Current through Register Vol. 48, No. 12, March 22, 2024
Any facility seeking PCCC level recognition shall meet
requirements for both the EDAP and PCCC levels.
a) Facility Requirements
A facility recognized as a PCCC Center shall provide the
following:
1) An EDAP-recognized
emergency department;
2) A distinct
Pediatric Intensive Care Unit (PICU);
3) A PICU Committee established as a standing
(interdisciplinary) committee within the hospital with membership that
includes, at a minimum, one physician, one RN, one respiratory therapist, and
other specialties as determined by the hospital;
4) Helicopter landing capabilities approved
by State and federal authorities;
5) Computerized axial tomography (CAT) scan
availability 24 hours a day;
6)
Laboratory 24 hours a day in-house, providing:
A) Standard analysis of blood, urine and body
fluids;
B) Blood typing and
cross-matching;
C) Coagulation
studies;
D) Comprehensive blood
bank or an agreement with a community central blood bank;
E) Blood gases and pH
determinations;
F) Microbiology,
including the ability to initiate aerobic and anaerobic cultures on site;
and
G) Drug and alcohol
screening;
7)
Hemodialysis capabilities or a transfer agreement;
8) Staff, including a child life specialist,
occupational therapy, speech therapy, physical therapy, social work, dietary,
psychiatry and child protective services;
9) Hospital support staff to act as a
resource and participate in multidisciplinary regional pediatric critical care
education;
10) A plan for
implementing a program of public information/education concerning emergency
care services for pediatrics; and
11) Support for active institutional and
collaborative regional research.
b) PICU Medical Director Requirements
A Medical Director shall be appointed, and a record of
appointment and acceptance shall be in writing.
1) Qualifications
The PICU shall have a dedicated Medical Director who
is:
A) Board certified in Pediatrics
by the ABP or the AOBP, and Board certified or in the process of certification
in Pediatric Critical Care Medicine by ABP, or Pediatric Intensive Care by
AOBP;
B) Board certified in
Pediatrics by the ABP or the AOBP, and Board certified in a pediatric
subspecialty with at least 50% practice in pediatric critical care. In this
situation, a physician who meets the criteria in subsection (b)(1)(A) shall be
appointed as Co-director;
C) Board
certified in Anesthesiology by the American Board of Anesthesiology (ABA), or
the American Osteopathic Board of Anesthesiology (AOBA), with practice limited
to infants and children and with a subspecialty certification in Critical Care
Medicine. In this situation, a physician who meets the criteria in subsection
(b)(1)(A) shall be appointed as Co-director; or
D) Board certified in Pediatric Surgery by
the American Board of Surgery (ABS) with a subspecialty certification in
Surgical Critical Care Medicine by the ABS. In this situation (ABS), a
physician who meets the criteria in subsection (b)(1)(A) shall be appointed as
Co-director.
2) The
Medical Director or Co-Director shall achieve certification within seven years
after his/her initial acceptance into the certification process for pediatric
critical care or intensive care medicine, and shall maintain
certification.
c) PICU
Medical Staff Requirements
1) Qualifications
A) The PICU shall have 24-hour in-hospital
coverage provided by a board certified pediatric intensivist, certified by ABP
or AOBP, or board eligible pediatric intensivist in the process of
certification by ABP or AOBP, who is responsible for the supervision of the
physicians listed in subsections (c)(1)(A)(i) and (ii), and who is available
within 30 minutes in-house after the determination is made that he or she is
needed. If the intensivist is not in-house, then one of the following shall be
available in-house:
i) Board certified
pediatrician certified by ABP or AOBP, or board eligible in pediatrics and in
the process of board certification; or
ii) A resident of PGY-2 or greater under the
auspices of a Pediatric Training Program, in the unit, with a PGY-3
in-house.
B) All
physicians listed in subsection (c)(1)(A) shall successfully complete and
maintain current recognition in one of the following courses: the AHA-AAP PALS
or ACEP-AAP APLS. PALS and APLS shall include both cognitive and practical
skills evaluation.
2)
Physician Specialist Availability
If the applying hospital is a Pediatric Trauma Center, the
applicable requirements for physician response times that meet Sections
515.2035
and
515.2045
shall be followed.
A) Attending level
physician specialists shall be on staff and are required to have the following:
i) Pediatric proficiency as defined by the
hospital credentialing process;
ii)
Board/sub-board certification in their specialty. If residency trained/board
prepared in their specialty, physicians shall achieve certification within
seven years after initial acceptance into the board/sub-board certification
process, and maintain certification; and
iii) 10 hours per year of pediatric CME
(category I or II) in his/her specialty.
B) The following on-call surgeons with
pediatric proficiency shall be available in-house within 60 minutes after the
determination is made that they are needed:
i) Surgeon; and
ii) Neurosurgeon, or transfer agreement with
another facility.
C)
On-call attending anesthesiologists with pediatric proficiency shall be
available in-house within 60 minutes after the determination is made that they
are needed. CRNAs with pediatric proficiency may initiate appropriate
procedures as identified in hospital by-laws.
D) On-staff subspecialists with the following
pediatric proficiency shall be available to the institution or by phone for
consultation within 60 minutes after the determination is made that they are
needed:
i) Cardiologist;
ii) Neonatologist;
iii) Nephrologist;
iv) Neurologist;
v) Orthopedic surgeon;
vi) Otolaryngologist; and
vii) Radiologist.
E) The following physician specialists shall
be available in the hospital or by consultation or transfer agreement with
another hospital:
i) Allergist or
immunologist;
ii) Cardiothoracic
surgeon;
iii) Craniofacial
(plastic) surgeon;
iv)
Endocrinologist;
v)
Gastroenterologist;
vi) Hand
surgeon;
vii)
Hematologist-oncologist;
viii)
Infectious disease;
ix)
Micro-vascular surgeon;
x)
Obstetrics/gynecology;
xi)
Ophthalmologist;
xii) Oral
surgeon;
xiii) Physiatrist
(physical medicine & rehabilitation);
xiv) Psychiatrist/psychologist;
xv) Pulmonologist; and
xvi) Urologist.
d) PICU Nurse
Practitioner, Clinical Nurse Specialist, and Physician Assistant Qualifications
1) Nurse practitioners shall:
A) Successfully complete a Pediatric Nurse
Practitioner program or Pediatric Critical Care Nurse Practitioner Program and
certification as an acute care pediatric nurse practitioner.
B) Hold a current Illinois APRN license. For
out-of-state facilities with Illinois recognition under the EMS, trauma, or
pediatric program, the nurse practitioner shall have an unencumbered license in
the state in which he or she practices.
C) Provide credentialing that reflects
orientation, ongoing training, and specific demonstrated competencies in the
care of the critically ill and injured pediatric patient, as defined by the
hospital credentialing process.
2) Clinical nurse specialists shall:
A) Successfully complete a clinical nurse
specialist program that includes pediatrics.
B) Maintain pediatric clinical nurse
specialist certification through a nationally recognized organization (AACN,
ANCC or an equivalent national organization).
C) Hold a current Illinois APRN license. For
out-of-state facilities with Illinois recognition under the EMS, trauma, or
pediatric program, the clinical nurse specialist shall have an unencumbered
license in the state in which he or she practices.
D) Provide credentialing that reflects
orientation, ongoing training, and specific demonstrated competencies in the
care of the critically ill and injured pediatric patient, as defined by the
hospital credentialing process.
3) PA shall:
A) Hold a current Illinois Physician
Assistant License. For out-of-state facilities that have Illinois recognition
under the EMS, trauma, or pediatric program, the professional shall have an
unencumbered license in the state in which he or she practices.
B) Provide credentialing that reflects
orientation, ongoing training and specific demonstrated competencies in the
care of the critically ill and injured pediatric patient as defined by the
hospital credentialing process.
4) All full- and part-time nurse
practitioners, clinical nurse specialists, and PAs shall successfully complete
and maintain current recognition in one of the following courses: the AHA-AAP
PALS or ACEP-AAP APLS. PALS and APLS shall include both cognitive and practical
skills evaluation.
5) All full- and
part-time nurse practitioners, clinical nurse specialists, and PAs shall have
documentation of a minimum of 50 hours of continuing education in pediatric
topics every two years that included a minimum of 25 hours in pediatric
critical care, and that are approved by an accrediting agency.
e) PICU Nursing Staff Requirements
1) Nurse manager. The PICU shall have a
designated nurse manager who shall:
A) Be
licensed as an RN;
B) Have the
equivalent of three years full-time clinical critical care experience, with a
minimum of one year in clinical pediatric care; and
C) Successfully complete and maintain current
recognition in one of the following courses: the AHA-AAP PALS or ACEP-AAP APLS.
PALS and APLS shall include both cognitive and practical skills
evaluation.
2) Pediatric
Clinical Nurse Expert. The PICU shall have a designated pediatric clinical
nurse expert who is a member of the unit leadership and who facilitates the
development, provision and conduction of clinical education, quality
improvement, and policy development aimed at promoting pediatric evidence-based
best practices. This nurse shall:
A)
Successfully complete:
i) An acute Care or
Primary Care Pediatric Nurse Practitioner Program and hold certification as an
acute care or primary care pediatric nurse practitioner;
ii) A Pediatric Clinical Nurse Specialist
Program and hold certification as a pediatric clinical nurse specialist;
or
iii) A masters or doctorate and
hold certification as a certified pediatric nurse (CPN), certified critical
care registered nurse in pediatrics (CCRN-P), or certified critical care
registered nurse in pediatrics - knowledge professional (CCRN-K).
B) Hold a current Illinois RN
license. For out-of-state facilities with Illinois recognition under the EMS,
trauma, or pediatric program, the RN shall have an unencumbered license in the
state in which he or she practices;
C) Successfully complete and maintain current
recognition in one of the following courses: the AHA-AAP PALS or ACEP-AAP APLS.
PALS and APLS shall include both cognitive and practical skills evaluation;
and
D) Provide documentation of a
minimum of 50 hours of continuing education in pediatric topics every two years
that include a minimum of 25 hours in pediatric critical care and that are
approved by an accrediting agency.
3) Nursing Patient Care Services
All RNs engaged in direct patient care activities
shall:
A) Successfully complete a
documented hospital and unit orientation according to hospital guidelines
before assuming full responsibility for patient care;
B) Complete a yearly competency review of
high-risk, low-frequency therapies;
C) Successfully complete and maintain current
recognition in one of the following courses: the AHA-AAP PALS, the ACEP-AAP
APLS or the ENA ENPC. PALS, APLS and ENPC shall include both cognitive and
practical skills evaluation; and
D)
Complete a minimum of 16 hours of pediatric emergency/critical care continuing
education hours every two years. Continuing education may include, but is not
limited to, CEU offerings, case presentations, competency testing, teaching
courses related to pediatrics or publications.
f) PICU Policies, Procedures, and Treatment
Protocols
The PICU will include, but not be limited to, having the
following age-specific policies/protocols in place:
1) Admission and discharge
criteria;
2) A staffing policy that
addresses nursing shift staffing patterns based on patient acuity;
3) A policy for managing the psychiatric
needs of the PICU patient; and
4)
Protocols, order sets, pathways or guidelines for management of high- and
low-frequency diagnoses.
g) Inter-facility Transfer/Transport
Requirements
A PCCC shall:
1)
Provide necessary consultation to those hospitals with which a transfer
agreement is established; accept pediatric transfers from those hospitals;
provide feedback as well as quality review to those hospitals on the transfer
and management process;
2) Have or
be affiliated with a transport system and team to assist referral hospitals in
arranging safe pediatric patient transport; and
3) Have a transfer/transport policy that
addresses the special needs of the pediatric population during
transport.
h) Quality
Improvement Requirements
1) Each PCCC shall
have members from the PICU, including the Medical Director, and from the
Pediatric Department who serve on the Multidisciplinary Pediatric Quality
Improvement Committee, which will include, but not be limited to: emergency
department, pediatric department, respiratory, laboratory, social service and
radiology staff.
2) The
Multidisciplinary Pediatric Quality Improvement Committee shall perform focused
outcome analyses of its PICU and other pediatric inpatient unit services on a
quarterly basis that consist of a review of at least the following:
A) All pediatric deaths;
B) All pediatric inter-facility
transfers;
C) All pediatric
morbidities or negative outcomes that are a result of treatment rendered or
omitted;
D) Pediatric quality
metrics that examine the process of care and identify potential patient care
and internal resource problems;
E)
Child abuse and neglect cases unless review is performed by another committee
in the hospital;
F) All
re-admissions within 48 hours after discharge from the emergency department or
inpatient care that result in admission to the PICU; and
G) Review of all potential and unanticipated
adverse outcomes.
i) PICU Equipment (See Appendix O)
The PCCC shall meet all equipment requirements as outlined in
Appendix O. In addition, a specialized pediatric resuscitation cart with
measuring device shall be readily available on each pediatric unit, containing
the required equipment.
j)
Pediatric Inpatient Care Service Requirements
1) Physician Requirements
A) The Chair of Pediatrics or the Pediatric
Inpatient Director shall have certification in pediatrics by the ABP or the
AOBP.
B) All hospitalists,
credentialed by their hospital to provide pediatric unit care, shall
successfully complete and maintain current recognition in one of the following
courses: the AHA-AAP PALS or the ACEP-AAP APLS. PALS and APLS shall include
both cognitive and practical skills evaluation.
C) The Medical Director of the PICU, or
his/her designee, shall be available on call and for consultation for all
pediatric in-house patients who may require critical care.
2) Nurse Manager Requirements
The nurse manager shall:
A) Be licensed as an RN. For out-of-state
facilities that have Illinois recognition under the EMS, trauma, or pediatric
program, the RN shall have an unencumbered license in the state in which he or
she practices;
B) Have the
equivalent of three years full-time pediatric experience; and
C) Complete and maintain current recognition
in one of the following courses: AHA-AAP PALS, the ACEP-AAP APLS or the ENA
ENPC. PALS, APLS and ENPC shall include both cognitive and practical skills
evaluation.
3) Nursing
Patient Care Services
All nurses engaged in direct patient care activities
shall:
A) Be licensed as an RN. For
out-of-state facilities with Illinois recognition under the EMS, trauma, or
pediatric program, the RN shall have an unencumbered license in the state in
which he or she practices;
B)
Complete a documented hospital and unit orientation according to hospital
guidelines before assuming full responsibility for patient care;
C) Complete a yearly competency review of
high-risk, low-frequency therapies based on patient population;
D) Complete and maintain current recognition
in one of the following courses: AHA-AAP PALS, the ACEP-AAP APLS or the ENA
ENPC. PALS, APLS and ENPC shall include both cognitive and practical skills
evaluation; and
E) Complete a
minimum of 16 hours of pediatric continuing education hours every two years.
Continuing education may include, but is not limited to, CEU offerings, case
presentations, competency testing, teaching courses related to pediatrics, or
publications.
k) Hospital General Pediatric Department
Policies, Procedures and Treatment Protocols. The pediatric department shall
have, but not be limited to:
1) A policy or
scope of services that outlines the pediatric department services, ages of
patients served, and admission guidelines;
2) A staffing policy that addresses nursing
shift staffing patterns based on patient acuity;
3) A safety and security policy for the
patient in the unit;
4) An
inter-facility transport policy that addresses safety and acuity;
5) An intra-facility transport policy that
addresses safety and acuity;
6) A
latex allergy policy;
7) A
pediatric organ procurement/donation policy;
8) An isolation precautions policy that
incorporates appropriate infection control measures;
9) A disaster policy that addresses the
specific medical and psychosocial needs of the pediatric population;
10) Protocols, order sets, pathways or
guidelines for management of high-risk and low-frequency diagnoses;
11) A pediatric policy that addresses the
resources available to meet the psychosocial needs of patients and family and
appropriate social work referral for the following indicators:
A) Child death;
B) Child has been a victim of or witness to
violence;
C) Family needs
assistance in obtaining resources to take the child home;
D) Family needs a payment resource for their
child's health needs;
E) Family
needs to be linked back to their primary health, social service or educational
system;
F) Family needs support
services to adjust to their child's health condition or the increased demands
related to changes in their child's health conditions; and
G) Family needs additional education related
to the child's care needs to care for the child at home.
12) A discharge planning policy or protocol
that includes the following:
A) Documentation
of appropriate primary care/specialty follow-up provisions;
B) Mechanism to access a primary care
resource for children who do not have a provider;
C) Discharge summary provision to appropriate
medical care provider, parent/guardian, which includes the following:
i) Information on the child's hospital
course;
ii) Discharge instructions
and education; and
iii) Follow-up
arrangements;
D)
Appropriate referral of patients to rehabilitation or specialty services for
children who may have any of the following problems:
i) Require the assistance of medical
technology;
ii) Do not exhibit
age-appropriate activity in cognitive, communication or motor skills,
behavioral, or social/emotional realms;
iii) Additional medical or rehabilitation
needs that may require specialized care, such as medication, hospice care,
physical therapy, home health, or speech/language services;
iv) Brain injury - mild, moderate or severe;
v) Spinal cord injury;
vi) Seizure behavior exhibited during acute
care or a history of seizure disorder and is not currently linked with
specialty follow up;
vii)
Submersion injury, such as a near drowning;
viii) Burn (other than a superficial
burn);
ix) Pre-existing condition
that experiences a change in health or functional status;
x) Neurological, musculoskeletal or
developmental disability; or
xi)
Sudden onset of behavioral change, for example, in cognition, language or
affect.
l) Quality Improvement Requirements
Representatives from the pediatric unit shall participate in
the multidisciplinary Pediatric Quality Improvement Committee (see subsection
(h)).
m) Equipment
Requirements (See Appendix O)
The PCCC shall meet all equipment requirements as outlined in
Appendix O. In addition, a specialized pediatric resuscitation cart with
measuring device shall be readily available on each pediatric unit, containing
the required equipment.