26 Tex. Admin. Code § 511.44 - Emergency Services
(a) A limited
services rural hospital (LSRH) shall provide the emergency care necessary to
meet the needs of its patients in accordance with acceptable standards of
practice.
(b) An LSRH shall provide
to each patient, without regard to the individual's ability to pay, an
appropriate medical screening, examination, and stabilization within the
facility's capability, including ancillary services routinely available to the
hospital, to determine whether an emergency medical condition exists and shall
provide any necessary stabilizing treatment.
(c) An LSRH shall have an emergency suite
that complies with §
511.163(e) of
this chapter (relating to Spatial Requirements).
(d) The organization of the LSRH's emergency
services must be appropriate to the scope of the services offered.
(e) Emergency services must be organized
under the direction of a qualified physician member of the LSRH's medical staff
who is the medical director or clinical director.
(f) Emergency services must be integrated
with other LSRH departments.
(g)
The LSRH must maintain patient medical records for all emergency patients. The
medical records shall contain patient identification, the reason for the visit,
name of physician, name of nurse, time admitted to the emergency suite,
treatment, time discharged, and disposition.
(h) The policies and procedures governing
medical care provided in the emergency suite must be established by and must be
a continued responsibility of the medical staff.
(i) There must be adequate medical and
nursing personnel qualified in emergency care to meet the written emergency
procedures and needs anticipated by the LSRH.
(j) There must be on-duty and on-site 24
hours a day, seven days a week at least one person qualified, as determined by
the medical staff, to initiate immediate appropriate lifesaving measures and at
least one nurse with current advanced cardiac life support and pediatric
advanced life support certification. This individual or individuals must be
able to receive patients and activate the appropriate medical resources to meet
the care needed by the patient.
(k)
Qualified personnel must be physically present in the emergency treatment area
at all times.
(l) An LSRH must
maintain schedules, names, and phone numbers of all physicians and others on
emergency call duty, including alternates. The LSRH must maintain the schedules
for at least one year.
(m) In
accordance with Code of Federal Regulations Title 42 (42 CFR)
§485.516(c)(4), there must be a physician, a physician assistant, or an
advanced practice registered nurse, with training or experience in emergency
care, on call and immediately available by telephone or radio contact, and
available on-site at the LSRH within 30 minutes, on a 24-hour a day basis, if
the LSRH is located in an area other than an area described in
42 CFR §
485.618(d)(1)(ii).
(n) Emergency services must be available
24-hours per day.
(o) An LSRH shall
keep adequate age-appropriate equipment, supplies, and medication used in
treating emergency cases and make this equipment, supplies, and medication
readily available for treating emergency cases.
(p) The age-appropriate emergency equipment
and supplies available at the LSRH shall include at least the following:
(1) emergency call system;
(2) oxygen;
(3) mechanical ventilatory assistance
equipment, including airways, manual breathing bag, endotracheal tubes, ambu
bag/valve/mask;
(4) cardiac
defibrillator;
(5) cardiac
monitoring equipment;
(6)
laryngoscopes and endotracheal tubes;
(7) suction equipment;
(8) stabilization devices for cervical
injuries;
(9) blood pressure
monitoring equipment;
(10) pulse
oximeter or similar medical device to measure blood oxygenation;
(11) tourniquets;
(12) immobilization devices;
(13) nasogastric tubes;
(14) splints;
(15) Intravenous (IV) therapy
supplies;
(16) suction
machine;
(17) chest
tubes;
(18) indwelling urinary
catheters; and
(19) drugs and
biologicals commonly used in life-saving procedures as specified by the medical
staff, which shall include:
(A)
analgesics,
(B) local
anesthetics,
(C)
antibiotics,
(D)
anticonvulsants,
(E) antidotes and
emetics,
(F) serums and
toxoids,
(G)
antiarrhythmics,
(H) cardiac
glycosides,
(I)
antihypertensives,
(J) diuretics,
and
(K) electrolytes and
replacement solutions.
(q) Equipment and supplies must be available
at the LSRH for administering intravenous medications as well as facilities for
bleeding control and emergency splinting of fractures.
(r) The LSRH shall periodically test
emergency equipment according to the LSRH's adopted policy.
(s) An LSRH shall provide, either directly or
under arrangements, services for the procurement, safekeeping, and transfusion
of blood, including the availability of blood products needed for emergencies
on a 24-hour a day basis.
(t)
Provision for the storage of blood and blood products must be made as needed.
If blood banking services are provided under an arrangement, the arrangement is
approved by the LSRH's medical staff and by the persons directly responsible
for the operation of the LSRH. An LSRH shall ensure all blood and blood
components are stored in accordance with §
511.45(h) of
this subchapter (relating to Laboratory Services).
(u) An LSRH shall, in coordination with
emergency response systems in the area, establish procedures under which a
physician is immediately available by telephone or radio contact on a 24-hour a
day basis to receive emergency calls, provide information on treatment of
emergency patients, and refer patients to the LSRH or other appropriate
locations for treatment.
Notes
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