Current through Register No. 40, October 3, 2024
The following shall apply if the hospital has a distinct
psychiatric unit:
(a) The psychiatric
unit shall have a clinical director, service chief or equivalent that meets the
training and experience requirements for examination by the American Board of
Psychiatry and Neurology, or the American Osteopathic Board of Neurology and
Psychiatry;
(b) The psychiatric
unit shall have a director of nursing services who shall be:
(1) A registered nurse (RN) currently
licensed in New Hampshire who has a master's degree or its equivalent in
psychiatric and mental health nursing; or
(2) An RN with a bachelor's degree and a
minimum of 3 years of experience in the care of the mentally ill and to include
one year in a nursing management position;
(c) Admission procedures shall include, in
addition to those specified in
He-P 802.19(a)
:
(1) A
psychiatric diagnosis;
(2) An
admitting diagnosis including any concurrent disease; and
(3) Completion of a psychosocial assessment
and family history as appropriate;
(d) The psychiatric unit shall provide
emergency psychiatric services on a 24 hour per day basis, 7 days per week;
(e) The hospital shall perform a
psychiatric evaluation as soon as practicable but no longer than 24 hours after
admission on each patient admitted to the psychiatric unit including:
(1) Medical history;
(2) Present mental status;
(3) Notation about the onset of symptoms and
circumstances leading to admission and admitting diagnosis;
(4) An estimate of the patients intellectual
functioning, memory functioning and orientation;
(5) An evaluation of the patient's use or
abuse of alcohol or drugs, as appropriate; and
(6) When indicated a neurological
examination;
(f) The
hospital shall require that each patient have an individual treatment plan
which includes:
(1) The diagnosis;
(2) An inventory of the patient's strengths
and weaknesses which would enable him to function in a normal situation;
(3) Treatment goals;
(4) The specific treatment modalities used
based on the strengths and weaknesses demonstrated by the patient;
(5) The responsibilities of each treatment
team member; and
(6) Documentation
as to the specific therapeutic activities the patient shall participate in
during his or her hospitalization;
(g) The psychiatric unit shall provide
therapeutic activities which are:
(1)
Appropriate to the needs and interests of the patients;
(2) Directed toward restoring the patient's
physical and psychosocial functioning; and
(3) In accordance with the treatment plan in
(f) above;
(h) Progress
notes shall be recorded in the patient's medical record by all personnel
involved in carrying out the individual treatment plan for each patient;
(i) In the psychiatric unit where
patients might be a hazard to themselves or others, all glazing, both interior
and exterior, borrow lights, and glass mirrors shall be fabricated with
laminated safety glass or protected by polycarbonate, laminate, or safety
screens;
(j) There shall be at
least one seclusion room for each 24 beds or fraction thereof on each
psychiatric unit;
(k) Seclusion
rooms, if used as a treatment modality, shall:
(1) Where restraining patients is provided,
have a maximum clear floor area of at least 60 square feet with a minimum wall
length of 7 feet and a maximum wall length of 11 feet;
(2) Be accessed by an anteroom or vestibule
that also provides access to a toilet room. The doors to the anteroom and the
toilet room shall be a minimum of 3 feet 8 inches wide;
(3) Be for only one patient;
(4) Have doors that permit staff observation
of patients through a view panel, while also maintaining provisions for patient
privacy. The view panel shall be fixed glazing with polycarbonate or laminate
on inside of glazing;
(5) Be under
constant observation, which may include video monitoring, when being used;
(6) Be constructed to prevent
patient hiding, escape, injury, or suicide;
(7) Be constructed of materials that are of a
type acceptable to the local authority having jurisdiction and the state
regulatory agency when the interior of the seclusion treatment room is padded
with combustible materials;
(8)
Not contain outside corners or edges;
(9) Have the ability to be locked as
applicable;
(10) Not have
electrical switches and receptacles within the rooms; and
(11) Have doors that swing out;
(l) The room(s) shall be
appropriately located for direct nursing observation;
(m) Forensic units shall have security
vestibules or sally ports at the unit entrance;
(n) Care and supervision of child psychiatric
patients shall be separate and distinct from adult psychiatric patients;
(o) Patient room areas with beds
or cribs shall be at least 100 square feet for single-bed rooms, 80 square feet
per bed and 60 square feet per crib in multiple-bed rooms;
(p) Geriatric, Alzheimer's and other dementia
units patient room areas shall be at least 120 square feet in single bedrooms
and 200 square feet in multiple-bed rooms;
(q) Maximum room capacity shall be 2
patients;
(r) A visitor room for
patients to meet with friends or family with a minimum floor space of 100
square feet shall be provided;
(s)
A quiet room shall be provided for a patient who needs to be alone for a short
period of time but does not require a seclusion room. Such a room shall be a
minimum of 80 square feet. A group therapy room may be combined with this space
if 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;
(t) When door closers are
required, they shall be mounted on the public side of the door rather than the
private patient side of the door and whenever possible they should be within
view of a nurse workstation;
(u)
Door hinges shall be designed to minimize points for hanging;
(v) Door lever handles shall point downward
when in the latched positions. All hardware shall have tamper-resistant
fasteners;
(w) All window glazing,
borrow lights, and glass mirrors shall be fabricated with laminated safety
glass or protected by polycarbonate, laminate, or safety screens;
(x) Clothing rods or hooks, if present, shall
be designed to minimize the opportunity for patients to cause injury;
(y) Drawer pulls shall be of the
recessed type to eliminate the possibility of use as a tie-off point;
(z) Special design considerations
for injury and suicide prevention shall be given to shower, bath, toilet and
sink hardware and accessories, including grab bars and toilet paper holders;
(aa) Grab bars are required in 10 percent of
the private/semi-private patient toilet rooms. Where grab bars are provided,
they shall be of a removable type and the space between the bar and the wall
shall be filled to prevent a cord being tied around it for hanging;
(ab) The following shall not be permitted:
(1) Towel bars;
(2) Shower curtain rods; and
(3) Lever handles;
(ac) In private patient bathrooms, the
ceiling shall be of the tamper-resistive type or of sufficient height to
prevent patient access;
(ad) In
patient bedrooms where acoustical ceilings are permitted, the ceiling shall be
secured or of sufficient height to prevent patient access;
(ae) In private patient bathrooms, any
plumbing, piping, ductwork, or other potentially hazardous elements shall be
concealed above a ceiling;
(af) In
patient bedrooms and bathrooms, ceiling access panels shall be secured or of
sufficient height to prevent patient access;
(ag) In patient bedrooms and bathrooms,
ventilation grilles shall be secured and have small perforations to eliminate
their use as tie-off point or shall be of sufficient height to prevent patient
access;
(ah) In unsupervised
patient areas, sprinkler heads shall be recessed or of a design to minimize
patient access;
(ai) In private
patient bathrooms, air distribution devices, lighting fixtures, sprinkler
heads, and other appurtenances shall be of the tamper-resistant type;
(aj) Electronic surveillance
systems shall not be required in psychiatric nursing units, but if provided for
the safety of the residents, any devices in resident areas shall be mounted in
a tamper-resistance enclosure that is unobtrusive; and
(ak) A nurse-call system shall meet the
requirements of UL 1069 Standard for Hospital Signaling and Nurse Call
Equipment. Use of alternate technologies that meet the requirements of UL 1069,
including radio frequency systems, shall be permitted for call systems and
shall have tamper-resistant fasteners.
#9580, eff
10-24-09
