D.C. Mun. Regs. tit. 22, r. 22-B3525

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B3525 - VENTILATOR SERVICES

3525.1

The CRFPID may care for ventilator person's in a ventilator care area upon compliance with Title III of the Nursing Home and Community Residence Facility Residents' Protections Act of 1985, effective April 18, 1986, D.C. Law 6108, D.C. Code § 32-1431 et seq . The CRFPID shall notify the Department of all relevant information regarding this service, including the names of the physician and nurses in charge of providing the service.

3525.2

Ventilator care shall be supervised by a physician who has special training and experience in diagnosing, treating and assessing problems related to ventilator patients.

3525.3

The CRFPID shall ensure that ventilator care services are provided by a sufficient number of qualified staff and that personnel provide ventilator care services commensurate with their documented training, experience, and competence.

3525.4

As appropriate, ventilator care personnel shall be competent in the following:

(a) The fundamentals of cardiopulmonary physiology and of fluids and electrolytes;

(b) The recognition, interpretation and recording of signs and symptoms of respiratory dysfunction and medication side effects, particularly those that require notification of a physician;

(c) The initiation and maintenance of cardiopulmonary resuscitation and other related life-support procedures;

(d) The mechanics of ventilation and ventilator function;

(e) The principles of airway maintenance, including endotracheal and tracheotomy care;

(f) The effective and safe use of equipment for administering oxygen and other therapeutic gases and providing humidification, nebulization and medication;

(g) Pulmonary function testing and blood gas analysis when these procedures are performed within the CRFPID providing ventilator care;

(h) Methods that assist in the removal of secretions from the bronchial tree, such as hydration, breathing and coughing exercises, postural drainage, therapeutic percussion and vibration, and mechanical clearing of the airway through proper suctioning technique;

(i) Procedures and observations to be followed during and after extubation; and

(j) Recognition of and attention to the psychosocial needs of persons, their families and supported decision maker.

3525.5

The CRFPID shall ensure that each ventilator is equipped with an alarm, designed to alert the registered nurse in charge of monitoring the ventilator, on both the pressure valve and the volume valve.

3525.6 In order to operate ventilator services, the CRFPID shall develop a plan of operation approved by the Department which shall include:

(a) A description of the services to be provided;

(b) A description of the staffing pattern;

(c) A description of the qualifications, duties and responsibilities of personnel;

(d) A quality assurance plan which shall include:

(1) Assignment of responsibility for monitoring and evaluating activities;

(2) Identification of indicators and appropriate clinical critical criteria for monitoring the most important aspects; and

(3) Establishment of thresholds (levels or trends) for the indicators that will trigger evaluation of care;

(e) Policies and procedures on the following:

(1) The transfer or referral of persons who require services that are not provided by the CRFPID;

(2) The administration of medicines unique to the needs of the ventilator person;

(3) Infection control measures to minimize the transfer of infection in the CRFPID;

(4) Pertinent safety practices, including the control of fire and medical hazards; and

(5) Protocols for emergency situations.

3525.7

When the ventilator care services are provided by an outside contractor, the CRFPID shall document the following:

(a) Approve the contractor based on the contractor's credentials, qualifications and experience; and

(b) Ensure that all contractors:

(1) Provide services twenty-four hours a day;

(2) Meet all safety requirements;

(3) Abide by all pertinent policies and procedures of the CRFPID;

(4) Provide services in accordance with the law governing the CRFPID;

(5) Participate in the monitoring and evaluation of persons;

(6) Participate in the monitoring and evaluation of the appropriateness of services provided as required by the CRFPID's quality assurance program; and

(7) Ensure that all contractual services are under the supervision of the CRFPID's medical director or the physician employed by the CRFPID to coordinate ventilator care services.

D.C. Mun. Regs. tit. 22, r. 22-B3525

Final Rulemaking published at 68 DCR 4282 (4/23/2021)