical services shall include labor, delivery, and nursery facilities, and be formally organized and operated to provide complete and effective care for each patient.
(a) Except in hospitals
licensed for 75 beds or less, the obstetrical service shall be separated from
other patient care rooms and shall have separate nursing staff. When
obstetrical services are provided in hospitals of 75 beds or less, there shall
be:
1. A written and enforced policy
concerning the placement of obstetrical patients in a manner most conducive to
meet their special needs, and
2.
Nursing staff who possess specialized skills in obstetrics and neonatal care,
whether by training or experience, and can provide service to obstetrical
patients and their infants on a 24 hour basis, whether on duty, on call, or on
a consultative basis.
(b)
In those hospitals with a formally organized obstetrical department, clean
gynecological and surgical patients may be admitted to the unit under specific
written controls approved by the medical staff and governing board when there
is a written demonstrated need in each case.
(c) Every infant born in a hospital shall be
properly identified immediately at the time of birth. Identification of the
infant shall be done in the delivery room, birthing room, or other place of
birth within the hospital, before either the mother or the infant is
transferred to another part of the facility.
(3) Special Care Units. The hospital shall ensure that a special care unit is a physically and functionally distinct entity within the hospital, has controlled access, and has an effective means of isolation for patients suffering from communicable or infectious disease or acute mental disorder.
(a) Special care units
shall provide:
1. Direct or indirect visual
observation by unit staff of all patients from one or more vantage
points;
2. A direct
intercommunication or alarm system between the nurse's station and the bedside;
and
3. Beds that are adjustable to
positions required by the patient, that are easily movable, and that have a
locking or stabilizing mechanism to attain a secure, stationary position.
Headboards, when present, shall be removable or adjustable to permit ready
access to the patient's head.
(b) Each special care unit shall be advised
by a physician who is a member of the organized medical staff.
(c) Each special care unit shall have its
relationship to other departments and units of the hospital specified in
writing (organizational chart).
(d)
All staff shall participate in annual in-service education programs concerning
cardiopulmonary resuscitation and safety and infection control
requirements.
(e) Written policies
and procedures shall be developed concerning the scope and provision of care in
each special care unit. Such policies and procedures shall be reviewed
annually, revised as necessary, dated to indicate the time of last review,
enforced, and include the following:
1.
Specific criteria for the admission and discharge of patients;
2. A system for informing the responsible
member of the organized medical staff of changes in the patient's
condition;
3. Methods for
procurement of equipment and drugs at all times;
4. Specific procedures relating to infection
and traffic control;
5.
Specification as to who may perform special procedures, under what
circumstances, and under what degree of supervision; and specific policies as
to the use of standing orders; and
6. A protocol for handling emergency
conditions related to the breakdown of essential equipment.
(f) No hospital shall hold itself out as a
Trauma Center unless it has been verified as a Trauma Center by the Department
of Health. Any violation of the Trauma Center provisions shall subject any
violator to appropriate remedies provided by section
395.1065,
F.S.
Rulemaking Authority 395.1055, 408.036 FS. Law Implemented 395.1055 FS.
New 8-15-18.
Disclaimer: These regulations may not be the most recent version. Florida 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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