Section 511.60 - Staffing and Staff Responsibilities(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).26 Tex. Admin. Code § 511.60
Adopted by Texas Register, Volume 48, Number 39, September 29, 2023, TexReg 5682, eff. 10/5/2023