N.H. Admin. Code § He-P 802.30

Current through Register No. 45, November 7, 2024

Section He-P 802.30 - Psychiatric Units

The following shall apply if the hospital has a distinct psychiatric unit:

(a) The psychiatric unit shall have a clinical director, service chief or equivalent that meets the training and experience requirements for examination by the American Board of Psychiatry and Neurology, or the American Osteopathic Board of Neurology and Psychiatry;

(b) The psychiatric unit shall have a director of nursing services who shall be:

(1) A registered nurse (RN) currently licensed in New Hampshire who has a master's degree or its equivalent in psychiatric and mental health nursing; or

(2) An RN with a bachelor's degree and a minimum of 3 years of experience in the care of the mentally ill and to include one year in a nursing management position;

(c) Admission procedures shall include, in addition to those specified in He-P 802.19(a) :

(1) A psychiatric diagnosis;

(2) An admitting diagnosis including any concurrent disease; and

(3) Completion of a psychosocial assessment and family history as appropriate;

(d) The psychiatric unit shall provide emergency psychiatric services on a 24 hour per day basis, 7 days per week;

(e) The hospital shall perform a psychiatric evaluation as soon as practicable but no longer than 24 hours after admission on each patient admitted to the psychiatric unit including:

(1) Medical history;

(2) Present mental status;

(3) Notation about the onset of symptoms and circumstances leading to admission and admitting diagnosis;

(4) An estimate of the patients intellectual functioning, memory functioning and orientation;

(5) An evaluation of the patient's use or abuse of alcohol or drugs, as appropriate; and

(6) When indicated a neurological examination;

(f) The hospital shall require that each patient have an individual treatment plan which includes:

(1) The diagnosis;

(2) An inventory of the patient's strengths and weaknesses which would enable him to function in a normal situation;

(3) Treatment goals;

(4) The specific treatment modalities used based on the strengths and weaknesses demonstrated by the patient;

(5) The responsibilities of each treatment team member; and

(6) Documentation as to the specific therapeutic activities the patient shall participate in during his or her hospitalization;

(g) The psychiatric unit shall provide therapeutic activities which are:

(1) Appropriate to the needs and interests of the patients;

(2) Directed toward restoring the patient's physical and psychosocial functioning; and

(3) In accordance with the treatment plan in (f) above;

(h) Progress notes shall be recorded in the patient's medical record by all personnel involved in carrying out the individual treatment plan for each patient;

(i) In the psychiatric unit where patients might be a hazard to themselves or others, all glazing, both interior and exterior, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

(j) There shall be at least one seclusion room for each 24 beds or fraction thereof on each psychiatric unit;

(k) Seclusion rooms, if used as a treatment modality, shall:

(1) Where restraining patients is provided, have a maximum clear floor area of at least 60 square feet with a minimum wall length of 7 feet and a maximum wall length of 11 feet;

(2) Be accessed by an anteroom or vestibule that also provides access to a toilet room. The doors to the anteroom and the toilet room shall be a minimum of 3 feet 8 inches wide;

(3) Be for only one patient;

(4) Have doors that permit staff observation of patients through a view panel, while also maintaining provisions for patient privacy. The view panel shall be fixed glazing with polycarbonate or laminate on inside of glazing;

(5) Be under constant observation, which may include video monitoring, when being used;

(6) Be constructed to prevent patient hiding, escape, injury, or suicide;

(7) Be constructed of materials that are of a type acceptable to the local authority having jurisdiction and the state regulatory agency when the interior of the seclusion treatment room is padded with combustible materials;

(8) Not contain outside corners or edges;

(9) Have the ability to be locked as applicable;

(10) Not have electrical switches and receptacles within the rooms; and

(11) Have doors that swing out;

(l) The room(s) shall be appropriately located for direct nursing observation;

(m) Forensic units shall have security vestibules or sally ports at the unit entrance;

(n) Care and supervision of child psychiatric patients shall be separate and distinct from adult psychiatric patients;

(o) Patient room areas with beds or cribs shall be at least 100 square feet for single-bed rooms, 80 square feet per bed and 60 square feet per crib in multiple-bed rooms;

(p) Geriatric, Alzheimer's and other dementia units patient room areas shall be at least 120 square feet in single bedrooms and 200 square feet in multiple-bed rooms;

(q) Maximum room capacity shall be 2 patients;

(r) A visitor room for patients to meet with friends or family with a minimum floor space of 100 square feet shall be provided;

(s) A quiet room shall be provided for a patient who needs to be alone for a short period of time but does not require a seclusion room. Such a room shall be a minimum of 80 square feet. A group therapy room may be combined with this space if the unit accommodates not more than 12 patients and when at least 225 square feet of enclosed private space is available for group therapy activities;

(t) When door closers are required, they shall be mounted on the public side of the door rather than the private patient side of the door and whenever possible they should be within view of a nurse workstation;

(u) Door hinges shall be designed to minimize points for hanging;

(v) Door lever handles shall point downward when in the latched positions. All hardware shall have tamper-resistant fasteners;

(w) All window glazing, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

(x) Clothing rods or hooks, if present, shall be designed to minimize the opportunity for patients to cause injury;

(y) Drawer pulls shall be of the recessed type to eliminate the possibility of use as a tie-off point;

(z) Special design considerations for injury and suicide prevention shall be given to shower, bath, toilet and sink hardware and accessories, including grab bars and toilet paper holders;

(aa) Grab bars are required in 10 percent of the private/semi-private patient toilet rooms. Where grab bars are provided, they shall be of a removable type and the space between the bar and the wall shall be filled to prevent a cord being tied around it for hanging;

(ab) The following shall not be permitted:

(1) Towel bars;

(2) Shower curtain rods; and

(3) Lever handles;

(ac) In private patient bathrooms, the ceiling shall be of the tamper-resistive type or of sufficient height to prevent patient access;

(ad) In patient bedrooms where acoustical ceilings are permitted, the ceiling shall be secured or of sufficient height to prevent patient access;

(ae) In private patient bathrooms, any plumbing, piping, ductwork, or other potentially hazardous elements shall be concealed above a ceiling;

(af) In patient bedrooms and bathrooms, ceiling access panels shall be secured or of sufficient height to prevent patient access;

(ag) In patient bedrooms and bathrooms, ventilation grilles shall be secured and have small perforations to eliminate their use as tie-off point or shall be of sufficient height to prevent patient access;

(ah) In unsupervised patient areas, sprinkler heads shall be recessed or of a design to minimize patient access;

(ai) In private patient bathrooms, air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type;

(aj) Electronic surveillance systems shall not be required in psychiatric nursing units, but if provided for the safety of the residents, any devices in resident areas shall be mounted in a tamper-resistance enclosure that is unobtrusive; and

(ak) A nurse-call system shall meet the requirements of UL 1069 Standard for Hospital Signaling and Nurse Call Equipment. Use of alternate technologies that meet the requirements of UL 1069, including radio frequency systems, shall be permitted for call systems and shall have tamper-resistant fasteners.

N.H. Admin. Code § He-P 802.30

#9580, eff 10-24-09

Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12407, Effective 10/24/2017, Expires 4/22/2018.

Amended by Volume XLI Number 6, Filed February 11, 2021, Proposed by #13166, Effective 1/28/2021, Expires 1/28/2031.