175 Neb. Admin. Code, ch. 9, § 008

Current through September 17, 2024

Section 175-9-008 - OPTIONAL SERVICES AND REQUIREMENTS

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:

008.01CRITICAL 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.

008.02EMERGENCY 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.

008.03HEMODIALYSIS 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.

008.04OBSTETRICAL 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.

008.05PEDIATRIC 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.

008.06SURGICAL 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.

008.07ANESTHESIA 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.

008.08REHABILITATION 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.

008.09RESPIRATORY 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.

008.10OUTPATIENT 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.

008.11ALZHEIMER'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.

008.12SOCIAL 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.

008.13PSYCHIATRIC 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.

008.14IN 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.

175 Neb. Admin. Code, ch. 9, § 008

Amended effective 11/11/2023

Amended effective 11/12/2023