Nutritional Services, Pharmacy Services, Laboratory, Radiology, and Respiratory Services, Nursing Services, Ambulatory, Obstetrical, and Special Care Units, Surgical and Anesthesia Departments, Licensed Programs, Housekeeping Services

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-3.240Nutritional Services

59A-3.241Pharmacy Services

59A-3.242Laboratory, Radiology, and Respiratory Services

59A-3.243Nursing Services

59A-3.244Ambulatory, Obstetrical, and Special Care Units

59A-3.245Surgical and Anesthesia Departments

59A-3.246Licensed Programs

59A-3.247Housekeeping Services

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 44 No. 62, March 29, 2018 issue of the Florida Administrative Register.

Changes will clarify language to align with guidelines and recommendations, remove obsolete language, remove outdated statutory language, remove rule references under the purview of DOH, and correct numbering and punctuation.

 

The following sections of the proposed rule will be changed to read:

 

59A-3.240 Nutritional Services.

All licensed hospitals shall have a dietetic department, service or other similarly titled unit which shall be organized, directed and staffed, and integrated with other units and departments of the hospitals in a manner designed to assure the provision of appropriate nutritional care and quality food service.

(1) through (8) No change.

(9) The dietetic department, service or other similarly titled unit shall be guided by written policies and procedures that cover food procurement, preparation and service. Dietetic department policies and procedures shall be developed by the director of the dietetic department with nutritional care policies and procedures developed by a registered dietitian, shall be subject to annual review, revised as necessary, dated to indicate the time of last review, and enforced. Written dietetic policies shall include the following:

(a) through (b) No change.

(c) A requirement that the The proper use and adherence to standards for nutritional care, including dietary reference intakes are as specified by the provider’s in a diet manual which is based on the current National Academy of Medicine, Food and Nutrition Board, Dietary Reference Intakes (DRIs).

(d) through (p) No change.

(10) through (20) No change.

Rulemaking Authority 395.1055, FS. Law Implemented 395.1055, FS. History–New _______, Formerly 59A-3.2085(1), F.A.C.

 

59A-3.241 Pharmacy Services.

No change.

 

59A-3.242 Laboratory, Radiology, and Respiratory Services.

(1) No change.

(2) Radiology Services. Each Class I and Class II hospital shall provide on the premises, and each Class III hospital shall provide on the premises or by contract, diagnostic imaging facilities commensurate with the hospital’s needs and conform to Chapter 404, F.S., Chapter 64E-5, F.A.C., Chapter 468, Part IV, F.S., and Chapter 64E-3, F.A.C. The radiology department or similarly titled unit shall have a radiologist to serve as medical director on a full time or part time consulting basis to discharge professional radiology services.

(a) No change

(b) Each hospital shall have certified radiologic technologists or basic x-ray machine operators in hospitals of 150 beds or less, and shall be on duty or on call at all times, pursuant to Chapter 468, Part IV, F.S.; and Chapter 64E-3, F.A.C.

(c) The use of all diagnostic imaging apparatus shall be limited to Florida licensed or certified individuals working within their scope of practice, as determined by their regulatory board personnel designated as specified in Chapter 468, Part IV, F.S., and Chapter 64E-3, F.A.C.

(d) No change

(e) The medical director shall maintain and enforce policies and procedures for the provision of all diagnostic and therapeutic radiation, imaging, and nuclear medicine services, and ensure compliance with the requirements of Chapter 64E-5, F.A.C. Such policies and procedures shall be written, reviewed annually, and revised as necessary in conformance with Chapter 64E-5, F.A.C., and shall be dated as to time of last review.

(f) No change

(g) The medical director shall document ensure documentation, and reporting to the Bureau of Radiation Control of the Department of Health of all misadministration of radioactive materials, as those terms are defined by Chapter 64E-5, F.A.C.

(h) No change

(3) No change

Rulemaking Authority 395.1055, FS. Law Implemented 395.1055, FS. History–New  _______, Formerly 59A-3.2085(9), 59A-3.2085(10), 59A-3.2085(11), F.A.C.

 

59A-3.243 Nursing Services.

No change.

 

59A-3.244 Ambulatory, Obstetrical, and Special Care Units. 

(1) through (2) No change

(3) Special Care Units. The hospital shall ensure that a special care unit is a physically and functionally distinct entity within the hospital, has controlled access, and has an effective means of isolation for patients suffering from communicable or infectious disease or acute mental disorder.

(a) through (e) No change.

(f) No hospital shall hold itself out as a Trauma Center unless it has been verified as a Trauma Center by the Department of Health in accordance with the Trauma Center provisions of Section 395.401, F.S., and Chapter 64J-2, F.A.C. Any violation of the Trauma Center provisions shall subject any violator to appropriate remedies provided by Section 395.1065, F.S.

Rulemaking Authority 395.1055, 395.401, 408.036, FS. Law Implemented 395.1055, 395.401, 408.036, FS. History–New _______, Formerly 59A-3.2085(7), 59A-3.2085(8), 59A-3.2085(12), F.A.C.

 

59A-3.245 Surgical and Anesthesia Departments.

No change.

 

59A-3.246 Licensed Programs. 

(1) No change.

(a) through (c) No change.

(d) Diagnostic Procedures. Procedures performed in the adult diagnostic cardiac catheterization laboratory shall include the following:

1. through 6. No change.

7. Diagnostic trans-septal procedures;

78. Intra-coronary ultrasound (CVIS);

89. Fluoroscopy; and

910. Hemodynamic stress testing.

(e) through (m) No change.

(2) Level I Adult Cardiovascular Services.

(a) Licensure.

1. through 3. No change.

4. The request shall confirm the hospital has one or more written transfer agreements with hospitals that operate a Level II adult cardiovascular services program, as specified in paragraph (2)(c) below including written transport protocols to ensure safe and efficient transfer of an emergency patient within 60 minutes. Transfer time is defined as the number of minutes between the recognition of an emergency as noted in the hospital’s internal log and the patient’s arrival at the receiving hospital.

5. through 11. No change.

(b) No change.

(c) Emergency Services. All providers of Level I adult cardiovascular program services shall have written transfer agreements developed specifically for emergency transfer of interventional cardiology patients with one or more hospitals licensed as a Level II adult cardiovascular services provider. Written agreements must be in place with a ground ambulance service capable of advanced life support and IABP transfer. Agreements may include air ambulance service, but must have ground ambulance backup. A transport vehicle must be on-site to begin transport within 30 20 minutes of a request and have a transfer time within 60 minutes. Transfer time is defined as the number of minutes between the recognition of an emergency as noted in the hospital’s internal log and the patient’s arrival at the receiving hospital. Transfer and transport agreements must be reviewed and tested once every 6 months, with appropriate documentation maintained, including the hospital’s internal log or emergency medical services data.

(d) through (g) No change.

(3) No change.

(4)  Stroke centers.

(a) through (d) No change.

(e) Comprehensive Stroke Center (CSC). A comprehensive stroke center shall have health care personnel with clinical expertise in a number of disciplines available.

1. Health care personnel disciplines in a CSC shall include:

a. through e. No change.

f. Advanced Practice Nurse(s) with particular expertise in neurological and/or neurosurgical evaluation and treatment, physician(s) with specialized expertise in critical care for patients with severe and/or complex neurological/neurosurgical conditions;

g. through i. No change.

j. A multidisciplinary team of health care professionals with expertise or experience in stroke, representing clinical or neuropsychology, nutrition services, pharmacy (including a Pharmacist with neurology/stroke expertise Pharmacy Doctorate (Pharm D) with stroke expertise), case management and social work workers.

2. No change.

3. A CSC shall have the following advanced diagnostic capabilities:

a. through i. No change.

43. Neurological Surgery and Endovascular Interventions:;

a. through h. No change.

i. Evacuation of intracranial hematomas;.

j. through k. No change.

54. A CSC shall have the following specialized infrastructure:

a. through b. No change.

c. Inpatient Units – These specialized units must have a subspecialty Medical Director with particular expertise in stroke (intensivist, pulmonologist, neurologist, neurosurgeon or neuro-intensivist) who demonstrates ongoing professional growth by obtaining at least 8 hours of 6 CME credits in cerebrovascular care education annually. A CSC shall provide:

(I) through (II) No change.

d. Rehabilitation and Post Stroke Continuum of Care –

(I) through (IV) No change.

(V) A CSC shall ensure that patients meeting acute care rehabilitation admission criteria are transferred to a CARF or TJC CARF/JCAHO accredited acute rehabilitation facility.

e. No change.

f. Professional standards for nursing – The CSC shall provide a career development track to develop neuroscience nursing, particularly in the area of cerebrovascular disease.

(I) through (II) No change.

(III) Nurses in the ICU caring for stroke patients, and nurses in neuroscience units must obtain at least 8 hours of continuing education credits (4 hours continuing education in the formalized CEU credits and 4 hours of continuing education related to their specialty that can be verified through documentation of participation).

g. No change.

65. A CSC will have a quality improvement program for the analysis of data, correction of errors, systems improvements, and ongoing improvement in patient care and delivery of services that include:

a. through d. No change.

(5)  Burn Units.

(a) No change.

(b) A hospital may apply for the initial licensure of a burn unit by submitting a hospital licensure application as specified in subsection 59A-3.066(2), Florida Administrative Code, indicating the addition of burn unit services, and attaching License Application Burn Unit Services, AHCA Form 3130-8012, January 2018, herein incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX. Both of these forms are available at: http://ahca.myflorida.com/MCHQ/HQALicensureForms/index.shtml. The Burn Unit Services Application must be signed by the hospital’s Chief Executive Officer. The applicant shall complete this form indicating the date that burn unit services will begin and that the hospital is in compliance with “Guidelines for the Operation of Burn Centers” but has not received initial verification as a burn unit. During this initial licensure period, the hospital license will indicate that the burn unit is “provisional”. The provisional status will be lifted upon completion of the verification process with the American Burn Association, and the burn unit will be fully licensed with the service listed on the hospital license.

(c) through (e) No change.

Rulemaking Authority 395.1055, 395.3038, 408.036, 408.0361, FS. Law Implemented 395.1055, 395.1065, 395.3038, 408.036, 408.0361, FS. History–New, _______, Formerly 59A-3.2085(13), 59A-3.2085(15), 59A-3.2085(16), 59A-3.2085(17), 59A-3.2085(18), FAC.

 

59A-3.247 Housekeeping Services. 

Each hospital shall have an organized housekeeping department with a qualified person designated as responsible for all housekeeping functions. The designated supervisor of housekeeping shall be responsible for developing written policies and procedures for coordinating housekeeping services with other departments, developing a work plan and assignments for housekeeping staff, and developing a plan for obtaining relief housekeeping personnel.

(1) through (2) No change.

(3) The designated supervisor of housekeeping shall develop, implement, and maintain an effective housekeeping plan to ensure that the facility is maintained in compliance with the following:

(a) through (i) No change.

(j) Garbage and refuse shall be removed from both interior and outside storage areas as often as necessary to prevent sanitary nuisance conditions. If garbage and refuse are disposed of on the facility premises, the method of disposal shall not create a sanitary nuisance and shall comply with the provisions of Chapter 62-701, F.A.C.

(4) No change.

(5) Effective control methods shall be employed to protect against the entrance into the facility and the breeding or presence on the premises of flies, roaches, rodents, and other vermin. Use of pesticides shall be in accordance with Chapter 5E-14, Part No. 1, F.A.C.

(6) No change.

Rulemaking Authority 395.1055, FS. Law Implemented 395.1055, FS. History–New _______, Formerly 59A-3.2085(6), F.A.C.