26 Tex. Admin. Code § 509.53 - Surgical Services within the Scope of the Practice of Emergency Medicine
(a) Surgical procedures performed in the
facility shall be limited to those emergency procedures that are approved by
the governing body on the recommendation of medical staff.
(b) Adequate supervision of surgical
procedures conducted in the facility shall be a responsibility of the governing
body, recommended by medical staff, and provided by appropriate medical
staff.
(c) Surgical procedures
shall be performed only by physicians, podiatrists, dentists, or other
practitioners, who are practicing within the scope of their license and
education, who are licensed to perform surgical procedures in Texas and who
have been granted privileges to perform those procedures by the governing body,
on the recommendation of the medical staff, and after medical review of the
physician's, podiatrist's, dentist's, or practitioner's documented education,
training, experience, and current competence.
(d) Surgical procedures to be performed in
the facility shall be reviewed periodically as part of the peer review portion
of the facility's quality assessment and performance improvement
program.
(e) An appropriate
history, physical examination, and per tinent preoperative diagnostic studies
shall be incorporated into the patient's medical record before a surgical
procedure.
(f) Unless otherwise
provided by law, the necessity or appropriateness of the proposed surgical
procedure, as well as any available alternative treatment techniques, shall be
discussed with the patient, or if applicable, with the patient's legal
representative before the surgical procedure.
(g) Licensed nurses and other personnel
assisting in the provision of surgical services shall be appropriately trained
and supervised and available in sufficient numbers for the surgical care
provided.
(h) Each treatment or
examination room shall be designed and equipped so that the types of surgical
procedures conducted can be performed in a manner that protects the lives and
ensures the physical safety of all persons in the area.
(1) If flammable agents are present in a
treatment or examination room, the room shall be constructed and equipped in
compliance with standards established by the National Fire Protection
Association (NFPA 99, Annex 2, Flammable Anesthetizing Locations, 1999) and
with applicable state and local fire codes.
(2) If nonflammable agents are present in a
treatment or examination room, the room shall be constructed and equipped in
compliance with standards established by the National Fire Protection
Association (NFPA 99, Chapters 4 and 8, 1999) and with applicable state and
local fire codes.
(i)
With the exception of those tissues exempted by the governing body after
medical review, tissues removed shall be examined by a pathologist, whose
signed or authenticated report of the examination shall be made a part of the
patient's medical record.
(j) A
description of the findings and techniques of surgical procedures shall be
accurately and completely incorporated into the patient's medical record
immediately after the procedure by the physician, podiatrist, dentist, or other
practitioner, acting within the scope of their license and education, who
performed the procedure. If the description is dictated, an accurate written
summary shall be immediately available to the physicians and practitioners
providing patient care and shall become a part of the patient's medical
record.
(k) The facility shall
provide adequate space, equipment, and personnel to ensure a safe environment
for treating patients during surgical procedures, including adequate safeguards
to protect the patient from cross infection.
(1) The facility shall isolate patients with
communicable diseases.
(2)
Acceptable aseptic techniques shall be used by all persons.
(3) Suitable equipment for rapid and routine
sterilization shall be available.
(4) The facility shall implement
environmental controls that ensure a safe and sanitary environment.
(l) Written policies and
procedures for decontaminating, disinfecting, sterilizing, and storing sterile
supplies shall be adopted, implemented, and enforced as described in §
509.57 of this subchapter
(relating to Sterilization).
(m)
Emergency power adequate for the type of surgical procedures performed shall be
available.
(n) Periodic calibration
and preventive maintenance of all equipment shall be provided in accordance
with manufacturer's guidelines.
(o)
Unless otherwise provided by law, the informed consent of the patient or, if
applicable, of the patient's legal representative shall be obtained before a
surgical procedure is performed.
(p) The facility shall establish a written
procedure for observing and caring for the patient during and after surgical
procedures.
(q) The facility shall
establish written protocols for instructing patients in self-care after
surgical procedures, including written instructions to be given to patients who
receive conscious sedation or regional anesthesia.
(r) Patients who have received anesthesia,
other than solely topical anesthesia, shall be allowed to leave the facility
only in the company of a responsible adult, unless the physician, physician
assistant, or an advanced practice registered nurse writes an order that the
patient may leave without the company of a responsible adult.
(s) The facility shall develop an effective
written procedure for the immediately transferring to a hospital patients
requiring emergency care beyond the capabilities of the facility. The facility
shall have a written transfer agreement with a hospital as set forth in §
509.65 of this subchapter
(relating to Patient Transfer Policy).
Notes
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No prior version found.