W. Va. Code R. § 64-12-8 - Patient Care Units or Departments

8.1. General Requirements.

8.1.1. The hospital shall develop and maintain all patient care units or departments in accordance with section 5 of this rule.

8.1.2. All patient care areas and units shall be segregated from areas used by the public or occupied by the hospital ancillary facilities, including adjunct diagnostic and treatment areas.

8.1.3. All areas in which patient care is rendered shall maintain or have easy access to an emergency cart for use in the event of patient respiratory or cardiac arrest. The contents of this cart, such as medications and supplies shall be determined by hospital policy. The frequency of monitoring of the contents of the emergency carts shall be determined by nursing service policies and procedures.

8.1.4. The hospital shall develop protocols for implementation of respiratory and cardiac arrest care on a 24-hour basis using all necessary staff throughout the hospital including any available physicians for immediate emergency response.

8.1.5. Each nursing unit and patient service department shall maintain a current policy and procedure manual governing the specific care provided by that unit or department. The manual shall be reviewed and revised at least every three years.

8.2. Patient Care and Nursing Unit.

8.2.1. The hospital shall provide private rooms to meet the needs of patients and programs of the hospital. There shall be no more than four beds in each patient room in existing construction. In construction after the approval date of this rule, there may be no more than two patient beds in each room.

8.2.2. No sleeping area may be located below ground level.

8.2.3. Each one bedroom shall contain a minimum floor area in existing construction of 100 square feet or 120 square feet in new construction. Each multiple bedroom shall contain a minimum floor area of 80 square feet for each bed in existing construction and 100 square feet for each bed in new construction.

8.2.4. Each patient room shall have direct entry from a corridor.

8.2.5. Artificial light shall be provided and include general illumination and other sources of illumination sufficient for reading, observations, examinations, and treatments.

8.2.6. All new or renovated facilities shall have a night light control switch located at the point of entry into patient rooms.

8.2.7. Patient rooms shall have movable furnishings. The director may make exceptions as needed regarding all furnishings for psychiatric hospitals. Patient rooms shall be equipped with the following:

8.2.7.a. An adjustable bed with side rails;

8.2.7.b. A cabinet or bedside table;

8.2.7.c. An over-bed table;

8.2.7.d. A wastepaper receptacle with impervious disposable liner or a disposable waste receptacle; and

8.2.7.e. Personal care items such as water pitcher, cups, emesis basin, and oral and personal hygiene products as necessary.

8.3. Obstetric Service.

8.3.1. Obstetric facilities, including accommodations for mothers and infants, and the delivery suites, shall be a self-contained unit and shall be segregated from all other parts of the hospital.

8.3.2. The supervision of the obstetric service shall be under the direction of a professional registered nurse licensed in West Virginia with experience in obstetric care.

8.3.3. The hospital shall establish specific policies for the training and competency of nursing personnel from other areas of the hospital working in the obstetric and neonatal care areas, or nursing personnel from the obstetric and neonatal care areas working on other units of the hospital.

8.3.4. Nursing personnel shall not move between perinatal and non-perinatal units without training and orientation to these areas.

8.3.5. The obstetric/delivery unit, the obstetric nursing unit, and the nursery shall be designed so that prenatal, natal, and postnatal processes are a continuous, safe, and satisfying experience for mother and infant.

8.3.6. Caesarean deliveries shall be performed in a caesarean delivery room suite or in the hospital's operating room.

8.3.7. The Caesarean delivery room shall be properly furnished, stocked, and maintained at all times to perform Caesarean delivery procedures.

8.3.8. As determined by medical staff, there shall be equipment for general anesthesia and a supply of drugs and anesthetics ordinarily needed for spinal, epidural, pudendal anesthesia, or a combination of the foregoing available at all times.

8.3.9. A heated bassinet or isolette shall be ready for the reception and care of the newborn infant in all delivery suites.

8.3.10. There shall be supplies and equipment for resuscitation of mother and newborn.

8.3.11. Staff shall maintain current certification in neonatal resuscitation.

8.3.12. The hospital shall establish and make available in all delivery suites a means of identification for each infant, approved by the medical staff, which shall be applied at the time of delivery in the delivery suite.

8.3.13. The medical staff or designee shall instill in the eyes of the newborn baby medications approved by the medical staff for the prevention of inflammation, according to current standards of practice.

8.3.14. Birthing rooms, labor/delivery/recovery rooms, or both are considered as delivery rooms for the purposes of this rule.

8.3.15. The hospital shall include the beds that are used for postnatal care in the count of the hospital's licensed beds.

8.3.16. Noninfectious patients may be admitted to the obstetrics unit according to policies and procedures for all services approved by the medical staff. If a patient develops an elevated temperature, she shall be moved to another location within the hospital.

8.4. Nursery.

8.4.1. A separate nursery shall be available for the care of newborn infants. The nursery shall not be used for any other purpose and shall be conveniently located in reference to the rooms of the mothers. The hospital shall provide postnatal provisions for the safety and security of the infant.

8.4.2. Nurseries shall provide 24 square feet of floor space per bassinet with at least 12 inches between bassinets.

8.4.3. A separate bassinet for each infant shall be provided, except in the case of multiple births in accordance with hospital policy.

8.4.4. In the case of each viable delivery, infants shall be weighed on accurate infant scales provided for each nursery.

8.4.5. There shall be other equipment and supplies essential for the care of newborns, including, but not limited to, isolettes and oxygen.

8.4.6. Commercially prepared formula shall be handled and prepared in a manner consistent with the requirements of the Department of Health Legislative Rule, Food Establishments, 64CSR17.

8.4.7. The hospital shall provide immediate segregation and isolation of any infant with a communicable infection.

8.4.8. All equipment shall be maintained separately for each infant.

8.4.9. The hospital shall furnish infant clothing and diapers.

8.4.10. The hospital shall include in the discharge planning process, instructions to the infant's care givers for feeding and care of the infant.

8.4.11. Air conditioning, heating and ventilation systems shall have supply delivered from ceiling outlets and return air shall be from the floor level.

8.5. Surgical Department.

8.5.1. The surgical department shall be under the direction of a physician licensed in West Virginia by the West Virginia Board of Medicine or West Virginia Board of Osteopathy and experienced in the practice of surgery. The surgeon or his or her designee shall be available to the hospital staff at all times.

8.5.2. The surgical suites shall be self-contained units under the supervision of a qualified registered professional nurse or physician experienced in the practice of surgery and licensed in West Virginia.

8.5.3. Access to the surgical area shall be limited to authorized personnel only.

8.5.4. There shall be no through traffic to any other part of the hospital.

8.5.5. The surgical suites shall be separated physically from the delivery unit and emergency unit.

8.5.6. The hospital shall maintain a current list of surgical privileges for all practitioners conducting surgical procedures both in the surgery suite and the area where the scheduling of surgical procedures is completed. The list shall be updated periodically and at least every two years with additions, deletions, or both of surgical privileges.

8.5.7. The hospital shall maintain a log for daily documentation of each surgical procedure and shall include the following information:

8.5.7.a. The patient's name;

8.5.7.b. The patient's hospital identification number;

8.5.7.c. The date of the procedure;

8.5.7.d. Total time of the procedure;

8.5.7.e. Names of the surgeon or practitioner and any assistants;

8.5.7.f. Names of nursing personnel in attendance;

8.5.7.g. Type of anesthesia and name of person administering it; and

8.5.7.h. The procedure performed.

8.5.8. There shall be a complete patient history and physical work up in the chart of every patient prior to surgery, except in emergencies. If the history and physical has been done but is not yet recorded in the patient's chart, there shall be a statement to that effect and an admission note in the chart by the practitioner who admitted the patient.

8.5.9. A completed and signed informed consent form for the intended surgical procedure shall be in the patient's chart before surgery, except in emergencies.

8.5.10. The hospital shall ensure completion and authentication by the practitioner, of the operative report describing techniques, findings, and tissues removed or altered immediately following surgery. The content and format of the operative report shall be determined by hospital policy.

8.5.11. Operating rooms shall be provided with adequate standard equipment and supplies to ensure sage surgical care.

8.5.12. Adequate provisions shall be made for the storage of sterile surgical supplies and instruments.

8.5.13. Separate scrub facilities with non-manual controls readily accessible to each operating room shall be provided.

8.5.14. The hospital shall have written policies concerning the use of flammable anesthetics in the event flammable anesthetics are used.

8.5.15. Staff clothing change areas shall be provided within the surgical suite.

8.6. Post-Anesthesia Care Unit.

8.6.1. There shall be adequate provisions for immediate post-anesthesia care in a room or area separate from the surgical suite.

8.6.2. For each bed, sufficient area shall be allowed to permit space for bulky equipment and to afford access of personal on all sides of the bed, including the head.

8.6.3. Beds shall be arranged so that all patients can be observed simultaneously.

8.6.4. Necessary equipment and adequate supplies shall be provided including space for proper storage.

8.6.5. Access to the post-anesthesia unit shall be limited to authorized personnel only.

8.6.6. The post-anesthesia unit shall be under the direction of a registered professional nurse licensed in West Virginia and experienced in the care and management of post-anesthesia patients.

8.6.7. At least one registered professional nurse and when necessary, one assisting person shall be in the post-anesthesia unit when a patient or patients are present.

8.6.8. The hospital shall record all pertinent information related to care provided while the patient is in the post-anesthesia unit in the patient's medical record. This includes physician orders, patient respirations, pulse and blood pressure, and treatments and medication given. The patient's condition on admission to the unit and transfer from the unit shall also be recorded in the patient's record.

8.6.9. If patients are not transferred to the recovery room, provisions shall be made for direct observation by a registered professional nurse until they have regained consciousness and are transferred to the intensive care unit.

8.7. Anesthesia Department.

8.7.1. The hospital shall have an organized anesthesia department under the medical direction of a qualified physician member of the medical staff licensed by the West Virginia Board of Medicine or West Virginia Board of Osteopathy in West Virginia who will be responsible for all anesthesia administered in the hospital.

8.7.2. Anesthesia may be administered only by a licensed practitioner permitted by state law to administer anesthesia, a certified registered nurse anesthetist as permitted by state law, or other professionals as permitted by the medical staff and state law.

8.7.3. A practitioner qualified for the administration of anesthesia shall perform a pre-anesthesia evaluation no more than 48 hours prior to surgery.

8.7.4. The hospital shall ensure completion of an intra operative anesthesia record for all surgical patients.

8.7.5. A practitioner qualified for the administration of anesthesia shall perform a post anesthesia evaluation within 48 hours of surgery for all inpatients.

8.7.6. The hospital's policy shall determine the content and format of the pre-anesthesia evaluation, intra operative anesthesia record, and the post anesthesia evaluation.

8.7.7. The hospital shall establish written policies for safeguards in the use of various types of anesthetics in accordance with the National Fire Protection Association.

8.7.8. The hospital shall store all equipment and medications used in administration of anesthesia in a secure, safe, and readily accessible location according to current professional standards. Qualified technicians shall service and maintain all equipment.

8.8. Pediatric Service.

8.8.1. Hospitals providing pediatric care shall have separate rooms designated for pediatric use.

8.8.2. Adult and pediatric patients shall not be placed in the same room at the same time. Designated pediatric rooms may be used for providing adult care when the rooms are not needed for pediatric patients.

8.8.3. The hospital shall have proper facilities and procedures for the isolation of children with infectious or communicable diseases.

8.8.4. The hospital shall have pediatric emergency supplies, medications, and equipment organized and readily available on any patient care unit that provides pediatric services.

8.9. Specialty Care and Critical Care Unit.

8.9.1. The hospital shall provide specialty care units, such as coronary care units and intensive care units, organized under the direction of a physician who is licensed in West Virginia and has experience in the specialty care provided.

8.9.2. The authority in determining criteria for admission, length of stay, and discharge and the resolution of operational problems shall be clearly delineated through policies developed cooperatively by the medical staff, nursing service, and administration and approved by the governing body.

8.9.3. A qualified physician shall be readily available to each unit at all times. The physician shall be available within 30 minutes for a response or an in-person meeting according to hospital policy. One physician may be available to more than one specialty unit at one time if the care provided is within his or her scope of practice.

8.9.4. The critical care unit organization and staffing shall be appropriate for the scope of services offered to ensure the health and safety of the patients.

8.9.5. The hospital shall provide nursing care under the supervision of a registered professional nurse licensed in West Virginia with experience in the specialty care provided.

8.9.6. Nursing personnel providing care in a specialty care unit shall have documented training and competence in the specific care provided.

8.9.7. An adequate number of staff shall be provided to ensure the health and safety of the patients.

8.9.8. A minimum of one registered professional nurse shall be on duty at all times and available to provide direct patient care.

8.9.9. Beds in a specialty care unit shall be arranged or provided with visual surveillance equipment to enable the nursing personnel to observe all patients closely and frequently from the nurse's station.

8.9.10. Equipment in a specialty care unit shall include at a minimum:

8.9.10.a. Variable height, adjustable beds, and adequate storage space for equipment and personal effects;

8.9.10.b. Bedside emergency call systems;

8.9.10.c. Bedside suctioning equipment;

8.9.10.d. Bedside cardiac monitoring equipment with an alarm system that can be monitored from the bedside or a centralized location;

8.9.10.e. An extended defibrillator;

8.9.10.f. Adequate respiratory care supplies and equipment for resuscitation; and

8.9.10.g. Sufficient supplies and equipment appropriate for the scope of services provided.

8.10. Outpatient Department.

8.10.1. Outpatient services shall be provided under the supervision of a registered professional nurse licensed in West Virginia or other health care professional as appropriate for the service being offered.

8.10.2. Outpatient departments shall be easily accessible for all patients receiving treatment.

8.10.3. Outpatient departments shall be conveniently located to other hospital departments, such as the laboratory and the radiology department.

8.10.4. The outpatient department shall have accommodations and facilities to provide for the care, comfort and privacy of patients.

8.10.5. The outpatient department staffing patterns shall be based upon patient needs and services provided.

8.10.6. The outpatient department medical staff shall meet the same requirements and qualifications that apply to the attending medical staff of the hospital including credentialing and privilege determination by the hospital governing body.

8.10.7. The outpatient department shall maintain accurate and complete medical records for all outpatients, according to hospital policy.

8.11. Emergency Department.

8.11.1. All general acute care hospitals shall provide emergency services, unless it would result in an unnecessary duplication of services.

8.11.2. The emergency department shall be under the direction of a physician experienced in emergency medicine who is licensed in West Virginia and who is a member of the hospital medical staff.

8.11.3. Emergency department non-physician staff shall be under the supervision of a registered professional nurse licensed in West Virginia.

8.11.4. All emergency department staff shall be currently certified in, at least, basic life support measures.

8.11.5. At least one registered professional nurse, certified in advanced cardiac life support, and other patient care personnel as needed, experienced in emergency care, shall be available for all hours that emergency services are provided.

8.11.6. All physicians employed to provide services in the emergency department shall maintain certification in advanced cardiac life support.

8.11.7. A physician or midlevel practitioner shall be on duty at the hospital to provide care whenever emergency services are provided.

8.11.8. If the hospital provides emergency services, the emergency department shall be located so as to permit easy access from automobiles and ambulances.

8.11.9. The emergency department shall keep records on all patients treated in the emergency department. The content and format of these records shall be determined by the hospital policy.

8.11.10. Emergency services shall be integrated with other departments of the hospital.

8.11.11. The hospital shall take all measures necessary to ensure compliance with the requirements of section 1867 of the Emergency Medical Treatment and Active Labor Act, even when the emergency services are not available.

Notes

W. Va. Code R. § 64-12-8