Current through September 17, 2024
A licensee may choose to provide any of the optional services
outlined below. Services must be provided in accordance with current standards
of practice and directed by a medical practitioner as determined by the
facility unless specified otherwise. If these services are provided, the
following are applicable:
008.01
CRITICAL CARE SERVICES. Critical care services such as
intensive care, coronary care, intensive newborn nursery, burn unit, transplant
center, or wound treatment center are to include:
(A) Supervision of each unit by a qualified
and competent registered nurse;
(B)
Qualifications and competency needed for each person assigned to work in the
unit;
(C) Medical and nursing
staffing coverage for each unit; and
(D) Written admission and discharge criteria
for each unit.
008.02
EMERGENCY SERVICES. Emergency services provided must
be in compliance with the Emergency Medical Treatment and Labor Act;
42 CFR §
489.24;
42 CFR §
489.20 (l), (m), (q), and
(r), on the effective date of this chapter.
This service must be provided under the direction of a practitioner who is
trained in emergency care and management and is to include:
(A) 24 hour per day medical and nursing staff
coverage, with medical staff and registered nurses on call;
(B) Personnel qualifications and competency
needed to carry out the written emergency procedures and anticipated needs of
the hospital; and
(C) Emergency
drugs, devices, biologicals, equipment, and supplies must be on hand and
immediately available for use in the emergency area to treat life-threatening
conditions.
008.02(i)
EMERGENCY SERVICES RECORDKEEPING REQUIREMENTS. An
emergency log must be maintained that includes:
(1) Patient full name and date of
birth;
(2) Date, time, and method
of patient's arrival to the Emergency Room;
(3) Physical findings;
(4) Name of treating practitioner;
(5) Disposition, including time, and location
patient was discharged to;
(6)
Documentation of assessments and any testing completed; and
(7) Documentation of any medications,
biologicals, or devices provided to the patient.
008.02(ii)
NOTIFICATION. If the facility ceases to provide
emergency services, the Division of Public Health Licensure Unit needs to be
notified in writing as soon as possible.
008.02(iii)
EMERGENCY SERVICES
PHYSICAL PLANT REQUIREMENTS. Dedicated space for emergency care
and treatment must be provided which includes:
(1) A well-marked, illuminated, covered, and
grade level entrance for both emergency vehicle and pedestrian
access;
(2) A waiting area for
patients and visitors that is in the direct observation of the reception,
triage, or control station;
(3)
Storage areas for general medical and surgical emergency supplies, medications,
and equipment which are under staff control and out of the path of normal
traffic; and
(4) A toilet room with
hand washing sink that is convenient to treatment or procedure rooms.
008.03
HEMODIALYSIS SERVICES. Hemodialysis services must
satisfy all the elements of the Conditions of Coverage as an End-Stage Renal
Disease facility 42 CFR
§ 405.2101, Subpart U, and
42 CFR §
494.62 on the effective date of this chapter
and 175 NAC 1.
008.04
OBSTETRICAL AND NEWBORN SERVICES. Obstetrical and
newborn services provided are to include:
(A)
Written policies and procedures outlining the care and treatment for prenatal,
postnatal, and newborn patients;
(B) Appropriate attire to be worn during
labor, delivery, and in the nursery;
(C) Staffing, including on call
availability;
(D) Supervision of
nursing care provided in labor, delivery, and in the nursery by a qualified
registered nurse;
(E) Written
directions outlining the use of oxytocic drugs and the administration of
anesthetics, sedatives, analgesics, and any other drugs, devices, and
biologicals in accordance with state and federal law;
(F) The flow of staff between the obstetric
and newborn units, and other patient care areas;
(G) Staff responsibilities during induction
or augmentation of labor;
(H)
Visitation and attendance during the birth process;
(I) Required laboratory testing;
(J) Written transfer criteria for both mother
and newborn;
(K) Discharge
criteria, including written discharge instructions in a manner and format which
the mother or their designee can understand;
(L) Reporting requirements;
(M) Emergency care, treatment, and equipment
needed to be immediately available; and
(N) Written procedures outlining the
identification and safeguarding of the newborn immediately after birth until
discharge.
008.04(i)
PERMANENT OBSTETRIC ADMISSION AND DISCHARGE PATIENT
INDEX. An index must be maintained that includes:
(1) Full name and date of birth of the
patient;
(2) The patient
identification number assigned by the facility;
(3) Date and time of admission and
discharge;
(4) Name of admitting
physician or certified midwife;
(5)
Type of anesthesia provided;
(6)
Time of birth;
(7) Gender of
newborn; and
(8) Place to which
mother and newborn were discharged or transferred.
008.04(ii)
OBSTETRICAL AND
NEWBORN PHYSICAL PLANT REQUIREMENTS. Dedicated space and equipment
for the provision of obstetrical and newborn services must be
available.
008.05
PEDIATRIC SERVICES. Pediatric services provided is to
include:
(A) Location of pediatric patients
must be in an area apart from adult patients and newborn infants;
(B) Drugs, devices, biologicals, equipment,
and supplies suitable for the treatment of pediatric patients;
(C) Methods to safeguard pediatric patients
while they are under care and treatment in the facility; and
(D) Conditions under which parents may stay
or 'room in' with pediatric patients.
008.06
SURGICAL
SERVICES. Surgical services are to include:
(A) Surgical services are provided only by
medical practitioners who are privileged at the facility to conduct the
specific surgical care and treatment they are privileged to provide;
(B) Restrictions on access to the surgical
suite and recovery room areas;
(C)
Attire worn by staff in the surgical suite and recovery room areas;
(D) Sterilization and disinfection of
equipment and supplies;
(E) Aseptic
surveillance and practice;
(F)
Responsibility for the supervision of the surgical suite and recovery
room;
(G) Immediate availability of
an emergency call system, cardiac monitor; defibrillator, suction, and
emergency airway supplies;
(H)
Availability of blood and blood products;
(I) The requirement for patient history and
physical examination;
(J) The
requirements for testing and disposal of surgical specimens;
(K) The circumstances that require the
presence of an assistant during surgery;
(L) Discharge criteria;
(M) Reporting requirements;
(N) The procedures for handling infectious
cases;
(O) Immediate post-surgical
care; and
(P) Requirements for
operative and surgical reports.
008.06(i)
SURGICAL SERVICES
RECORD KEEPING REQUIREMENTS. A roster must be maintained in the
surgical suite which delineates the surgical privileges granted to each medical
practitioner; and an up to date operating log must be maintained that includes:
(1) Full name, date of birth, and
identification number of each patient;
(2) Date, starting and ending times for each
surgical procedure;
(3) Surgical
procedure or procedures performed;
(4) Name of the surgeon and any
assistants;
(5) Name of nursing
personnel, both scrub and circulating;
(6) Type of anesthesia utilized during the
procedure; and
(7) The name and
title of the person administering anesthesia.
008.06(ii)
SURGICAL SERVICES
PHYSICAL PLANT REQUIREMENTS. Dedicated space and equipment for the
types of surgical procedures provided by the facility must be available, which
includes:
(1) A preoperative patient area
with sufficient space and equipment to accommodate both ambulatory and
non-ambulatory patients under the direct visual control of the nursing
staff;
(2) Operating rooms for
major surgical procedures that require general or regional block anesthesia and
support of vital bodily functions with a minimum floor area of 300 square feet
and a minimum of 16 feet of clear dimension;
(3) Procedure rooms for invasive and minor
surgical procedures performed in conjunction with oral, parental, or
intravenous sedation or under analgesic or dissociative drugs have a minimum
floor area of 200 square feet and a minimum of 14 feet clear
dimension;
(4) Treatment rooms for
procedures performed under topical, local, or regional anesthesia without
pre-operative sedation have a minimum floor area of 120 square feet and a
minimum of 10 feet clear dimension;
(5) A recovery area containing a medication
station, hand washing sink, charting area, and equipment and supply storage
space;
(6) A dressing area must be
provided when the hospital provides outpatient surgeries which has patient
dressing and toilet rooms separate from staff gowning areas; and
(7) Housekeeping and soiled utility areas
exclusively for the surgical suite.
008.07
ANESTHESIA
SERVICES. Anesthesia services is to include:
(A) Provision of anesthesia by medical or
nurse anesthetist students under the supervision and direct oversight of an
individual qualified to administer anesthesia in their scope of
practice;
(B) Equipment
maintenance;
(C) Safety measures to
guard against hazards;
(D)
Infection control measures; and
(E)
The maintenance, cleaning, and use of equipment to ensure patient safety and to
minimize the risk of the transmission of infection.
008.08
REHABILITATION
SERVICES. Rehabilitation services is to include:
(A) The scope and care of services provided
at the facility;
(B) Staff
qualifications, competency, and credentialing requirements;
(C) The provision of therapy in accordance
with written medical practitioner orders;
(D) Coordination with other services in the
hospital;
(E) Treatment plan
documentation and record keeping requirements; and
(F) The maintenance, cleaning, and use of
therapy equipment, to ensure patient safety and to minimize the risk of the
transmission of infection.
008.09
RESPIRATORY CARE
SERVICES. Respiratory care services are to include:
(A) Supervision by a qualified respiratory
care practitioner;
(B) The
provision of respiratory care services by qualified personnel, acting within
their scope of practice;
(C)
Coordination with other services in the facility;
(D) Treatment plan documentation and record
keeping requirements; and
(E) Types
of equipment needed to provide the scope of care provided in the facility,
along with cleaning, maintenance, and calibration requirements.
008.10
OUTPATIENT
SERVICES. Outpatient services is to include:
(A) The provision of outpatient services in
accordance with medical practitioner orders;
(B) Staffing to meet the needs of the
patients as determined by the facility;
(C) Documentation and record keeping
requirements to integrate the outpatient medical record with the patient's
existing inpatient record, if applicable; and
(D) Equipment needed to provide the scope of
care provided in the facility, along with cleaning, maintenance, and
calibration requirements.
008.11
ALZHEIMER'S, DEMENTIA, AND
RELATED CONDITIONS SERVICES. Licensees that provide inpatient
services for patients with these conditions in a distinct unit must ensure
personalized patient rooms, activity areas, separate dining areas, and must
include features that support patient orientation to their surroundings; areas
for specialized treatment and care; hand washing sinks; secured storage for
equipment and supplies; call and security systems and an area for medication
storage and distribution.
008.12
SOCIAL WORK SERVICES. Social work services provided
are to be directed by a certified social worker. Services must include:
(A) The scope and care of patients receiving
social work services, including the role in intervention, discharge planning
and referral for patients;
(B)
Assessment of personal and social functioning of patients;
(C) Record keeping and retention
requirements; and
(D) Coordination
with other services provided to patients in the hospital.
008.13
PSYCHIATRIC OR MENTAL
HEALTH SERVICES. Psychiatric or mental health services in a
distinct unit is to ensure a therapeutic environment that provides for both
patient and staff safety. Patient rooms must have:
(A) Tamper-resistant air distribution
devices, lighting fixtures, sprinkler heads, and safety devices;
(B) Ventilation, exhaust, heating, and
cooling components that are inaccessible to patients;
(C) Bedroom, toilet, and bathing room doors
that are not lockable or capable of being obstructed from within; and
(D) Electrical outlets protected by ground
fault interrupting devices.
008.14
IN PATIENT HOSPICE
SERVICES. Inpatient hospice services provided in a distinct unit
must have private patient rooms, space to accommodate overnight stays, dining,
and visiting spaces for family and visitors.
