007.05.00 Ark. Code R. 003

Current through Register Vol. 49, No. 10, October, 2024

Rule 007.05.00-003 - Addendum - Ambulatory Surgery Center - Extended Recovery Time

ADDENDUM TO THE 1999 RULES AND REGULATIONS FOR HOSPITALS AND RELATED lNSTITUTlONS IN ARKANSAS PURSUANT TO ACT 414 OF 1961 AS AMENDED EXTENDED RECOVERY TIME

I. Scope/Limitations of Services

A. The extended recovery time service shall be approved by the Health Facility Services Division prior to implementation of the service.

B. Ambulatory Surgery Centers shall have the capability to Provide care for post surgical patients requiring continued nursing or medical treatment, but whose condition does not warrant acute hospitalization. The extended recovery period shall not exceed 23 hours and 59 minutes. The extended recovery period shall be limited to:

1. Observation;

2. Control of nausea/vomiting;

3. Replacement of fluids; and

4. Pain management.

C. Patients shall be screened prior to surgery and prior to Admission to the overnight area to ascertain that established admission criteria is met.

D. Services shall not include intensive nursing care, continuous monitoring due to the instability of vital signs, administration of IV cardiac or anti-hypertensive drugs, or treatment of any unstable underlying medical condition.

E. If a question arises as to whether or not a patient is an appropriate candidate for extended stay, the decision shall be made by the Medical Director or Administrator.

II. Admission Criteria

A. Physician's order shall be obtained for transfer to extended stay;

B. Stable vital signs and 0₂ saturation level;

C. Oriented to person, place, and time (a return to preoperative mentation);

D. Presence of satisfactory airway;

E. Absence of significant bleeding;

F. Stabilized or resolution of any acute problem;

G. Movement of extremities following regional anesthetic;

H. Level of consciousness which permits patient to call for nurse;

I. Recovery will require 23 hours 59 minutes or less prior to discharge;

J. The surgeon and anesthesia provider (or their designee of similar training and expertise) shall be present or immediately available; and

K. Patient assessment and orientation shall be recorded in the medical record.

III. Discharge Criteria

A. Discharge shall be done in keeping with the same criteria established for the discharge of any patient from the Ambulatory Surgery Center.

B. The patient shall be discharged within 23 hours and 59 minutes of his/her admission to extended recovery by the surgeon or anesthesiologist or his/her designee.

C. If the patient's condition is such that discharge is deemed inappropriate, arrangements shall be made for hospital transfer.

D. Postoperative prescription orders and instructions shall be given to the patient and responsible adult with an understanding of instructions verbally by the person(s) receiving them and a copy retained in the medical record.

IV. Transfer Requirements to Acute Care Facility

A. Patients who require continuous monitoring due to the instability of vital signs;

B. Patients who require administration of IV cardiac or anti-hypertensive drugs;

C. Patients who require treatment of any unstable underlying medical condition;

D. Patients whose pain management or observation requires longer than 23 hours and 59 minutes;

E. Patients who have a lowered level of consciousness than their preoperative status; and

F. Patients who exhibit current or potential airway complications.

V. Supervision of Extended Recovery Care

A. Ambulator}' Surgery Centers shall provide adequate supervision of extended stay area to assure quality patient care and safety.

B. The extended stay area shall be staffed with a minimum of two caregivers at all times.

1. At least one of the caregivers shall be a Registered Nurse.

2. All caregivers shall be Basic Cardiac Life Support (BCLS) certified.

3. At least one Registered Nurse on duly at all times shall be Advanced Cardiac Life Support (ACLS) certified.

4. The anesthesiologist (or designee) and the surgeon (or designee) shall be present or immediately available.

VI. Emergency Procedures

A. Any emergency or life-threatening situation shall be handled in a manner that provides the most appropriate and rapid care to best meet the patient needs.

B. Local Emergency Medical Sendees (EMS) shall be notified that regular hours are trying extended on the days patients require extended recoveiy care.

C. Appropriate drugs, supplies and equipment shall be immediately available to the area, including a fully stocked crash cart with defibrillator and oxygen tank.

D. Transfer agreements to a local acute care hospital and ambulance transportation covering the Ambulatory Surgery Center shall include the extended stay area.

VII. Medications

The Ambulatory Surgery Center shall have provisions for obtaining prescribed drugs and biologicals to meet the needs of the population served. In addition, policies and procedures shall be developed and implemented for the handling of medications brought into the facility by patients. Should it be necessary to administer a patient's own medications, a signed physician's order shall be in the medical record identifying the medication(s) along with the route and directions for use.

VIII. Medical Records

A. Ambulatory Surgery Centers shall have an expanded medical record for patients in extended stay.

B. The same medical record rmryshall be utilized that was initiated upon admission for surgery.

C. A discharge note shall be written upon discharge from acute recovery care.

D. An admission note, to include a patient assessment by a Registered Nurse, shall be included when the patient is received in the extended care area.

E. Pertinent observations, treatments, and medications shall be documented in the nurses' notes.

F. A closing entry or discharge summary shall include information/observations regarding the patient's condition and the care provided throughout the extended care.

G. Patient food allergies and preferences-shall be documented. Meal intake and toleration of diet shall be documented by nursing personnel in the nurses' notes.

IX. Patient Nutrition

A. If meals are prepared onsite, the Food and Nutrition Services shall be supervised by a qualified individual on the days the facility is open. A qualified individual shall be at a minimum a certified dietary manager.

B. The food preparation area shall included at a minimum:

1. Refrigerator/freezer;

2. Microwave oven;

3. Handwashing sink with towel and soap dispensers;

4. Counter space;

5. Garbage cans with cover;

6. Storage area for food, food preparation equipment and tableware; and

7. A three (3) compartment sink, if disposables are not utilized at all times.

C. If meals are not prepared onsite, the food served to the patient shall be obtained from a food service establishment that operates in accordance with the Arkansas Department of Health Rules and Regulations Pertaining to Food Service Establishments.

D. Leftover foods shall not be stored for future patient use.

X. Physical Facilities

Extended stay may permit patient sleeping accommodations in the post-anesthesia recovery area.

XI. Staffing

A. At least one (1) registered nurse shall be on duty at all times while the center is in operation, with supportive personnel as needed.

B. Non-nursing personnel, i.e., aides, housekeeping, etc. shall be assigned in sufficient numbers and with sufficient training to meet the patient-s needs.

XII. Security Procedures

A. Measures shall be employed to ensure the security of patients, families, physicians, and employees while at the center after normal working hours.

B. The parking lot shall be well-lit, with frequent checks made for light bulbs needing replacement.

C. At least two employees shall be present inside the facility when patients are present.

XIII. Quality Improvement/Risk Management Plan

A. Ambulatory Surgery Centers shall assure the same QI plan is followed for extended recovery care patients as general patients.

B. Each extended recovery patient shall receive the same Patient Satisfaction Questionnaire as general surgical patients upon discharge from the facility.

C. Each extended recovery care patient shall receive a postoperative call if they are discharged to home. If they are discharged to an alternate health care facility (i.e., rehab) a discharge summary shall be obtained upon discharge from that facility.

D. During the first year of extended recover)' services a quarterly report of the plan review shall be sent to the Health Facility Services Division of the Department.

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007.05.00 Ark. Code R. 003

8/8/2000