CHAPTER 133. SPECIAL CARE UNITS
133.2. Types of special care units.
133.4. Organization and staffing.
133.6. Special care unit nursing service.
EDUCATION AND TRAINING
133.12. Special requirements.
FACILITIES AND EQUIPMENT
133.31. Policies and procedures.
The provisions of this Chapter 133 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631, unless otherwise noted.
§ 133.1. Principle.
Special care units, as appropriate for the hospital, shall be developed for patients who require extraordinary care.
The provisions of this § 133.1 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
§ 133.2. Types of special care units.
A special care unit of a hospital is an area set aside for the treatment of patients who require extraordinary care on a concentrated and continuous basis. There are two kinds of special care units as follows:
(1) Multipurpose for the intensive treatment of critically ill patients with a wide variety of diagnoses.
(2) Specific purpose for the continuous care of patients in special diagnostic categories. These categories include but are not limited to:
(ii) Coronary care.
(iii) Neonatal care.
(iv) Postobstetric and post operative recovery care.
(v) Pulmonary care.
(vi) Renal dialysis.
(vii) Surgical, including trauma, intensive care units.
The provisions of this § 133.2 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
§ 133.3. [Reserved].
The provisions of this § 133.3 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631; reserved September 19, 1980, effective September 20, 1980, 10 Pa.B. 3761. Immediately preceding text appears at serial pages (37886) and (37887).
§ 133.4. Organization and staffing.
Special care units shall be organized so as to function effectively and shall be integrated with other departments or services of the hospital.
The provisions of this § 133.4 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
§ 133.5. Director.
(a) Special care units shall be under the direction of a physician who has a special interest in and, preferably, additional experience in providing the type of care supplied by the special care unit. If an experienced physician is not available, direction of the unit may be provided by a medical staff committee.
(b) The special care unit director or committee shall be responsible for the establishment and implementation of written policies governing the following:
(1) Proper utilization of the service.
(2) Staff participation in appropriate training programs for safe and effective use of diagnostic and therapeutic equipment, for cardiopulmonary resuscitation and for other aspects of intensive care.
(3) Supervision of the collection and analysis of clinical data needed for the retrospective evaluation of care provided in the unit.
§ 133.6. Special care unit nursing service.
(a) When a special care unit is occupied, specialized nursing services shall be provided to ensure medically appropriate and effective patient care.
(b) Nursing services shall be provided in accordance with Chapter 109 (relating to nursing services), as well as the following:
(1) At no time may the occupied unit be without a registered professional nurse. Other registered nurses and health care personnel may serve as assistant or backup personnel under the direct supervision of a qualified special care unit nurse.
(2) When a special care unit is occupied, the professional nurse on each tour of duty shall be responsible for the nursing care in the unit. The nurse so assigned shall be qualified by training and experience and shall have demonstrated appropriate competence.
The provisions of this § 133.6 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
EDUCATION AND TRAINING
§ 133.11. Principle.
A continuing education program developed especially for the personnel of the special care unit shall be provided in order to enable the personnel to maintain and improve their skills, as well as to learn new techniques. The program may be inside or outside the hospital.
The provisions of this § 133.11 issued under 67 Pa.C.S. § § 61016104.
The provisions of this § 133.11 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631; amended September 19, 1980, effective September 20, 1980, 10 Pa.B. 3761. Immediately preceding text appears at serial page (37888).
§ 133.12. Special requirements.
(a) Special care unit personnel shall be prepared for their responsibilities through appropriate training and educational programs. Each staff member shall have completed an education course specifically oriented to his level of participation in the care of patients who require extraordinary care.
(b) The educational programs should prepare special care unit personnel to:
(1) Recognize, interpret and record appropriate signs and symptoms in the critically ill patients.
(2) Initiate cardiopulmonary resuscitation.
(3) Administer electrolytes and fluids parenterally.
(4) Use equipment in the unit safely and effectively.
(5) Perform specialized nursing procedures peculiar to the needs of patients in the unit.
(6) Prevent contamination and cross-infection.
(7) Exercise appropriate safety precautions in the use of electrical or electronic equipment.
(8) Recognize and attend to the psychological and social needs of the patients and their families.
The provisions of this § 133.12 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
FACILITIES AND EQUIPMENT
§ 133.21. Facilities.
Facilities provided for special care units shall be specifically designed and equipped for the type of special care to be provided.
The provisions of this § 133.21 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
§ 133.22. Equipment.
(a) The type and quality of equipment provided in a special care unit shall depend upon the needs of the patient treated.
(b) There shall be a written preventive maintenance program which includes techniques for cleaning and for contamination control as well as for the scheduled periodic testing of equipment with records kept of the results of such testing.
(c) Special safety precautions related to proper grounding, current leakage and device safety shall be observed when electronic devices are used. Potential electrical hazards must be recognized and guarded against in instances where electrically operated beds are used. Documentation of safety testing shall be retained for the life of the equipment.
The provisions of this § 133.22 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631.
§ 133.31. Policies and procedures.
(a) Because of the intensity of care given within the special care unit and of the critical nature of the illnesses of patients cared for in it, written policies and procedures additional to basic hospital policies shall be developed to guide personnel in the management of the unique situations which may occur within the unit. These policies and procedures shall be developed by the medical staff, the nursing staff, other appropriate hospital departments and services and the chief executive officer and shall be approved by the appropriate committee of the medical staff. They shall be reviewed and revised as necessary.
(b) Policies and procedures established in accordance with subsection (a) of this section should give special attention to the following:
(1) Functions and authority of the unit director, with special emphasis on the working relationships that exist between the attending physicians and the director.
(2) Admission and discharge criteria, including priority determinations.
(3) Staff responsibility for special procedures and specifications as to which procedures are to be done, by whom, under what circumstances, and under what degree of supervision. Special procedures, as used in this paragraph, may include cardiopulmonary resuscitation, tracheotomy, ordering of medications, administration of parenteral fluids and other medications, and obtaining of blood and other laboratory specimens.
(4) The assignment of responsibility for a preventive and corrective maintenance program, including procedures to follow in the event of breakdown of essential equipment.
(5) The use and location of special equipment and supplies.
(6) Respiratory care, including assisted ventilation and humidification.
(7) Infection control and isolation procedures.
(8) Procedures for priority orders for laboratory tests.
(9) Standing orders, if any.
(10) Regulations governing visitors and traffic control.
The provisions of this § 133.31 issued under 67 Pa.C.S. § § 61016104.
The provisions of this § 133.31 adopted December 9, 1977, effective December 10, 1977, 7 Pa.B. 3631; amended September 19, 1980, effective September 20, 1980, 10 Pa.B. 3761. Immediately preceding text appears at serial page (37889).
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