Current through Register Vol. 51, No. 19, September 20, 2024
A.
A nursing home which holds a current and valid operating license may establish
special care units with the approval of the:
(1) Office of Health Care Quality;
and
(2) Department's Office of
Capital Planning, Budgeting and Engineering Services.
B. A facility may notify the Department of
its intention to establish a special care unit before developing and submitting
the required documents for approval as described in §C of this
regulation.
C. The nursing home
shall obtain Departmental approval of the following pertaining to the special
care unit:
(1) A description and scope of
services to be provided;
(2) An
organization chart of the special care unit and its relationship to the rest of
the nursing home;
(3) A description
of staffing patterns;
(4)
Qualifications, duties, and responsibilities of personnel;
(5) A quality assurance plan which includes:
(a) Assignment of responsibility for
monitoring and evaluation activities;
(b) Identification of the predominant aspects
of care provided;
(c)
Identification of indicators and appropriate clinical criteria for monitoring
the most important aspects of care;
(d) Establishment of thresholds (levels or
trends) for the indicators that will trigger evaluation of care;
(e) Monitoring of the important aspects of
care by collecting and organizing data for each indicator;
(f) Evaluation of care when thresholds are
reached in order to identify opportunities to improve either care or
problems;
(g) Taking actions to
improve care or to correct the problems;
(h) Assessing the effectiveness of the
actions, documenting the improvement in care, and assessing the quality
assurance process; and
(i)
Communication of the results of the monitoring and evaluation process to
relevant individuals or services;
(6) Policies and procedures, including:
(a) The transfer or referral of residents who
require services that are not provided by the special care unit;
(b) The administration of medications that
are relevant to the special care residents in the special care units;
(c) Infection control measures to minimize
the transfer of infection in the special care unit;
(d) Pertinent safety practices, including the
control of fire and mechanical hazards; and
(e) Preventive maintenance for equipment in
the special care unit;
(7) Protocols for obtaining specialized
services, such as arterial blood gases or other STAT services;
(8) Protocols for emergency situations;
and
(9) An inventory of any
specialized equipment to be housed on the unit to provide services in the
special care unit.
D. A
facility that has been approved to establish a special care unit shall meet all
applicable requirements of this chapter.
E. Physician Coordinator.
(1) If the facility's medical director does
not have special training and experience in the discipline of the assigned
special care unit, the facility shall hire a physician who is appropriately
trained and experienced to provide:
(a)
Overall medical supervision of the special care unit; and
(b) Coordination of all services for the
assigned special care unit.
(2) The facility shall verify the candidate's
credentials before employment as physician coordinator.
(3) The physician coordinator, or a designee
who meets the requirements of §E(1) of this regulation, shall:
(a) Respond personally or arrange for another
qualified physician to respond to situations warranting medical intervention;
and
(b) Be available to provide any
required consultation.
F. Staffing. The nursing home shall ensure
that each unit is sufficiently staffed with qualified personnel to provide
appropriate treatment and meet the care needs of the residents.
G. Nursing Services.
(1) The director of nursing shall designate a
registered nurse who has education, training, and experience in caring for the
needs of the special care residents to coordinate all nursing care within the
special care unit.
(2) Nursing
staff shall be:
(a) Knowledgeable about the
emotional and rehabilitative aspects of the special care unit residents;
and
(b) Capable of initiating
appropriate therapeutic interventions when needed.
H. Design.
(1) A special care unit shall meet the
general construction requirements of Regulations .08, .42, and .41 of this
chapter, and the requirements in this regulation.
(2) The nursing home shall ensure that floor
space allocated to each bed meets minimum requirements listed in Regulation .49
of this chapter, and is sufficient to accommodate the special equipment
necessary to meet the needs of residents.
I. Radiologic and Laboratory Services. The
facility shall ensure that diagnostic radiologic and clinical laboratory
services are available 24 hours a day. The services may be provided through
contractual arrangements with providers that meet applicable federal and State
laws and regulations.
J. Quality
Assurance Program. The facility shall:
(1)
Develop a quality assurance plan to monitor and evaluate the care provided in
each special care unit; and
(2)
Monitor and evaluate the quality and appropriateness of care provided by the
special care unit as part of the facility's overall quality assurance
program.
