216-40-10 R.I. Code R. § 5.5

Current through June 12, 2024

Section 216-RICR-40-10-5.5 - Patient Care Services

5.5.1Admission, Transfer and Discharge

A. Each FASC shall have written admission, transfer and discharge policies and procedures pertaining to at least the following:

1. Types of surgical procedures and conditions acceptable for admission;

2. Emergency admission;

3. Requirements for pre-admission history in accordance with §5.5.5(C) of this Part;

4. Transfer of patients for continuity of care or emergency care;

5. Discharge of patient with responsible adult, as indicated;

6. Constraints imposed by limitations of services, physical facilities; and

7. Instruction of patients on self-care upon discharge.

5.5.2Patient Care Management

A. Each patient shall be under the continuing supervision of a physician and provisions shall be made to assure the availability of a physician through the period of a patient's stay in the FASC.

B. A mechanism shall be established for the development and periodic review and revision of patient care policies and procedures which shall pertain to no less than:

1. Scope of services provided either directly or per contractual arrangements;

2. Criteria for admission, transfer and discharge;

3. Physician services and consultation services;

4. Radiology and laboratory services; and

5. Counseling services, if indicated.

C. The names and telephone number(s) of physicians to be called in an emergency including rescue or ambulance services shall be posted and easily accessible.

D. No medication shall be given except on the signed order of a lawfully authorized person. Emergency telephone orders shall be signed within twenty-four (24) hours.

5.5.3Anesthesia Service

A. A qualified anesthesiologist shall be on the staff.

B. There shall be written policies and procedures regarding:

1. Privileges of staff for anesthesiology established in accordance with §5.4.1(E) of this Part;

2. Emergency coverage;

3. Administration of anesthetics;

4. The maintenance of safety controls; and

5. Qualifications and supervision of non-physician anesthetists. In addition, the policies shall include provisions for at least the following:

a. Pre-anesthesia evaluation by a physician;

b. Safety of the patient during the anesthesia period;

c. Review of patient's condition prior to induction of anesthesia and post-anesthetic evaluation; and

d. Recording of all events related to each phase of anesthesia care.

5.5.4Counseling and Referral Service

When irreversible procedures are to be performed, such as human sterilization or termination of pregnancy, or when indicated in other situations, counseling service shall be provided through physicians, qualified nurses, social workers or trained counselors or a list of counseling agencies shall be made available to patients.

5.5.5Nursing Care Service

A. Nursing care service shall be under the direction of a full time licensed registered nurse who has training and experience in surgical nursing, and who shall be responsible for the supervision of nursing care needs of patients in preparation for and during the surgical procedure, and during the recovery period until discharged from the FASC by the responsible physician.

B. The number and type of registered nurses and ancillary personnel shall be based on the scope of services provided and staff capabilities, to ensure direct patient care as needed throughout the period of the patient(s) stay.

C. It shall be the responsibility of the registered nurse to obtain directly from the patient, per telephone if possible, a pre-admission history, distinct from the history obtained by the private physician.

5.5.6Infection Control

A. A mechanism shall be established by the Medical Director for the development of infection control policies which shall pertain to no less than:

1. Infection surveillance activities

2. Sanitation and asepsis;

3. Isolation of patients with known or suspected infectious diseases;

4. Handling and disposal of waste and contaminants;

5. Sterilization, disinfection and laundry;

6. Reporting, recording and evaluation of occurrences of infections; and

7. Documentation of infection rate.

B. The facility shall report promptly to the licensing agency infectious diseases which may present a potential hazard to patients, personnel and the public. Included are the reportable diseases and the occurrences of other diseases in outbreak form.

5.5.7Surgical Service

A. Written staff rules and regulations and policies shall be established to govern surgical services which shall include surgical staff privileges, supporting services of professional and paramedical personnel, provisions for emergency coverage and operating suite procedures.

B. Surgical procedures shall be performed only by physicians, dentists or podiatrists who are licensed in the state and who have been granted privileges to perform those procedures by the governing body of the FASC in accordance with §5.4.1(E) of this Part.

C. Each FASC shall have a written transfer agreement for transferring patients to a nearby hospital when hospitalization is indicated, or shall permit elective surgery only by licensed practitioners who have similar privileges at a nearby licensed hospital and approved by the governing body of the FASC.

D. Surgical procedures performed in the FASC shall be limited to those procedures and approved by the governing body.

E. If termination of pregnancy procedures are performed in a FASC the requirements of the rules and regulations for the Termination of Pregnancy (Part 20-10-6 of this Title) shall apply.

F. An anesthesiologist or another physician qualified in resuscitative technique shall be present or immediately available until all patients operated on a given day have been discharged.

G. Each operating room suite shall be:

1. Under the supervision of a person qualified by training and experience in operating room service;

2. Designed and equipped so that the types of surgery conducted and the type of anesthesia utilized (general or local) shall meet the fire and safety requirements of §§5.7.2(C) and/or (D) of this Part;

3. Designed to include recovery rooms, proper scrubbing, sterilizing and dressing room facilities, storage for anesthetic agents;

4. Equipped to carry out all necessary and emergency procedures; and

5. Provided with prominently posted policies and procedures pertaining to safety controls.

H. All tissues/specimens removed at surgery shall be submitted for pathological examination except those exempted by the surgeon in writing.

I. Procedures shall be established to obtain blood or blood substitutes on a timely basis.

J. The patient's medical record shall be available in the operating room at the time of surgery and shall contain no less than the following information:

1. A medical history and physical examination;

2. A signed consent form for surgical procedure; and

3. A pre-operative diagnosis.

K. An accurate and complete description of operative procedure shall be recorded by the operating surgeon immediately following completion of surgery.

L. Areas for the processing of clean and dirty supplies and equipment shall be separated by physical barriers.

M. Written procedures shall be established for all sterilization and for the appropriate disposal of wastes and contaminated supplies.

N. Reports of bacteriological tests and dated recordings of thermometer charts and inspection records shall be maintained on the premises.

5.5.8Supplies and Equipment

A. Supplies of appropriate sterile linens, gloves, dressings and so forth, shall be maintained in sufficient quantities for regular and emergency use.

B. Such surgical instruments, accessory and operating room lights and resuscitation equipment as are appropriate for the types of surgery and surgical risks which may be encountered in a FASC shall be provided and maintained in clean and sterile condition.

C. Supplies of appropriate drugs, medications, fluids, electrolyte solutions, etc. shall be maintained in sufficient quantities for regular and emergency use.

5.5.9Deficiencies and Plans of Correction

A. The licensing agency shall notify the governing body or other legal authority of a facility of violations of individual standards through a notice of deficiencies which shall be forwarded to the facility within fifteen (15) days of inspection of the facility unless the director determines that immediate action is necessary to protect the health, welfare, or safety of the public or any member thereof through the issuance of an immediate compliance order in accordance with R.I. Gen. Laws § 23-1-21.

B. A facility which received a notice of deficiencies must submit a plan of correction to the licensing agency within fifteen (15) days of the date of the notice of deficiencies. The plan of correction shall detail any requests for variances as well as document the reasons therefore.

C. The licensing agency will be required to approve or reject the plan of correction submitted by a facility within fifteen (15) days of receipt of the plan of correction.

D. If the licensing agency rejects the plan of correction, or if the facility does not provide a plan of correction or if a facility whose plan of correction has been approved by the licensing agency fails to execute its plan within a reasonable time, the licensing agency may invoke the sanctions enumerated in §5.3.6 of this Part. If the facility is aggrieved by the action of the licensing agency, the facility may appeal the decision and request a hearing in accordance with R.I. Gen. Laws Chapter 42-35.

5.5.10Laboratory and Radiology Services

A. Each FASC may perform on the premises limited procedures such as urinalysis and CBC, provided that personnel are qualified by training and are under supervision of a physician.

B. The requirements of the "Rules and Regulations for the Control of Radiation [R 23-1.3 -RAD]" pertaining to radiology shall apply to those FASC providing such services.

5.5.11Medical Records

A. A member of the professional staff shall be designated to supervise the medical records and to ensure proper documentation, completion, indexing, filing, retrieval and safe storage.

B. A medical record shall be established and maintained for every patient cared for in the FASC.

C. Each medical record shall contain sufficient information and data to support the diagnosis, plan of treatment and shall contain no less than the following:

1. Patient identification, (name, address, birth date, etc.);

2. Medical history and physical examination;

3. Pre-operative and final diagnosis;

4. Nurses' notes;

5. Anesthesiologists reports, medical consultation, and counseling (if any);

6. Surgeon's operative notes, progress report and discharge notes;

7. Instructions given patient upon discharge; and

8. Other related reports.

5.5.12Medical Consultation

Consultation and assistance in specialty fields shall be readily available and used as indicated prior to and when necessary following a surgical procedure. A facility shall maintain a current list of consultants available.

5.5.13Emergency Transfer

Each FASC shall have resources available for the emergency transfer of patients to a hospital. When indicated, a physician, physician assistant, or nurse shall accompany the patient.

216 R.I. Code R. § 216-RICR-40-10-5.5