Current through Vol. 24-04, March 15, 2024
Rule 1239.
(1)
Psychiatric nursing units shall be designed for the care of ambulatory and
nonambulatory inpatients. Provision shall be made in the design for adapting
the area for various types of psychiatric therapies that will be used and for
providing a noninstitutional atmosphere for ambulatory patients. The unit shall
provide a safe environment for patients and staff. Details of such facilities
shall be as described in the approved functional program.
(2) For patient rooms, each psychiatric
nursing unit shall meet the standards noted in
R 330.1243, except as follows:
(a) Windows in psychiatric units shall have
an operable section or sash controlled by keys or tools that are under the
control of the staff. The degree of security required shall be determined by
program requirements, but operation of the window sash shall be restricted to
inhibit possible escape or suicide. Where glass fragments may create a hazard
because of the type of patients expected, safety glazing or other appropriate
security features, or both, shall be used.
(b) A nurses' call system is not required,
but if it is included, provision shall be made to permit removal of the system
or for covering call button outlets.
(c) Bedpan flushing devices may be omitted
from patient room toilets in psychiatric nursing units.
(3) For service areas, each psychiatric
nursing unit shall meet the standards noted in
R 330.1243, with modifications as
follows:
(a) The drug distribution unit shall
provide for security against unauthorized access.
(b) In place of a nourishment station,
kitchen service may be provided within the unit. If used, kitchen service shall
include all of the following:
(i) A sink
equipped for handwashing.
(ii)
Storage space.
(iii) A
refrigerator.
(iv) Facilities for
meal preparation.
(c)
Storage space for stretchers and wheelchairs may be outside the psychiatric
unit if provision is made for convenient access as needed for handicapped
patients.
(d) A bathtub or shower
shall be provided for each 6 beds not otherwise served by bathing facilities
within the patient rooms.
(4) All of the following elements shall be
provided within each psychiatric nursing unit:
(a) A separate charting area which provides
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.
(b) Not less than 2 separate social spaces, 1
appropriate for noisy activities and 1 for quiet activities. The combined area
shall be not less than 3.72 square meters (40 square feet) per patient with not
less than 11.1 square meters (120 square feet) for each of the 2 spaces,
whichever is greater. This space may be shared with dining
activities.
(c) Space for group
therapy. This may be combined with the quiet space noted in subdivision (b) of
this subrule if an additional area of not less than 0.7 square meters (8 square
feet) per patient is added to the area and not less than 21 square meters (225
square feet) of space, enclosed for privacy, is available for group therapy
activities.
(d) Patient laundry
facilities with automatic washer and dryer.
(5) All of the following elements shall be
provided, but may be either within the psychiatric unit or immediately
accessible to it:
(a) Rooms for examination
and treatment with a minimum area of not less than 11.1 square meters (120
square feet). Examination treatment rooms for medical surgical patients may be
shared by the psychiatric unit patients. These rooms may be on a different
floor if conveniently accessible.
(b) Separate consultation rooms with a
minimum floor space of 9.3 square meters (100 square feet) each shall be
provided at the rate of 1 consultation room for each 30 psychiatric beds. The
rooms shall be designed for acoustical and visual privacy and constructed to
achieve a noise reduction of not less than 45 decibels.
(c) Each psychiatric unit shall contain 1.39
square meters (15 square feet) of separate space per patient for occupational
therapy with a minimum total area of not less than 18.6 square meters (200
square feet), whichever is greater. Space shall be provided for handwashing,
work counters, storage, and displays. Occupational therapy areas may serve more
than 1 nursing unit. When psychiatric units contain less than 16 beds, the
occupational therapy functions may be performed within the noisy activities
area, if not less than an additional 0.9 square meters (10 square feet) per
patient served is included.
(6) Within the psychiatric nursing unit there
shall be a seclusion room or rooms for patients requiring security and
protection. The rooms shall be located for direct nursing staff supervision.
Each room shall be for only 1 patient. It shall have an area of not less than
9.3 square meters (100 square feet) and be constructed to prevent patient
hiding, escape, injury, or suicide. If a facility has more than 1 psychiatric
nursing unit, the number of seclusion rooms shall be a function of the total
number of psychiatric beds in the facility. Seclusion rooms may be grouped
together. The seclusion room is intended for short-term occupancy by a patient
who has become violent or suicidal. Therefore, special fixtures and hardware,
including ground fault interrupters (GFI) for electrical circuits and
tamperproof outlets, shall be used. Doors shall open out and shall permit staff
observation of the patient while maintaining patient privacy. If the interior
of a seclusion room is padded with combustible materials, the room area,
including the floor, walls, ceiling, and all openings, shall be protected with
not less than 1-hour-rated construction.
