Current through Reg. 49, No. 52; December 27, 2024
(a) The LSRH must
have a professional health care staff that includes one or more physicians, and
may include one or more physician assistants, or advanced practice registered
nurses (APRN).
(b) Any ancillary
personnel are supervised by the professional staff.
(c) There shall be a written delineation of
functions, qualifications, and patient care responsibilities for all categories
of personnel.
(d) The LSRH shall
maintain documentation of evidence that all personnel are trained prior to
treatment of services.
(e) The
staff shall be sufficient to provide the services essential to the operation of
the LSRH.
(f) A nurse shall be on
duty whenever the LSRH has one or more patients receiving emergency care or
observation care.
(g) If the LSRH
provides outpatient services, the services shall meet the needs of the patients
in accordance with acceptable standards of practice.
(1) The LSRH shall assign an individual to be
responsible for outpatient services.
(2) The LSRH shall have appropriate
physicians on staff and other professional and nonprofessional personnel
available.
(3) The physician must:
(A) provide medical direction for the LSRH's
health care activities and consultation for, and medical supervision of, the
health care staff;
(B) participate,
in conjunction with any physician assistant or nurse practitioner members, in
developing, executing, and periodically reviewing the LSRH's written policies
governing the services it furnishes;
(C) review periodically, in conjunction with
any physician assistant or nurse practitioner members, the LSRH patient
records, provide medical orders, and provide medical care services to the
patients of the LSRH; and
(D)
review periodically and sign a sample of outpatient records of patients cared
for by APRN or physician assistants only to the extent where state law requires
record reviews or co-signatures, or both, by a collaborating
physician.
(h)
A physician must be present for sufficient periods of time to provide medical
direction, consultation, and supervision for the services provided in the LSRH,
and is available through direct radio or telephone communication or electronic
communication for consultation, assistance with medical emergencies, or patient
referral.
(i) The physician
assistant, the nurse practitioner, or clinical nurse specialist members of the
LSRH staff shall:
(1) participate in the
development, execution and periodic review of the written policies governing
the services the LSRH furnishes; and
(2) participate with a physician in a
periodic review of the patients' health records.
(j) The physician assistant, nurse
practitioner, or clinical nurse specialist shall perform the following
functions to the extent they are not being performed by a physician:
(1) provides services in accordance with the
LSRH's policies; and
(2) arranges
for, or refers patients to, needed services that cannot be furnished at the
LSRH, and assures that adequate patient health records are maintained and
transferred as required when patients are referred.
(k) Whenever a patient is placed in
observation care at the LSRH by a nurse practitioner, physician assistant, or
clinical nurse specialist, a physician on the staff of the LSRH is notified of
the patient's status.
(l) When
required by law, the quality and appropriateness of the diagnosis and treatment
furnished by nurse practitioners, clinical nurse specialists, and physician
assistants at the LSRH must be evaluated by a member of the LSRH staff who is a
physician or by another physician under contract with the LSRH.
(m) The quality and appropriateness of the
diagnosis and treatment provided by a physician at the LSRH must be evaluated
by one of the following:
(1) One Quality
Improvement Organization (QIO) or equivalent entity;
(2) in the case of distant-site physicians
and practitioners providing telemedicine services to the LSRH's patient under
an agreement between the LSRH and a distant-site hospital, the distant-site
hospital; or
(3) in the case of
distant-site physicians and practitioners providing telemedicine services to
the LSRH's patients under a written agreement between the LSRH and a
distant-site telemedicine entity, one QIO or equivalent entity.
(n) The LSRH staff shall consider
the findings of the evaluation and make the necessary changes as specified in
Code of Federal Regulations Title 42 §485.528 (b) - (d) (relating to
Condition of participation: Staffing and staff responsibilities).
(o) There shall be an organized nursing
service under the direction of a qualified registered nurse (RN). The LSRH
shall be staffed to assure that the nursing needs of all patients are
met.
(p) There shall be a written
plan of administrative authority for all nursing services with responsibilities
and duties of each category of nursing personnel delineated and a written job
description for each category. The scope of nursing service shall include
nursing care rendered to patients preoperatively, intraoperatively, and
postoperatively.
(1) The responsible
individual for nursing services shall be a qualified RN whose responsibility
and authority for nursing service shall be clearly defined and includes
supervision of both personnel performance and patient care.
(2) There shall be a written delineation of
functions, qualifications, and patient care responsibilities for all categories
of nursing personnel.
(3) Surgical
technicians and licensed vocational nurses may be permitted to serve in the
scrub nurse role under the direct supervision of an RN; they shall not be
permitted to function as circulating nurses in the operating rooms. Licensed
vocational nurses and surgical technicians may assist in circulatory duties
under the direct supervision of a qualified RN.
(4) Nursing services shall be provided in
accordance with current recognized standards or recommended
practices.
(5) The LSRH shall
adopt, implement and enforce policies and procedures to comply with Texas
Health and Safety Code Chapter 259 (relating to Surgical Technologists at
Health Care Facilities).
(6) There
shall be an adequate number of RNs on duty to meet the following minimum staff
requirements: director of the department (or designee), and supervisory and
staff personnel for each service area to assure the immediate availability of
an RN for emergency care or for any patient when needed.
(7) An RN shall assign the nursing care of
each patient to other nursing personnel in accordance with the patient's needs
and the preparation and qualifications of the nursing staff
available.
(8) There shall be other
nursing personnel in sufficient numbers to provide nursing care not requiring
the service of an RN.
(9) An RN
qualified, at a minimum, with current certification in advanced cardiac life
support and pediatric advanced life support shall be on duty and on the
premises at all times whenever patients are present in the LSRH.
(q) All direct patient care staff
must have current certification in basic cardiac life support.
(r) In addition to meeting the requirements
for nursing staff under subsections (p) and (q) of this section, LSRHs shall
comply with the following staffing requirements.
(1) LSRHs that provide only topical
anesthesia, local anesthesia, or minimal sedation are required to have a second
individual on duty on the premises who is trained and currently certified in
basic cardiac life support until all patients have been discharged from the
facility.
(2) LSRHs that provide
moderate sedation/analgesia are required to have the following additional
staff:
(A) a second individual on duty on the
premises who is trained and currently certified in basic cardiac life support
until all patients have been discharged from the facility; and
(B) an individual trained and currently
certified in advanced cardiac life support and, if surgery is performed on
pediatric patients, pediatric advanced life support shall be available until
all patients have been discharged from the post-anesthesia care unit.
(s) LSRHs that provide
deep sedation/analgesia, general anesthesia, or regional anesthesia shall have
the following additional staff:
(1) a second
individual on duty on the premises who is trained and currently certified in
basic cardiac life support until all patients have been discharged from the
facility; and
(2) an individual who
is trained and currently certified in advanced cardiac life support and, if
surgery is performed on pediatric patients, pediatric advanced life support
shall be on duty on the premises and sufficiently free of other duties to
enable the individual to respond rapidly to emergency situations until all
patients have been discharged from the post-anesthesia care unit.
(t) As applicable, the LSRH shall
establish a nursing peer review committee to conduct nursing peer review, as
required by Texas Occupations Code Chapter 303 (relating to Nursing Peer
Review).
