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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 133HOSPITAL LICENSING
SUBCHAPTER COPERATIONAL REQUIREMENTS
RULE §133.41Hospital Functions and Services

      (v) Within 10 working days after the date of admission, the written treatment plan shall be provided. It shall be in the person's primary language, if practicable. What is or would have been practicable shall be determined by the facts and circumstances of each case. The written treatment plan shall be provided to:

        (I) the patient;

        (II) a person designated by the patient; and

        (III) upon request, a family member, guardian, or individual who has demonstrated on a routine basis responsibility and participation in the patient's care or treatment, but only with the patient's consent unless such consent is not required by law.

      (vi) The written treatment plan shall be reviewed by the interdisciplinary team at least every two weeks.

      (vii) The written treatment plan shall be revised by the interdisciplinary team if a comprehensive reassessment of the patient's status or the results of a patient case review conference indicates the need for revision.

      (viii) The revision shall be incorporated into the patient's record within seven working days after the revision.

      (ix) The revised treatment plan shall be reduced to writing in the person's primary language, if practicable, and provided to:

        (I) the patient;

        (II) a person designated by the patient; and

        (III) upon request, a family member, guardian, or individual who has demonstrated on a routine basis responsibility and participation in the patient's care or treatment, but only with the patient's consent unless such consent is not required by law.

  (8) Discharge and continuing care plan. The patient's interdisciplinary team shall prepare a written continuing care plan that addresses the patient's needs for care after discharge.

    (A) The continuing care plan for the patient shall include recommendations for treatment and care and information about the availability of resources for treatment or care.

    (B) If the patient's interdisciplinary team deems it impracticable to provide a written continuing care plan prior to discharge, the patient's interdisciplinary team shall provide the written continuing care plan to the patient within two working days after the date of discharge.

    (C) Prior to discharge or within two working days after the date of discharge, the written continuing care plan shall be provided in the person's primary language, if practicable, to:

      (i) the patient;

      (ii) a person designated by the patient; and

      (iii) upon request, to a family member, guardian, or individual who has demonstrated on a routine basis responsibility and participation in the patient's care or treatment, but only with the patient's consent unless such consent is not required by law.

(d) Dietary services. The hospital shall have organized dietary services that are directed and staffed by adequate qualified personnel. However, a hospital that has a contract with an outside food management company or an arrangement with another hospital may meet this requirement if the company or other hospital has a dietitian who serves the hospital on a full-time, part-time, or consultant basis, and if the company or other hospital maintains at least the minimum requirements specified in this section, and provides for the frequent and systematic liaison with the hospital medical staff for recommendations of dietetic policies affecting patient treatment. The hospital shall ensure that there are sufficient personnel to respond to the dietary needs of the patient population being served.

  (1) Organization.

    (A) The hospital shall have a full-time employee who is qualified by experience or training to serve as director of the food and dietetic service, and be responsible for the daily management of the dietary services.

    (B) There shall be a qualified dietitian who works full-time, part-time, or on a consultant basis. If by consultation, such services shall occur at least once per month for not less than eight hours. The dietitian shall:

      (i) be currently licensed under the laws of this state to use the titles of licensed dietitian or provisional licensed dietitian, or be a registered dietitian;

      (ii) maintain standards for professional practice;

      (iii) supervise the nutritional aspects of patient care;

      (iv) make an assessment of the nutritional status and adequacy of nutritional regimen, as appropriate;

      (v) provide diet counseling and teaching, as appropriate;

      (vi) document nutritional status and pertinent information in patient medical records, as appropriate;

      (vii) approve menus; and

      (viii) approve menu substitutions.

    (C) There shall be administrative and technical personnel competent in their respective duties. The administrative and technical personnel shall:

      (i) participate in established departmental or hospital training pertinent to assigned duties;

      (ii) conform to food handling techniques in accordance with paragraph (2)(E)(viii) of this subsection;

      (iii) adhere to clearly defined work schedules and assignment sheets; and

      (iv) comply with position descriptions which are job specific.

  (2) Director. The director shall:

    (A) comply with a position description which is job specific;

    (B) clearly delineate responsibility and authority;

    (C) participate in conferences with administration and department heads;

    (D) establish, implement, and enforce policies and procedures for the overall operational components of the department to include, but not be limited to:

      (i) quality assessment and performance improvement program;

      (ii) frequency of meals served;

      (iii) nonroutine occurrences; and

      (iv) identification of patient trays; and

    (E) maintain authority and responsibility for the following, but not be limited to:

      (i) orientation and training;

      (ii) performance evaluations;

      (iii) work assignments;

      (iv) supervision of work and food handling techniques;

      (v) procurement of food, paper, chemical, and other supplies, to include implementation of first-in first-out rotation system for all food items;

      (vi) ensuring there is a four-day food supply on hand at all times;

      (vii) menu planning; and

      (viii) ensuring compliance with §§229.161 - 229.171 of this title (relating to Texas Food Establishments).

  (3) Diets. Menus shall meet the needs of the patients.

    (A) Therapeutic diets shall be prescribed by the physician(s) responsible for the care of the patients. The dietary department of the hospital shall:

      (i) establish procedures for the processing of therapeutic diets to include, but not be limited to:

        (I) accurate patient identification;

        (II) transcription from nursing to dietary services;

        (III) diet planning by a dietitian;

        (IV) regular review and updating of diet when necessary; and

        (V) written and verbal instruction to patient and family. It shall be in the patient's primary language, if practicable, prior to discharge. What is or would have been practicable shall be determined by the facts and circumstances of each case;

      (ii) ensure that therapeutic diets are planned in writing by a qualified dietitian;

      (iii) ensure that menu substitutions are approved by a qualified dietitian;

      (iv) document pertinent information about the patient's response to a therapeutic diet in the medical record; and

      (v) evaluate therapeutic diets for nutritional adequacy.

    (B) Nutritional needs shall be met in accordance with recognized dietary practices and in accordance with orders of the physician(s) or appropriately credentialed practitioner(s) responsible for the care of the patients. The following requirements shall be met.

      (i) Menus shall provide a sufficient variety of foods served in adequate amounts at each meal according to the guidance provided in the Recommended Dietary Allowances (RDA), as published by the Food and Nutrition Board, Commission on Life Sciences, National Research Council, Tenth edition, 1989, which may be obtained by writing the National Academies Press, 500 Fifth Street, NW Lockbox 285, Washington, D.C. 20055, telephone (888) 624-8373.

      (ii) A maximum of 15 hours shall not be exceeded between the last meal of the day (i.e. supper) and the breakfast meal, unless a substantial snack is provided. The hospital shall adopt, implement, and enforce a policy on the definition of "substantial" to meet each patient's varied nutritional needs.

    (C) A current therapeutic diet manual approved by the dietitian and medical staff shall be readily available to all medical, nursing, and food service personnel. The therapeutic manual shall:

      (i) be revised as needed, not to exceed 5 years;

      (ii) be appropriate for the diets routinely ordered in the hospital;

      (iii) have standards in compliance with the RDA;

      (iv) contain specific diets which are not in compliance with RDA; and

      (v) be used as a guide for ordering and serving diets.

(e) Emergency services. All licensed hospital locations, including multiple-location sites, shall have an emergency suite that complies with §133.161(a)(1)(A) of this title (relating to Requirements for Buildings in Which Existing Licensed Hospitals are Located) or §133.163(f) of this title, and the following.

  (1) Organization. The organization of the emergency services shall be appropriate to the scope of the services offered.

    (A) The services shall be organized under the direction of a qualified member of the medical staff who is the medical director or clinical director.

    (B) The services shall be integrated with other departments of the hospital.

    (C) The policies and procedures governing medical care provided in the emergency suite shall be established by and shall be a continuing responsibility of the medical staff.

    (D) Medical records indicating patient identification, complaint, physician, nurse, time admitted to the emergency suite, treatment, time discharged, and disposition shall be maintained for all emergency patients.

  (2) Personnel.

    (A) There shall be adequate medical and nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the hospital.

    (B) Except for comprehensive medical rehabilitation hospitals and pediatric and adolescent hospitals that generally provide care that is not administered for or in expectation of compensation:

      (i) there shall be on duty and available at all times at least one person qualified as determined by the medical staff to initiate immediate appropriate lifesaving measures; and

      (ii) in general hospitals where the emergency treatment area is not contiguous with other areas of the hospital that maintain 24 hour staffing by qualified staff (including but not limited to separation by one or more floors in multiple-occupancy buildings), qualified personnel must be physically present in the emergency treatment area at all times.

    (C) Except for comprehensive medical rehabilitation hospitals and pediatric and adolescent hospitals that generally provide care that is not administered for or in expectation of compensation, the hospital shall provide that one or more physicians shall be available at all times for emergencies, as follows.

      (i) General hospitals, except for hospitals designated as critical access hospitals (CAHs) by the Centers for Medicare & Medicaid Services (CMS), located in counties with a population of 100,000 or more shall have a physician qualified to provide emergency medical care on duty in the emergency treatment area at all times.

      (ii) Special hospitals, hospitals designated as CAHs by the CMS, and general hospitals located in counties with a population of less than 100,000 shall have a physician on-call and able to respond in person, or by radio or telephone within 30 minutes.

    (D) Schedules, names, and telephone numbers of all physicians and others on emergency call duty, including alternates, shall be maintained. Schedules shall be retained for no less than one year.

  (3) Supplies and equipment. Adequate age appropriate supplies and equipment shall be available and in readiness for use. Equipment and supplies shall be available for the administration of intravenous medications as well as facilities for the control of bleeding and emergency splinting of fractures. Provision shall be made for the storage of blood and blood products as needed. The emergency equipment shall be periodically tested according to the policy adopted, implemented and enforced by the hospital.

  (4) Required emergency equipment. At a minimum, the age appropriate emergency equipment and supplies shall include the following:

Cont'd...

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