Sec. 10.07.02.24. Special Care Units — Respiratory Care Unit

A. A respiratory care unit shall meet the:

(1) General requirements established for all special care units as outlined in Regulation .23 of this chapter; and

(2) Requirements of this regulation.

B. The nursing home shall submit to the Department and obtain approval of the following:

(1) All documents required in Regulation .23 of this chapter;

(2) Policies and procedures for all aspects of care as outlined in Regulation .23 of this chapter, and the following:

(a) Qualifications, duties, and responsibilities of staff, including the staff who are permitted to perform the following procedures:

(i) Cardiopulmonary resuscitation;

(ii) Obtaining arterial blood gas samples and their analyses;

(iii) Pulmonary function testing;

(iv) Therapeutic chest percussion and vibration;

(v) Bronchopulmonary drainage;

(vi) Coughing and breathing exercises;

(vii) Mechanical ventilatory and oxygenation support for residents; and

(viii) Aerosol, humidification, and medical gas administration;

(b) Weaning from mechanical ventilatory support and discharge planning for residents of the respiratory care unit; and

(c) The procurement, handling, storage, and dispensing of medical gases.

C. Physician Coordinator. If the nursing home’s medical director does not have special training and experience in diagnosing, treating, and assessing respiratory problems, the nursing home shall employ or contract with a Board-certified pulmonologist who has the special knowledge and experience to provide:

(1) Overall medical supervision of the respiratory care unit; and

(2) Coordination of all services for the respiratory care unit.

D. Staffing. The nursing home shall ensure that:

(1) The nurse manager or the director of nursing of vent units has a background in ventilator care or is qualified in ventilator management;

(2) Respiratory care services are provided by a sufficient number of qualified personnel; and

(3) Respiratory care personnel provide respiratory care services commensurate with their documented training, experience, and competence.

E. Design.

(1) Emergency Power. The nursing home unit shall meet all applicable requirements in Regulation .46 of this chapter for emergency electrical power, including the provision of:

(a) Emergency lighting in the respiratory care unit where life support equipment is used; and

(b) Duplex receptacles connected to the facility's emergency generator to provide emergency power to operate life support equipment and nonflammable medical gas systems in the respiratory care unit.

(2) Ventilator Alarms. The facility shall ensure that each ventilator is equipped with an alarm on both the pressure valve and the volume valve for safety.

(3) Piped Medical Gas Systems.

(a) To service the medical gas systems, a vendor or staff shall be trained and accredited in accordance with NFPA 99 Health Care Facilities Code.

(b) The vendor or staff may provide the following services:

(i) Installation;

(ii) Inspection; or

(iii) Testing.

(c) The nursing home shall ensure that all piped medical gas systems adhere to the following standards:

(i) NFPA 99 Health Care Facilities Code; and

(ii) NFPA 101 Life Safety Code.

F. The nursing home shall provide pulmonary function testing and blood gas or pulse analysis capability on-site or through contractual arrangements with providers who meet applicable State and federal laws and regulations.

G. Contractual Services. When any respiratory care services are provided by an outside contractor, the facility shall:

(1) Approve the contractor based on the contractor's credentials, training, and experience;

(2) Ensure that all contractors:

(a) Provide services 24 hours a day;

(b) Meet all safety requirements;

(c) Abide by all pertinent policies and procedures of the facility;

(d) Provide services in accordance with all laws and regulations governing the facility; and

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

(3) Ensure that all contractual services receive overall medical supervision and coordination by the facility's physician coordinator of the respiratory care unit.