Section 143.013 - Required Facilities, Equipment and Safety Precautions and Procedures for Phase II and Phase III ProgramsFacilities and equipment necessary for the delivery of Phase II and Phase III components of the cardiac rehabilitation program shall be readily available for use.
(A)Monitoring During Exercise Therapy Sessions During Phase II and Phase III Programs.(1) Continuous electrocardiographic monitoring equipment shall be available for use with new participants and for periodic checks as deemed necessary by the supervising personnel.(2) The medical director or his/her designated physician shall be present on the premises during exercise therapy sessions unless the premises is covered by a licensed hospital's medical emergency response team. The designated physician shall be qualified to respond to cardiac emergencies and be currently certified by the American Heart Association in Advanced Cardiac Life Support (ACLS).(3) At least one R.N. certified in Advanced Cardiac Life Support by the American Heart Association shall be in attendance at each exercise session in order to monitor patients.(4) Where Phase III patients are exercising there shall be in attendance a minimum ratio of one professional staff member to five patients and at least two staff members on the premises.(5) Participants shall be instructed in a method to monitor their own exercise intensity (heart rate, perceived exertion, symptoms).(B)Emergencies/Cardiopulmonary Resuscitation.(1) All health care personnel in attendance at the exercise sessions shall be certified in Basic Life Support by the American Heart Association.(2) There shall be a written protocol for medical emergencies. There shall be periodic review and drill of this protocol by the staff frequentlyenough to maintain proficiency during emergencies and in all instances at least on a quarterly basis. A written record of the drills shall be maintained.(3) Emergency instructions shall be posted in the exercise area.(4) Emergency drugs and equipment for initiation of Advanced Cardiac Life Support (as stipulated by the program's policy) shall be readily available on-site during all exercise sessions. Such drugs shall be accessible only to authorized persons. Expired drugs and sterile supplies shall be removed from storage. At a minimum emergency supplies shall include:
(a) Portable defibrillator with "quick" look capabilities(b) Oxygen tank with regulator and mask(c) Suction and intubation equipment(d) Emergency drugs and intravenous equipment(e) Blood pressure cuff and stethoscope(f) Sublingual nitroglycerin(g) Timing device which times to the second(C)Environmental and Physical Plant Considerations. (1) Each program shall maintain its physical facilities in good repair, in a safe. comfortable and sanitary state, free from dirt, vermin, solid waste and objectionable odors.(2) Environmental conditions shall be consistent with written protocols established by the program that reflect safe environmental conditions.(3) Drinking water shall be readily available at exercise sessions.(4) Each program shall provide adequate space and equipment for reception and waiting areas, for administrative staff offices, and for the storage of patient records.(5) Each program shall provide conveniently located handwashing and toilet facilities adequate for patients and personnel. A soap dispenser disposable towels or electronic hand dryers, and a waste receptacle shall be provided at each handwashing sink.(6) Each program shall provide all rooms which do not have direct access to the outside, with satisfactory mechanical ventilation.(7) Each program shall provide storage space adequate and suitable for equipment and bulk office supplies.(D)Preventive Maintenance. (1) A written preventive maintenance program shall be established and implemented to insure that all equipment is maintained in safe and proper working order.(2) A maintenance check shall be regularly performed on all mechanical and electronic medical equipment.(3) Electronic equipment shall be properly grounded and calibrated consistent with manufacturer's recommendations or other generally accepted standards.