Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 175 - HEALTH CARE FACILITIES AND SERVICES LICENSURE
Chapter 7 - HEALTH CLINICS
Section 175-7-006 - STANDARDS OF OPERATION, CARE AND TREATMENT

Universal Citation: 175 NE Admin Rules and Regs ch 7 ยง 006

Current through September 17, 2024

175 NAC 7-006 applies to the following types of health clinics unless specified otherwise: public health clinics, ambulatory surgical centers, facilities at which ten or more abortions are performed during any one calendar week, facilities providing hemodialysis, and facilities providing labor and delivery services. Each health clinic must organize, manage, and administer in a manner consistent with the size, resources, and type of services to assure each patient receives the necessary care and treatment.

006.01 Licensee Responsibilities

The licensee of each health clinic must assume the responsibility for the total operation of the facility. The licensee responsibilities include:

1. Monitoring policies to assure the appropriate administration and management of the health clinic;

2. Maintaining the health clinic's compliance with all applicable state statutes and relevant rules and regulations;

3. Providing quality care and treatment to patients whether care and treatment are furnished by health clinic staff or through a contract with the health clinic;

4. Periodically reviewing reports and recommendations regarding the Quality Assurance/Performance Improvement program and implementing programs and policies to maintain and improve the quality of patient care and treatment;

5. Maintaining written minutes of meetings and actions;

6. Designating an administrator who is responsible for the day to day management of the health clinic and defining the duties and responsibilities of the administrator in writing;

7. Notifying the Department in writing within five working days when a vacancy in the administrator position occurs including who will be responsible for the position until another administrator is appointed;

8. Notifying the Department in writing within five working days when the vacancy is filled including effective date and name of person appointed administrator; and

9. Determining if emergency medical technician-intermediates or emergency medical technician-paramedics may perform activities within their scope of practice as either an employee or volunteer within the health clinic.

006.02 Administration

The administrator is responsible for planning, organizing, and directing the day to day operation of the health clinic. The administrator must report in all matters related to the maintenance, operation and management of the health clinic and be directly responsible to the licensee or to the person or persons delegated governing authority by the licensee. The administrator's responsibilities include:

1. Being on the premises a sufficient number of hours to permit adequate attention to the management of the health clinic;

2. Providing for the protection and promotion of patients' health, safety, and well-being;

3. Maintaining staff appropriate to meet patient needs;

4. Designating a substitute, who is responsible and accountable for management of the health clinic, to act in the absence of the administrator; and

5. Developing procedures which require the reporting of any evidence of abuse, neglect or exploitation of any patient served by the health clinic in accordance with Neb. Rev. Stat. § 28-372 of the Adult Protective Services Act or in the case of a child, in accordance with Neb. Rev. Stat. § 28-711.

6. Determining the supervision of and training for emergency medical technician-intermediates or emergency medical technician-paramedics.

006.03 Staff Requirements

Each health clinic must maintain a sufficient number of staff with the qualifications, training, and skills to meet operational and patient needs. Each health clinic must have job descriptions for each staff position, which include minimum qualifications required for the position.

7-006.03A Employment Eligibility: Each health clinic must ensure and maintain evidence of the following:
7-006.03A1 Staff Credentials: Each health clinic must verify:
1. The current active licensure, registratio , certification or other credentials in accordance with applicable state law, prior to staff assuming job responsibilities and must have procedures for verifying that the current status is maintained; and

2. That an emergency medical technician-intermediate or an emergency medical technician-paramedic providing service in the health clinic is employed by or serving as a volunteer member of an emergency medical service licensed by the Department.

7-006.03A1a If unlicensed staff assist in provision of care or treatment, such staff must be supervised by the appropriate licensed health care professional.

7-006.03A2 Health Status: Each health clinic must establish and implement policies and procedures related to the health status of staff to prevent the transmission of disease to patients.
7-006.03A2a Each health clinic must complete a health history screening for all staff prior to assuming job responsibilities and must require staff to have a physical examination when the results of the health history screening indicate the examination is necessary.

7-006.03A3 Criminal Background and Registry Checks: Each health clinic must complete and maintain documentation of pre-employment criminal background and registry checks on each unlicensed direct care staff member.
7-006.03A3a Criminal Background Checks: The health clinic must complete a criminal background check through a governmental law enforcement agency or a private entity that maintains criminal background information.

7-006.03A3b Registry Checks: The health clinic must check for adverse findings on each of the following registries:
1. Nurse Aide Registry;

2. Adult Protective Services Central Registry;

3. Central Register of Child Protection Cases; and

4. Nebraska State Patrol Sex Offender Registry.

7-006.03A3c The health clinic must:
1. Determine how to use the criminal background and registry information, except for the Nurse Aide Registry, in making hiring decisions;

2. Decide whether employment can begin prior to receiving the criminal background and registry information; and

3. Document any decision to hire a person with a criminal background or adverse registry findings, except for the Nurse Aide Registry. The documentation must include the basis for the decision and how it will not pose a threat to patient safety or patient property.

7-006.03A3d The health clinic must not employ a person with adverse findings on the Nurse Aide Registry regarding patient abuse, neglect, or misappropriation of patient property.

7-006.03B Training: Each health clinic must ensure staff receive training in order to perform job responsibilities.
7-006.03B1 Orientation: Each health clinic must provide and maintain evidence of an orientation program for all new staff and, as needed, for existing staff who are given new assignments. The orientation program must include an explanation of the:
1. Job duties and responsibilities;

2. The health clinic's sanitation and infection control program;

3. Organizational structure;

4. Patient Rights;

5. Patient care policies and procedures;

6. Personnel policies and procedures;

7. Emergency procedures;

8. Disaster preparedness plan; and

9. Reporting requirements for abuse, neglect and exploitation in accordance with the Adult Protective Services Act, Neb. Rev. Stat. § 28-372 or in the case of a child in accordance with Neb. Rev. Stat. § 28-711 and with health clinic policies and procedures.

7-006.03B1a Each health clinic that approves emergency medical technician-intermediates and emergency medical technician-paramedics to provide service as either an employee or a volunteer must provide orientation to registered nurses, physicians, and physician assistants involved in the supervision of emergency medical technician-intermediates and emergency medical technician-paramedics. The orientation must include:
1. Information regarding the scope of practice of an emergency medical technician-intermediate or emergency medical technician-paramedic; and

2. Supervision requirements, as determined by the governing authority of the health clinic, for emergency medical technician-intermediates and emergency medical technician-paramedics, to perform activities within their scope of practice as defined in 172 NAC 11, Regulations Governing Out-of-Hospital Emergency Care Providers, Section 11-006.

7-006.03B2 Ongoing Training: Each health clinic must maintain evidence of ongoing/continuous inservices or continuing education provided for staff. A record must be maintained including date, topic and participants. Specialized training of staff to permit performance of particular procedures or to provide specialized care, whether as part of a training program or as individualized instruction, must be documented in personnel records.

7-006.03C Employment Record: Each health clinic must maintain a current employment record for each staff person. The record must include information on orientation, inservice, credentialing and health history screening.

006.04 Patient Rights

Each health clinic must protect and promote each patient's rights. This includes the establishment of written policies and procedures and enforcement of such to ensure the operations of the clinic afford patients the opportunity to exercise their rights. At a minimum, each patient must have the right to:

1. Respectful and safe care by competent personnel;

2. Be informed of patient rights during the admission process;

3. Be informed in advance about care and treatment and related risks;

4. Make informed decisions regarding care and treatment and to receive information necessary to make those decisions;

5. Refuse care and treatment and to be informed of the medical consequences of refusing such;

6. Formulate advance directives and to have the health clinic comply with the directives unless the clinic notifies the patient of the inability to do so;

7. Personal privacy and confidentiality of medical records;

8. Be free from abuse, neglect and exploitation;

9. Access information contained in his/her medical record within a reasonable time when requested;

10. Receive health clinic services without discrimination based upon race, color, religion, gender, national origin, or payer. Health clinics are not required to provide uncompensated or free care and treatment unless otherwise required by law; and

11. Voice complaints and grievances without discrimination or reprisal and have those complaints and grievances addressed.

7-006.04A Grievances: Each health clinic must establish and implement a process that promptly addresses grievances filed by patients or their designee. The process, includes, but is not limited to:
1. A procedure for submission of grievances that is made available to patients or representatives;

2. Time frames and procedures for review of grievances and provision of a response; and

3. How information from grievances and responses are utilized to improve the quality of patient care and treatment.

006.05 Quality Assurance/Performance Improvement

Each health clinic must have an effective quality assurance/performance improvement program to evaluate care and treatment provided to patients. The program includes, but is not limited to:

1. A written plan of implementation;

2. Evaluation of care and treatment provided both by staff and through contract;

3. For ambulatory surgical centers, the tracking of surgical procedures that result in unplanned patient admissions to a hospital within 72 hours of a procedure, due to post surgical complications;

4. Appropriate action to address problems found through the program;

5. Evaluation of the outcome of any action taken; and

6. Reporting to the governing authority.

006.06 Patient Care and Treatment

Each health clinic must establish and implement written policies and procedures that encompass all care and treatment provided to patients. The policies and procedures are consistent with prevailing professional standards, delineate the scope of services provided in the health clinic and encompass aspects to protect the health and safety of patients.

7-006.06A Administration of Medications: Each health clinic must establish and implement policies and procedures to ensure patients receive medications only as legally prescribed by a medical practitioner in accordance with the Five Rights and prevailing professional standards.
7-006.06A1 Methods of Administration of Medications: When the health clinic is responsible for the administration of medications, it must be accomplished by the following methods:
7-006.06A1a Self Administration: The health clinic must allow patients of the health clinic to self-administer medications, with or without supervision, when assessment determines the patient is capable of doing so.

7-006.06A1b Licensed Health Care Professional: When the health clinic utilizes licensed health care professionals for whom medication administration is included in the scope of practice, the health clinic must ensure the medications are properly administered in accordance with prevailing professional standards.

7-006.06A1c Provision of Medication by a Person Other Than a Licensed Health Care Professional: When the health clinic utilizes persons other than a licensed health care professional in the provision of medications, the health clinic must follow 172 NAC 95 Regulations Governing the Provision of Medications by Medication Aides and Other Unlicensed Persons and 172 NAC 96 Regulations Governing the Medication Aide Registry. Each health clinic must establish and implement policies and procedures:
1. To ensure that medication aides who provide medications are trained and have demonstrated the minimum competency standards specified in 172 NAC 95-004.

2. To ensure that competency assessments and/or courses for medication aides have been completed in accordance with the provisions of 172 NAC 96-005.

3. That specify how direction and monitoring will occur when the health clinic allows medication aides to perform the routine/acceptable activities authorized by 172 NAC 95-005 and as follows:
a. Provide routine medication; and

b. Provision of medications by the following routes:
(1) Oral, which includes any medication given by mouth including sublingual (placing under the tongue) and buccal (placing between the cheek and gum) routes and oral sprays;

(2) Inhalation which includes inhalers and nebulizers, including oxygen given by inhalation;

(3) Topical application of sprays, creams, ointments, and lotions, and transdermal patches; and

(4) Instillation by drops, ointments, and sprays into the eyes, ears, and nose.

4. That specify how direction and monitoring will occur when the health clinic allows medication aides to perform the additional activities authorized by 172 NAC 95-009, which include but are not limited to:
a. Provision of PRN medications;

b. Provision of medications by additional routes including but not limited to gastrostomy tube, rectal, and vaginal; and/or

c. Participation in monitoring.

5. That specify how competency determinations will be made for medication aides to perform routine and additional activities pertaining to medication provision.

6. That specify how written direction will be provided for medication aides to perform the additional activities authorized by 172 NAC 95-009.

7. That specify how records of medication provision by medication aides will be recorded and maintained.

8. That specify how medication errors made by medication aides and adverse reactions to medications will be reported. The reporting must be:
a. Made to the identified person responsible for direction and monitoring;

b. Made immediately upon discovery; and

c. Documented in patient medical records.

7-006.06A2 Each health clinic must establish and implement policies and procedures for reporting any errors in administration or provision of prescribed medications to the prescriber in a timely manner upon discovery and a written report of the error must be prepared and maintained.

7-006.06A3 Each health clinic must establish and implement policies and procedures for reporting any adverse reaction to a medication, in a timely manner upon discovery, to the prescriber and for documenting such event in the patient's medical record.

7-006.06A4 Each health clinic must establish and implement procedures to ensure patients receive medications as prescribed by a medical practitioner. At a minimum, the following must be evident:
1. A current policy and procedure manual regarding the handling of medications in the health clinic;

2. A count of all controlled substances in the health clinic every 24 hours; and

3. Only authorized personnel designated by health clinic policy are allowed access to medications.

7-006.06B Verbal Orders: Each health clinic must establish and implement appropriate policies and procedures for those staff authorized to receive telephone and verbal diagnostic and therapeutic orders.

7-006.06C Patient Education: Each health clinic must establish and implement a process to ensure patients and/or their designee receive appropriate education and instruction to assist in understanding the identified condition and the necessary care and treatment. Any instructions at the time of discharge must be given in writing.

7-006.06D Patient Transfers: Each health clinic must transfer to a health care facility and have procedures for continued care of any patient whose condition does not allow dismissal within 24 hours.

006.07 Record Keeping Requirements

Each health clinic must maintain records and reports in such a manner to ensure accuracy and easy retrieval.

7-006.07A Medical Records: Every patient who receives care or treatment in a health clinic must have a medical record established. Medical records must contain sufficient information to clearly identify the patient and document the diagnosis, care, treatment, and results accurately.
7-006.07A1 Content: Medical records must contain, when applicable, the following information:
1. Identification data;

2. Chief complaint;

3. Medical history;

4. Physical examination;

5. All pathology/laboratory and radiology reports;

6. Properly executed informed consent forms;

7. Consultation reports;

8. Medical practitioner orders;

9. Care and treatment provided;

10. Progress notes;

11. Pertinent observations and events; and

12. Instructions to patients, including discharge/dismissal.

7-006.07A2 Medical records must contain entries which are dated, legible, and indelible. The author of each entry must be identified and authenticated. Authentication must include signature, written initials, or computer entry.

7-006.07A3 Retention: Each health clinic must maintain and preserve all medical records in original, microfilm, electronic, or other similar form, for a period of at least five years. In the case of a minor, the medical records must be kept until three years after the age of majority has been attained. When a health clinic ceases operation, all medical records must be transferred as directed by the patient or authorized representative to the licensed health care facility or health care service to which the patient is transferred. All other medical records that have not reached the required time for destruction must be stored to assure confidentiality and the Department must be notified of the address where stored.

7-006.07A4 Confidentiality: Medical records must be kept confidential, available only for use by authorized persons or as otherwise permitted by law. Records must be available for examination by authorized representatives of the Department.

7-006.07A5 Access: Patient information and/or records will be released only with consent of the patient or designee or as required by law.

7-006.07A6 Destruction: Medical records may be destroyed only when they are in excess of five years of age. In order to ensure confidentiality, each health clinic must destroy or dispose of medical records by shredding, incineration, electronic deletion, or another equally effective protective measure.

7-006.07B Other Records/Reports: In addition to patient medical records, each health clinic must maintain accurate and complete administrative records of the clinic operation for not less than three years unless longer is required by law.
7-006.07B1 A report that summarizes the scope and volume of services provided at the health clinic each year must be maintained.

006.08 Infection Control

Each health clinic must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections and communicable diseases.

7-006.08A The infection control program must include, but is not limited to:
1. The responsible person(s) for the program;

2. A system for identifying, reporting, investigating, and controlling infections and communicable diseases of patients and staff;

3. A definition of nosocomial infection;

4. A system for reporting known or suspected cases of infection acquired at the health clinic among patients and for maintaining records of such infection;

5. Maintenance of a record of infection, communicable disease and nosocomial infections;

6. Implementation of corrective action plans; and

7. Mechanism for evaluation of the program.

7-006.08A Equipment and Supplies: Each health clinic must establish and implement written policies and procedures for cleaning, sterilization and storage of supplies and equipment. Equipment and supplies must be maintained in accordance with prevailing professional standards to protect patients from infection.

7-006.08B Handwashing: Facilities for handwashing must be easily accessible and good handwashing techniques must be practiced by staff before and after patient contact.

7-006.08C Food Service: Each health clinic that provides food service must store, prepare, protect, and dispose of food in a safe and sanitary manner and in accordance with the Food Code.

006.09 Pharmacotherapy Services

Each health clinic that provides pharmacotherapy services to meet patient needs must maintain drugs, devices, and biologicals under the supervision of a licensed Nebraska pharmacist or licensed Nebraska physician. The storage, control, handling, compounding, administration, provision, and dispensing of drugs, devices, and biologicals must be in accordance with state and federal law.

Any health clinic that conducts a pharmacy or engages in the practice of pharmacy must do so in accordance with Neb. Rev. Stat. §§ 71-1,142 to 71-1, 147.61.

Each health clinic must ensure that information relating to interactions, contraindications, side effects, toxicology, dosage, indications for use, and routes of administration for drugs, devices, and biologicals is available to staff at all times.

7-006.09A Emergency Drugs, Devices, and Biologicals: Emergency drugs, devices, and biologicals, as determined by the need of patients served by each health clinic, must be readily available for use when an emergency occurs.

7-006.09B Prescribing Drugs, Devices, and Biologicals: Each health clinic must establish appropriate policies and procedures for those personnel authorized to receive telephone and verbal orders for drugs, devices, and biologicals. A separate policy and procedure must be required in health clinics where drugs, devices, and biologicals are dispensed to patients. All written orders and prescriptions must be legible as required by 175 NAC 7-006.07A 1.

7-006.09C Preparation and Compounding of Drugs, Devices, and Biologicals: A current policy and procedure manual regarding the handling of drugs, devices and biologicals in the health clinic must be available at all times to personnel authorized to administer or provide such. The manual must include information on preparation and must comply with all state and federal law regarding the practice of pharmacy.

7-006.09D Dispensing of Drugs, Devices, and Biologicals: All drugs, devices, and biologicals dispensed from a health clinic must be dispensed by a pharmacist, a physician with a dispensing permit, or in accordance with Neb. Rev. Stat. §§ 711, 147.39 to 71-1, 147.61.

7-006.09E Storage of Drugs, Devices, and Biologicals: All drugs, devices, and biologicals must be stored in secured areas and stored in accordance with the manufacturer's, distributor's, packager's, or dispensing pharmacist's instructions for temperature, light, humidity, and other storage instructions. Only authorized personnel, designated by policy and procedure of the health clinic as responsible for administration, provision, or dispensing, must have access to drugs, devices, and biologicals. The supply of drugs, devices, and biologicals must be protected and restricted to use for legally authorized purposes and must be checked on a regular basis to ensure expired, mislabeled, unlabeled, or unusable products are not available for patient use.

7-006.09F Record Keeping: All drugs, devices, and biologicals administered, provided, or dispensed for a patient must be recorded in the patient's medical record. The record must specify the name, dosage, date, time, and route of administration or provision and identification of the person who administered or provided such.
7-006.09F1 A complete and accurate record of all drugs, devices, and biologicals received, stored, administered, provided, dispensed, or disposed of by the health clinic must be kept and maintained for not less than five years.

7-006.09F2 Each health clinic must have a policy and procedure for the reporting and recording of any abuse or loss of drugs, devices, and biologicals. Such policy must be in accordance with state and federal law concerning abuse and loss of drugs, devices, and biologicals.

7-006.09G Sample Drugs, Devices, and Biologicals: Personnel of a health clinic must not receive manufacturer, distributor, or packager samples in violation of any state or federal law.
7-006.09G1 A complete and accurate record of all drugs, devices, and biologicals samples received, stored, administered, provided, dispensed, or disposed of by the health clinic must be kept and maintained for not less than five years.

7-006.09G2 All samples administered, provided, or dispensed to a patient must be recorded in the patient's medical record.

7-006.09H Investigational Drugs, Devices, and Biologicals: All drugs, devices, and biologicals being used as a part of a clinical investigation must be maintained in a locked and separate area from all other drugs, devices, and biologicals. All investigational drugs, devices, and biologicals should be administered only in accordance with the clinical study protocol.

7-006.09I Disposal of Drugs, Devices, and Biologicals: Each health clinic must ensure that expired, mislabeled, unlabeled, or unusable drugs, devices, and biologicals are not available for patient use and are disposed of in accordance with clinic policies and state and federal law. The disposal must be conducted on a routine basis to prevent storage of large quantities of expired, mislabeled, unlabeled, or unusable drugs, devices, and biologicals.

006.10 Laboratory Services

All laboratory testing, whether provided directly by the health clinic or through agreement, must comply with the Clinical Laboratory Improvement Amendments of 1988 as amended (CLIA).

7-006.10A Complete laboratory test result reports must be kept in patient medical records.

006.11 Radiology Services

Each health clinic that provides radiology services must be under the direction of a physician and must comply with the provisions of Neb. Rev. Stat. §§ 71-3501 to 71-3520 of the Radiation Control Act and the regulations promulgated thereunder.

7-006.11A Personnel performing medical radiography procedures must be licensed in accordance with Neb. Rev. Stat. §§ 71-3515.01 to 71-3515.02 of the Radiation Control Act and the regulations promulgated thereunder.

006.12 Ambulatory Surgical Center

Each ambulatory surgical center must meet the regulations specified in 175 NAC 7-006.01 to 7-006.09 and 7-006.15. In addition, each ambulatory surgical center must meet all requirements to qualify for a written agreement with the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services or its successor to participate in Medicare as an ambulatory surgical center as defined in 42 CFR 416.1 to 416.200 attached to these regulations and incorporated by this reference.

7-006.12A Each ambulatory surgical center is limited to performing surgical and other medical procedures that can be safely performed in a dedicated operating room or suite and which may require a postoperative recovery room for convalescent stay. An ambulatory surgical center can only provide surgical services to persons who are admitted to and discharged from the ambulatory surgery center within the same working day and must not retain patients past midnight of the day of admission.

7-006.12B Each ambulatory surgical center must maintain a chronological permanent admission and discharge record that, at a minimum, includes:
1. Full name of each patient;

2. Identification number assigned by the ambulatory surgical center;

3. Date and time of admission and discharge;

4. Surgical procedure(s) performed;

5. Inclusive time of surgical procedure(s);

6. Name of surgeon and any assistants(s);

7. Name of nursing personnel (scrubbing and circulating);

8. Type of anesthesia; and

9. Name and title of person administering anesthesia.

7-006.12C Each ambulatory surgical center must provide discharge planning to patients or their designee.
7-006.12C1 If a patient is discharged to a health care facility or health care service, necessary medical information must be transferred to the receiving facility or service.

7-006.12D Before discharge from the ambulatory surgical center, the patient must be evaluated for proper recovery. Qualified personnel must remain with the patient until the patient's status is stable and protective reflexes have returned to normal. A patient may be discharged only when a medical practitioner and facility policies determine it is safe and appropriate to discharge. The ambulatory surgical center must establish medical criteria for discharge which is consistent with prevailing professional standards.

7-006.12E Each ambulatory surgical center must, at least annually, provide surgeons performing surgery at the facility a report as to the number and rates of surgical infections in patients of the surgeons.

006.13 Hemodialysis Services

Each health clinic providing hemodialysis services must be licensed as a health clinic and must meet the regulations specified in 175 NAC 7006.01 to 7-006.11 and 7-006.15. In addition, each health clinic must meet all requirements to qualify for a written agreement with the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services or its successor to participate in Medicare for hemodialysis services as defined in 42 CFR 405.2100 to 405.2163, attached to these regulations and incorporated by this reference.

006.14 Labor and Delivery Services

Each facility, not licensed as a hospital, that provides labor and delivery services must be licensed as a health clinic and must meet the regulations specified in 175 NAC 7-006.01 to 7-006.11; 7-006.15 and the following requirements:

7-006.14A Care and Treatment: Each facility must establish and implement written policies and procedures to ensure the safe delivery of care and treatment to patients. The policies and procedures must include, but are not limited to, the following:
1. Care and treatment during antepartum, intrapartum, postpartum, and newborn care;

2. Appropriate attire to be worn during labor and delivery;

3. The use of oxytocic drugs and administration of anesthetics, sedatives, analgesics, and other drugs, devices, and biologicals;

4. Visitation and attendance during the birth process; and

5. Method for identification of every newborn immediately after birth.

7-006.14B Staff: Each facility must have a sufficient number of qualified staff to meet the needs of patients. The staff must function in accordance with their scope of practice.
7-006.14B1 Appropriate licensed health care professional staff must be on call at all times and available on-site at the facility within 30 minutes.

7-006.14B2 Nursing care during labor and delivery including care of the newborn must be supervised by a qualified registered nurse.

7-006.14B3 The direction and coordination of all medical aspects of the facility's policies must be by a physician designated by the governing authority.

7-006.14B4 At least one physician, certified nurse midwife, or registered nurse must be present at all times when a mother or newborn is in the facility.

7-006.14C Emergency Equipment and Supplies: Each facility must have the necessary, drugs, devices, biologicals, equipment, and supplies immediately available for provision of care and treatment should an equipment emergency arise.
7-006.14C1 The following emergency equipment must be available in the facility to provide care to both adults and newborns:
1. Emergency call system;

2. Oxygen;

3. Mechanical ventilation assistance equipment including airways and manual breathing bags;

4. Cardiac defibrillator;

5. Cardiac monitoring equipment;

6. Tracheotomy sets;

7. Laryngoscopes and endotracheal tubes; and

8. Suction equipment.

7-006.14D Emergency Transfer: Each facility must have a written agreement for emergency care with a hospital that provides obstetrical services or each medical practitioner practicing at the facility must have admitting privileges at a transferring hospital.
7-006.14D1 Each facility must have the capability to transfer and transport the mother and/or newborn to the contract hospital(s) timely or have a written contract with an ambulance service that will assure timely response.

7-006.14E Admission and Discharge: Each facility must establish and implement criteria for rejection, admission, discharge, and continuing care of patients which is clearly defined and made available for review to persons requesting such.
7-006.14E1 Admissions to the facility must be restricted to low-risk patients who have received antepartum care in accordance with the facility's policies.

7-006.14E2 Planned Caesarean Section procedures are prohibited.

7-006.14E3 Each mother and newborn must be discharged within 24 hours after admission, in a condition which will not endanger the well-being of either. If the condition of mother or newborn does not allow discharge within 24 hours, then transfer to a hospital must occur.

7-006.14E4 Verbal and written instructions must be provided for observation and care of both the mother and newborn after discharge. The mother and newborn must be discharged in the care of the father or a responsible adult who will assist in their transport from the facility.

7-006.14F Records: Each facility must maintain a permanent admission and discharge patient index that includes, but is not limited to:
1. Full name of patient and identification number assigned by the facility;

2. Date and time of admission and discharge;

3. Name of admitting physician or certified nurse midwife;

4. Type of anesthesia;

5. Time of birth;

6. Gender of newborn; and

7. Disposition or place to which mother and newborn were discharged/ transferred.

7-006.14G All births must be reported in accordance with Neb. Rev. Stat. § 71-604.

006.15 Environmental Services

Each health clinic must provide a safe, clean, and comfortable environment for patients. Every detached building on the same premises used for care and treatment must comply with 175 NAC 7.

7-006.15A Housekeeping and Maintenance: The facility must provide the necessary housekeeping and maintenance to protect the health and safety of patients.
7-006.15A1 The facility's buildings and grounds must be kept clean, safe and in good repair.

7-006.15A2 All garbage and rubbish must be disposed of in such a manner as to prevent the attraction of rodents, flies, and all other insects and vermin. Garbage must be disposed in such a manner as to minimize the transmission of infectious diseases and minimize odor.

7-006.15A3 The facility must maintain adequate lighting, environmental temperatures, and sound levels in all areas that are conducive to the care and treatment provided.

7-006.15A4 The facility must maintain and equip the premises to prevent the entrance, harborage, or breeding of rodents, flies, and all other insects and vermin.

7-006.15B Equipment, Fixtures, and Furnishings: The facility must provide and maintain all equipment, fixtures, and furnishings clean, safe and in good repair.
7-006.15B1 The facility must establish and implement a process designed for routine and preventative maintenance of equipment and furnishings to ensure that such equipment and furnishings are safe and function to meet the intended use.

7-006.15C Linens: The facility must maintain an adequate supply of linen necessary for the care and treatment of patients. Linen must be clean and in good repair.
7-006.15C1 The facility must establish and implement procedures for the storage and handling of soiled and clean linens.

7-006.15C2 When the facility provides laundry services, water temperatures to laundry equipment must exceed 160 degrees Fahrenheit or the laundry may be appropriately sanitized or disinfected by another acceptable method in accordance with manufacturer's instructions.

7-006.15D Pets: The health clinic must assure any facility owned pet does not negatively affect patients. The health clinic must have policies and procedures regarding pets that include:
1. An annual examination by a licensed veterinarian;

2. Vaccinations as recommended by the licensed veterinarian that include, at a minimum, current vaccination for rabies for dogs, cats, and ferrets;

3. Provision of pet care necessary to prevent the acquisition and spread of fleas, ticks and other parasites; and

4. Responsibility for care and supervision of the pet by health clinic staff.

7-006.15E Environmental Safety: The health clinic must be responsible for maintaining the environment in a manner that minimizes accidents.
7-006.15E1 The facility must maintain the environment to protect the health and safety of patients by keeping surfaces smooth and free of sharp edges, mold, or dirt; keeping floors free of objects and slippery or uneven surfaces and keeping the environment free of other conditions which may pose a potential risk.

7-006.15E2 The facility must maintain all doors, stairways, passageways, aisles, or other means of exit in a manner that provides safe and adequate access for care and treatment.

7-006.15E3 The facility must provide water for bathing and handwashing at safe and comfortable temperatures to protect patients from potential for burns or scalds.
7-006.15E3a The facility must monitor and maintain water temperatures that accommodate comfort and preferences but not to exceed the following temperatures:
1. Water temperature at patient handwashing fixtures must not exceed 120 degrees Fahrenheit.

2. Water temperatures at bathing and therapy fixtures must not exceed 110 degrees Fahrenheit.

7-006.15E4 The facility must establish and implement policies and procedures to ensure hazardous/poisonous materials are properly handled and stored to prevent accidental ingestion, inhalation, or consumption of the hazardous/poisonous materials by patients.

7-006.15E5 The facility must restrict access to mechanical equipment which may pose a danger to patients.

7-006.15F Disaster Preparedness and Management: The health clinic must establish and implement disaster preparedness plans and procedures to ensure that patient care and treatment, safety, and well-being are provided and maintained during and following instances of natural (tornado, flood, etc.) and other disasters, disease outbreaks, or other similar situations causing patients to remain at the clinic. Such plans and procedures must address and delineate:
1. How the clinic will maintain the proper identification of each patient to ensure that care and treatment coincide with the patient's needs;

2. How the clinic will move patients to points of safety or provide other means of protection when all or part of the building is damaged or uninhabitable due to natural or other disaster;

3. How the clinic will protect patients during the threat of exposure to the ingestion, absorption, or inhalation of hazardous substances or materials;

4. How the clinic will provide food, water, medicine, medical supplies, and other necessary items for care and treatment in the event of a natural or other disaster; and

5. How the clinic will provide for the comfort, safety, and well-being of patients in the event of 24 or more consecutive hours of:
a. Electrical or gas outage;

b. Heating, cooling, or sewer system failure, or

c. Loss or contamination of water supply.

Disclaimer: These regulations may not be the most recent version. Nebraska 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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