Current through Register Vol. 50, No. 9, September 20, 2024
A. The layout,
design of details, equipment and furnishings shall be such that patients shall
be under close observation and shall not be afforded opportunities for hiding,
escape or injury to themselves or others. The environment of the unit shall be
characterized by a feeling of openness with emphasis on natural light and
exterior views. Interior finishes, lighting and furnishings shall suggest a
residential rather than an institutional setting while conforming with
applicable fire safety codes. Security and safety devices shall not be
presented in a manner to attract or challenge tampering by patients.
B. Windows or vents shall be arranged and
located so that they can be opened from the inside to permit venting of
combustion products and to permit occupants direct access to fresh air in
emergencies. The operation of windows shall be restricted to inhibit possible
escape or suicide. Where windows or vents require the use of tools or keys for
operation, the tools or keys shall be either located on the same floor in a
prominent location accessible to staff or carried by every staff member. With
hospitals that have approved engineered smoke control systems, the windows may
be fixed. Where glass fragments pose a hazard to certain patients, safety
glazing and/or other appropriate security features shall be used. There shall
be no curtain or venetian blind chords.
C. Where grab bars are provided, they shall
be institutional type, shall not rotate within their fittings, be securely
fastened with tamper-proof screw heads, and shall be free of any sharp or
abrasive elements. If grab bars are mounted adjacent to a wall, the space
between the wall and the grab bar shall be 1 1/2 inches.
D. Where towel racks, closet and shower
curtain rods are provided, they shall be the breakaway type.
E. Plastic bags and/or trash can liners shall
not be used in patient care areas.
F. Electrical receptacles shall be of the
safety type or protected by 5-milliampere ground-fault-interrupters.
G. There shall be outdoor space for patient
recreation.
H. Patient Rooms
1. A nurses call system is not required, but
if it is included, provisions shall be made for easy removal, or for covering
call button outlets. A hospital shall have written policies and procedures to
address call where no electronic system is in place.
2. Bedpan-flushing devices may be omitted
from patient room toilets in psychiatric nursing units.
3. Visual privacy (e.g., cubicle curtains) in
multi-bed rooms is not required.
4.
Free standing closets shall be secured to the wall.
5. Electric patient beds are not to be
used.
I. Service Areas
1. A secured storage area controlled by staff
shall be provided for patients' belongings that are determined to be
potentially harmful (e.g., razors, nail files, cigarette lighters).
2. Drugs and biologicals shall be stored in
locked compartments under proper temperature controls, and only authorized
personnel shall have access to the keys.
3. Food service may be one or a combination
of the following:
a. a nourishment
station;
b. a kitchenette designed
for patient use with staff control of heating and cooking devices;
c. a kitchen service including a hand washing
fixture, storage space, refrigerator, and facilities for meal
preparation.
4. Storage
space for stretchers and wheelchairs may be outside the psychiatric unit,
provided that provisions are made for convenient access as needed for
handicapped patients.
5. A separate
charting area shall be provided with provisions for acoustical privacy. A
viewing window to permit observation of patient areas by the charting nurse or
physician may be used if the arrangement is such that patient files cannot be
read from outside the charting space.
6. At least two separate social spaces, one
appropriate for noisy activities and one for quiet activities shall be
provided. The combined area shall be at least 40 square feet per patient with
at least 120 square feet for each of the two spaces. This space may be shared
by dining activities.
7. Space for
group therapy shall be provided. This may be combined with the quiet space
noted above when the unit accommodates not more than 12 patients, and when at
least 225 square feet of enclosed private space is available for group therapy
activities.
8. An automatic washer
and dryer shall be provided for patient laundry.
9. Room(s) for examination and treatment with
a minimum area of 120 square feet shall be provided within or in close
proximity to the unit.
10. Separate
consultation room(s) with minimum floor space of 100 square feet each, provided
at a room-to-bed ratio of one consultation room for each 12 psychiatric beds
shall be provided within the unit for interviews with patients and their
families. The room(s) shall be designed for acoustical and visual privacy and
constructed to achieve a noise reduction of at least 45 decibels.
11. Psychiatric hospitals or units shall
provide 15 square feet of separate space per patient for occupational therapy,
with a minimum total area of at least 200 square feet, whichever is greater.
This space shall include provision for hand washing, work counter(s), storage
and displays. Occupational therapy areas may serve more than one nursing unit.
When the psychiatric nursing unit(s) contain fewer than 12 beds, the
occupational therapy functions may be performed within the noisy activities
area, if at least an additional 10 square feet per patient served is
included.
12. A conference and
treatment planning room for use by the psychiatric unit shall be provided. This
room may be combined with the charting room.
J. Seclusion Treatment Room
1. There shall be at least one seclusion room
for up to 24 beds or a major fraction thereof. It is intended for short-term
occupancy by violent or suicidal patients and provides for patients requiring
security and protection. The room(s) shall be either located for direct nursing
staff supervision or observed through the use of electronic monitoring
equipment.
2. If electronic
monitoring equipment is used, it shall be connected to the hospital's emergency
electrical source.
3. Each room
shall be for single occupancy and contain at least 60 square feet. It shall be
constructed to prevent patient hiding, escape, injury or suicide.
4. Where restraint beds are required by the
functional program, 80 square feet shall be required.
5. If a facility has more than one
psychiatric unit, located at the same geographical address, the number of
seclusion rooms shall be determined by the total number of psychiatric beds at
that location. However, if there are psychiatric units located at multiple and
different geographical addresses, there shall be a seclusion room that meets
these requirements at each off-site campus that offers inpatient psychiatric
services.
6. Special fixtures and
hardware for electrical circuits shall be used.
7. The minimum ceiling height shall be 9
feet.
8. Doors shall be 3 feet 8
inches wide, and shall permit staff observation of the patient while also
maintaining provisions for patient privacy.
9. Seclusion rooms shall be accessed by an
anteroom or vestibule which also provides direct access to a toilet
room.
K. Ceiling
construction in psychiatric patient rooms and seclusion room(s) shall be
monolithic or tamper proof.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
40:2100-2115.
