AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NO.:RULE TITLE:
59A-5.0085Departments and 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. 46 No. 218, November 6, 2020 issue of the Florida Administrative Register.
The following sections of the proposed rule will be changed to read:
59A-5.0085 Departments and Services.
(1) through (6) No change.
(7) Pediatric services.
(a) A center providing surgical services to patients under the age of 18 years (pediatric) must include age- and size-appropriate criteria in written policies and procedures regarding admissions, surgical services, anesthesia services, post-operative recovery, and discharge planning. The policies and procedures must be approved by the medical staff and the governing board, and be reviewed annually by the pediatric medical director, and signed and dated at the time of each review, revised as necessary, and enforced.
1. All patients shall meet admission and preoperative clearance criteria established by the medical staff and approved by the governing board. However, no patient may be admitted prior to age 30 days. Patients must be at least 6 months of age.
2. Patients less than 24 months of age must be admitted and discharged on the same calendar day.
2.3. Patients who were born less than 37 completed weeks gestation (premature) must be at least 60 weeks of age post conception 15 months of age, weaned off apnea monitors, and cleared by an anesthesiologist or certified registered nurse anesthetist under the on-site medical direction of a licensed physician have the patient’s primary care physician clearance for the procedure in an ambulatory surgical center setting.
3.4. Patients must not be oxygen dependent at baseline.
5. Patients must have a Body Mass Index in the range of 5th to 85th percentile.
6. Patients must not have a Do Not Resuscitate status.
7. Patients must undergo preoperative screening by an anesthesiologist to assess the pre-anesthesia medical co-morbidities. The screening must assign a classification, such as the American Society of Anesthesiologists Physical Status Classification System. Only patients classified as healthy or with mild systemic disease, as defined by the center’s organized medical staff, may be admitted for surgical services.
(b) Accommodations must be made for the parent or guardian to remain at the center from admission through discharge.
(c) Surgical services may be provided to patients for conditions that are not emergency medical conditions elective procedures only. Procedures utilizing general anesthesia must be under 4 hours.
(d) Each center must include its pediatric cases in the have a specific pediatric quality assessment and improvement system as described in 59A-5.019, F.A.C. that includes peer review, multidisciplinary review and the monitoring of processes and outcomes.
(e) Each center must have a written transfer agreement with a hospital providing pediatric surgical services. Centers must ensure the mode of emergency transportation has age- and size-appropriate equipment.
(f) A pediatric anesthesiologist or pediatric surgeon must serve as pediatric medical director.
(e)(g) One or more persons currently certified in Pediatric Advanced Life Support (PALS) must be present and available to the pediatric patient who is sedated, anesthetized, recovering from anesthesia, or receiving perioperative opioids.
(f)(h) Each center providing surgical services requiring a length of stay past midnight must be staffed with the following professionals with specialized training and expertise in the treatment of pediatric patients:
1. A surgeon who is board-certified or eligible in a pediatric surgical subspecialty or a board-certified or eligible surgeon with additional training and expertise with pediatric patients acceptable to the governing board pediatric medical director.
2. An anesthesiologist or other physician or a certified registered nurse anesthetist under the on-site medical direction of a licensed physician or an anesthesiologist assistant under the direct supervision of an anesthesiologist Anesthesia personnel, as described in subsection (2) shall be present in the room with the pediatric patient throughout all general anesthesia, regional anesthesia and monitored anesthesia care.
3. Nursing and other direct care staff must have specialized training and experience with pediatric patients. Nursing personnel must be PALS and/or and Advanced Cardiac Life Support certified. There must be at least one registered professional nurse on duty for each pediatric patient at all times.
(g)(i) Each center providing surgical services requiring a length of stay past midnight must have kitchen facilities and equipment available to store ready-to-eat foods and beverages. Equipment must include handwashing facilities and a refrigerator.
(h)(j) Age- and size-appropriate equipment and resources related to the care of pediatric patients must be available on site, including
1. Operating tables;
2. Pre- and post-operative beds;
3. Anesthesia equipment and supplies;
4. Resuscitation devices;
5. Oxygen saturation monitors;
6. Pharmacologic supplies and administration devices; and
7. Blood pressure cuffs.
(8) The Agency will review this rule five years from the effective date and re-promulgate, amend or repeal the rule as appropriate, in accordance with Section 120.54, F.S. and Chapter 1-1, F.A.C.
Rulemaking Authority 395.1055 FS. Law Implemented 395.009, 395.1055, 395.1011 FS. History–New 12-12-96, 9-28-14, Amended _ .
