Current through Register Vol. 24-18, September 15, 2024
This section only applies to an RTF in its licensed capacity
to provide pediatric transitional care services according to this
chapter.
(1) The licensee must
establish and implement policies and procedures that:
(a) Describe how the licensee meets the
infants' health care needs by satisfying the requirements of this section;
and
(b) Are reviewed and approved
by a pediatrician, a pediatric physician's assistant, or pediatric ARNP at
least biennially.
(2)
The licensee may only provide pediatric transitional care services to infants
who:
(a) Are less than twelve months of
age;
(b) Have been exposed to drugs
before birth;
(c) Require
twenty-four-hour continuous residential care and skilled nursing services as a
result of drug exposure; and
(d)
Are medically assessed by a pediatrician, physician's assistant, or pediatric
ARNP and referred to the RTF by the department of children, youth, and families
regional hospitals or private parties.
(3) The licensee may only admit drug exposed
infants that primarily require withdrawal management services and whose
condition has been determined by a pediatrician, physician's assistant, or
pediatric ARNP to be otherwise medically stable and predictable.
Admissions must contain a complete discharge summary from the
sending facility.
(4) The
licensee shall not admit infants solely for treatment of complex medical
conditions requiring specialized care, monitoring, and equipment including, but
not limited to, respiratory compromise requiring assisted ventilation or
continuous oxygen, conditions requiring a peripherally inserted central
catheter line, or conditions requiring nasogastric tubes.
(5) The staffing and staffing ratios in this
subsection apply at all times. The licensee shall provide twenty-four-hour
medical supervision to infants according to the following minimum staffing
requirements:
(a) One registered nurse shall
be present and on duty at the facility at all times;
(b)
(i) One
registered nurse or licensed practical nurse shall be present and on duty for
every eight infants requiring morphine or other controlled substances for
treatment of condition;
(ii) One
registered nurse or licensed practical nurse shall be present and on duty for
every sixteen infants provided that the staffing ratio of subsection (3) of
this section is not exceeded.
(c) One trained caregiver to four infants;
and
(d) A pediatrician, physician's
assistant, or pediatric ARNP responsible for the supervision of infant medical
care and nursing services must be available by phone twenty-four hours a day
for consultation and on-site for medical examinations.
(6) The licensee may provide services for an
infant for up to forty-five days. Pediatric transitional care services may be
extended beyond forty-five days if the pediatrician, physician's assistant, or
pediatric ARNP on staff determines it to be medically necessary and with
consent of the infant's parent, legal guardian, or state agency with placement
and care authority. The assessment and determination must be conducted and
entered into the infant's record no less than two days before the infant's
forty-fifth day at the RTF and must include the medical reasons for the
extended stay.
(7) The licensee
shall provide trainings to parents or legal guardians, foster parents, and
relatives on:
(a) Reading your infant's signs
and signals;
(b) Managing feeding
difficulties;
(c) Managing stimulus
in a family environment;
(d) Impact
of drugs in utero on developmental milestones;
(e) Managing your stress and that of your
family; and
(f) Therapeutic
benefits of touch, sound and light in modulating infant behavior.
(8) The licensee shall provide for
medical examinations and consultations by a pediatrician, physician's
assistant, or pediatric ARNP for each infant with the frequency and regularity
recommended by the American Academy of Pediatrics and according to the time
frames in this subsection.
Medical assessments, examinations, screenings, and other
services relevant to an infant's individual service plan shall include:
(a) An initial health assessment of the
infant conducted and completed by a registered nurse upon the infant's
arrival;
(b) An initial medical
examination of the infant conducted and completed by a pediatrician,
physician's assistant or pediatric ARNP within twenty-four hours, if on
morphine, otherwise seventy-two hours of the infant's arrival unless a
pediatrician, physician's assistant or pediatric ARNP orders a shorter time
frame;
(c) Medical examinations of
infants conducted every three weeks by a pediatrician, physician's assistant,
or pediat-ric ARNP unless a pediatrician, physician's assistant or pedi-atric
ARNP orders a shorter time frame;
(d) A plan of management for neonatal
abstinence syndrome (NAS). Licensees must use a NAS scoring tool approved by
the department. NAS scoring must be conducted and completed based on the
infant's condition and treatment by a trained licensed practical nurse,
registered nurse, pediatrician, physician's assistant, or pediatric ARNP on
staff at the RTF. A licensed practical nurse can gather NAS scoring data but
cannot analyze the data to inform medication dosage and other treatment
decisions;
(e) Infant developmental
screening tests, approved by the department, within thirty days after the
infant's arrival at the RTF; and
(f) If written consent is given by the parent
or guardian, administration of all routinely recommended vaccinations to the
infant at the ages and intervals according to the national immunization
guidelines in the "Advisory Committee on Immunization Practices (ACIP)
Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or
Younger-United States, 2018"; as published in the "Morbidity
and Mortality Weekly Report (MMWR) 2018; 67(5):156-157."
(9) The licensee must:
(a) Provide transportation of the infant to
and from the RTF, if needed. Transportation requirements shall include the
following:
(i) All vehicles used for
transportation must be in good working condition and insured by the
licensee;
(ii) Drivers must be at
least twenty-one years of age, have proof of a valid driver's license, and be
employed by the RTF;
(iii) Drivers
must be accompanied by a trained caregiver or licensed health care provider
employed by the RTF to attend to the infant during transport; and
(iv) Child passenger restraint requirements
must be in compliance with
RCW
46.61.687.
(b) Limit admission, transfer, discharge, and
referral processes to infants for whom the RTF is qualified by staff, services,
equipment, building design and occupancy to provide safe care;
(c) Refer infants for health care provided
outside of the RTF as needed such as, but not limited to, laboratory, dental,
ambulatory care, or specialty services;
(d) Follow all prescribed treatments,
modified diets, activities, or activity limitations;
(e) Keep health care appointments;
(f) Provide a health assessment any time an
infant exhibits signs or symptoms of an injury, illness or abnormality for
which a medical diagnosis and treatment are indicated;
(g) Address serious illness, medical
emergencies, or threat to life, to include:
(i) Criteria for determining the degree of
medical stability of infants;
(ii)
Observing infants for signs and symptoms of illness or trauma;
(iii) Reporting abnormal signs and symptoms
according to an established protocol;
(iv) Criteria requiring an infant's immediate
transfer to a hospital;
(v) How
staff transmits the infant's medical and related data in the event of a
transfer;
(vi) How to notify the
parent or guardian, personal representative, or next of kin in the event of an
emergency, threat to life, serious change in the infant's condition, transfer
of an infant to another facility, or death; and
(vii) When to consult with internal or
external resource agencies or entities such as poison control, fire department,
or police.
(h) Assure
provisions of each infant's personal care items and durable medical equipment
including storing and labeling each resident's personal care items separately,
preventing contamination, and preventing access by other residents;
(i) Develop and implement the policies and
procedures explaining how nursing staff will be used including:
(i) Scheduling of hours on-site and
availability by phone;
(ii)
Supervision, assessment, and training of other staff;
(iii) Delegation to other staff;
(iv) Medication management;
(v) Treatment planning;
(vi) Health screenings; and
(vii) Health assessments.
(10) In satisfying the
requirements of this chapter, the licensee must also collaborate with the
department of children, youth, and families regarding individual safety plans
and to meet family and medical needs as contractually required.
(11) The licensee shall have equipment to
support infants receiving pediatric transitional care services in adequate
supply to meet the medical needs of the population:
(a) Cardiac respiratory monitors for each
infant receiving morphine or as medically indicated;
(b) Pediatric pulse oximeter in each infant
room;
(c) Plumbed or portable
oxygen tanks and suction devices in an adequate supply to meet infant
needs;
(d) Digital thermometers
designed for pediatric use in each infant room;
(e) Scales used for weighing
infants;
(f) Warming beds in
adequate supply to meet infant needs;
(g) Refrigerator with thermometer for storing
infant formula;
(h) Refrigerator
with thermometer, approved for storing medications and vaccinations consistent
with Centers for Disease Control and Prevention "Vaccine Storage and
Handling Toolkit, January 2018"; and
(i) Infant first-aid kit.
(12) The licensee must develop and
implement policies and procedures that ensure unauthorized persons do not
access the pediatric transitional care services unit.
