justicedao/ipfs_state_laws huggingface dataset:
333-505-0010 Administrator (1) Each hospital shall employ or contract with a chief executive officer (CEO) or administrator who is responsible for the operation of the hospital and hospital based services in a manner commensurate with the authority conferred by the governing body, supports the delivery of high quality hospital care and services and ensures compliance with all hospital policies and applicable state and federal laws and regulations. In determining the appropriate number of facilities for which a CEO or administrator is responsible, the governing body of the hospital or health system should consider distance between hospitals and the size and complexity of each facility. (2) For hospitals with attached long-term care facilities, the CEO may function as administrator of both the hospital and the long-term care facility. (3) The hospital shall notify the Oregon Health Authority, in writing, of the voluntary or involuntary termination of the CEO or administrator as well as the appointment of a new CEO or administrator. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.055 History: PH 34-2024, minor correction filed 04/08/2024, effective 04/08/2024 PH 17-2012, f. 12-20-12, cert. ef. 1-1-13 PH 11-2009, f. & cert. ef. 10-1-09 HD 2-2000, f. & cert. ef. 2-15-00 HD 21-1993, f. & cert. ef. 10-28-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89
333-505-0040 Personnel (1) A hospital shall: (a) Maintain a sufficient number of qualified personnel to provide effective patient care and all other related services. (b) Have written personnel policies and procedures that are available to personnel. (c) Provide orientation for new employees. (d) Have an annual continuing education plan. (e) Have a job description for each position that delineates the qualifications, duties, authority and responsibilities inherent in each position. (f) Provide an annual work performance evaluation for each employee with appropriate records maintained. (g) Have an employee health screening program for the purpose of protecting patients and employees from communicable diseases, including but not limited to requiring tuberculosis testing for employees in accordance with OAR 333-505-0070. (2) A hospital shall restrict the work of employees with restrictable diseases in accordance with OAR 333-019-0010. (3) The actions taken by a hospital under this rule shall be fully documented for each employee and made available to Oregon Health Authority representatives upon request. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 History: PH 35-2024, minor correction filed 04/08/2024, effective 04/08/2024 PH 49-2020, minor correction filed 05/08/2020, effective 05/08/2020 PH 11-2009, f. & cert. ef. 10-1-09 HD 2-2000, f. & cert. ef. 2-15-00 HD 21-1993, f. & cert. ef. 10-28-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89
333-505-0060 Quality Assessment and Performance Improvement (1) The governing body of a hospital must ensure that there is an effective, written, facility-wide quality assessment and performance improvement program to evaluate and monitor the quality and appropriateness of patient care. (2) All organized services related to patient care, including services furnished by a contractor, must be evaluated. (3) Written documentation of quality assessment and performance improvement activities shall be recorded at least quarterly. (4) Healthcare associated infections, adverse drug reactions, errors in administration of drugs, and blood and blood product transfusions must be evaluated. (5) All medical and surgical services performed in the hospital must be evaluated as they relate to appropriateness of diagnosis and treatment. (6) The hospital must have an ongoing plan, consistent with available community and hospital resources, to provide and make available social work, psychological, and educational services to meet the medically-related needs of its patients. Statutory/Other Authority: ORS 441.055 Statutes/Other Implemented: ORS 441.025 History: PH 17-2012, f. 12-20-12, cert. ef. 1-1-13 PH 11-2009, f. & cert. ef. 10-1-09 HD 2-2000, f. & cert. ef. 2-15-00 HD 21-1993, f. & cert. ef. 10-28-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89
333-505-0075 HIV Post-Exposure Prophylaxis (1) Effective January 1, 2024, a hospital must adopt, maintain, and implement a policy for the dispensing of human immunodeficiency virus (HIV) post-exposure prophylaxis or therapies to a patient for occupational or nonoccupational exposure to HIV. (2) The policy must conform to the following guidelines except for as otherwise provided in section (3) of this rule: (a) Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Updated Guidelines for Antiretroviral Postexposure Prophylaxis after Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV, United States, 2016. (b) Centers for Disease Control and Prevention, Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. (3) For any patient evaluated at the hospital within 72 hours of a possible occupational or nonoccupational exposure to HIV, a hospital shall ensure that: (a) Hospital personnel dispense to a patient at least a five-day supply of HIV post-exposure prophylactic medication or other therapies unless medically contraindicated; and (b) Information on the importance of starting and completing the medication regimen, as well as resources to ensure access to the full medication regimen, is provided to the patient at the time the first dose of the five-day supply is dispensed. (4) Hospital personnel must document in the patient’s medical record the date the post-exposure prophylaxis or therapies and information on starting and completing the medication regimen was distributed. NOTE: The guidelines cited in this rule are available from the agency. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 & 441.068 History: PH 2-2024, adopt filed 01/29/2024, effective 01/29/2024
333-505-0090 Request for Tissues and Organs (1) A hospital administrator or his or her designee shall contact the appropriate organ or tissue procurement organization when a patient dies at the hospital or when a patient's death is imminent. (2) After consultation with an organ or tissue procurement organization, the hospital administrator or his or her designee shall communicate with the patient or legal next-of-kin and request that the patient's organs and tissue be donated as an anatomical gift, unless: (a) The medical record shows that the patient has made an anatomical gift; (b) The appropriate procurement organizations or the medical examiner has ruled out the potential donor based on accepted medical standards; (c) The legal next-of-kin are not available because: (A) They cannot be located in a timely manner after reasonable effort by the procurement organizations or the hospital; or (B) They are mentally incompetent. (d) In the opinion of the attending physician after consulting with the procurement organization, it is determined that the request would contribute toward the severe emotional distress of the patient or legal next-of-kin. (3) For purposes of this rule, "legal next-of-kin" is the class of persons described in ORS 97.965 and in addition to spouse, includes Oregon registered domestic partner. (4) The hospital shall document the request or the absence of a request, in the medical record of the decedent and provide information on the request and its disposition to the person filing the death certificate. (5) An anatomical gift by a legal next-of-kin or authorized person may be made by a document of gift signed by the donor or made by his or her telegraphic, recorded telephonic or other recorded message. (6) A hospital or training requestor who acts or omits to act with probable cause in accord with the terms of ORS 97.951 through 97.978 and these rules is not subject to criminal or civil liability. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 History: PH 11-2009, f. & cert. ef. 10-1-09
333-505-0100 Training for Requestors (1) All persons making requests for donations of organs, tissues, and eyes shall have received hospital-provided or procurement organization-provided training in accordance with this rule. (2) Training for requestors shall include but is not limited to: (a) The legal requirements of ORS 97.951 through 97.978 and these rules, and the necessity for completion of the portion of the death certificate regarding organ, tissue and eye retrieval. (b) Specifics of organ tissue and eye donation, including: identification of potential donors; medical uses of donated organs, tissues, and eyes; the history and success of transplant programs; reimbursement mechanisms for expenses relating to organ, tissue, and eye retrieval; (c) A review of the psychological, social, cultural, ethical and religious factors affecting willingness to donate organs, tissues, and eyes, and resistance to organ, tissue, and eye donation, and a review of materials developed to train individuals to request organ, tissue, and eye donation with reasonable discretion and sensitivity; (d) The family's right to refuse and the need to respect this right; (e) The effect on funeral arrangements and cost; and (f) The importance of consulting with the attending physician. (3) Requestors shall be able to demonstrate knowledge of the training content as defined in this rule. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 History: PH 11-2009, f. & cert. ef. 10-1-09
333-505-0110 Hospital Compliance (1) A hospital shall demonstrate compliance with OAR 333-505-0090 and 333-505-0100 by maintaining a file, available for Oregon Health Authority review, including the following: (a) Training curriculum; (b) Hospital policy and procedure regarding request and training for tissues, eyes, and organs; (c) If not included in policy and procedure, criteria for selection of requestor; (d) Method by which 24-hour scheduling of requestor(s) is established; and (e) Policies and procedures for communicating with procurement organizations regarding the availability of donor organs, tissues, and eyes. (2) Hospitals may provide appropriate procurement organization personnel access to medical records of decedents on a periodic basis. The timing of this review will be mutually agreed to by both the hospital and procurement organizations. Procurement organizations will provide appropriate staff to conduct the review in the hospital. The purpose of this review will be to provide information to the hospital to assist in compliance with state and federal regulations related to organ, tissue and eye donation. If the hospital agrees to the review, all findings will remain strictly confidential. (3) In the case of a hospital in which organ transplants are performed, the hospital must be a member of the Organ Procurement and Transplantation network established under Section 372 of the Public Health Service Act and abide by its rules and requirements. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 History: PH 38-2024, minor correction filed 04/08/2024, effective 04/08/2024 PH 11-2009, f. & cert. ef. 10-1-09
333-505-0120 Emergency Contraception (1) A hospital providing care to a female victim of sexual assault shall: (a) Promptly provide the victim with unbiased, medically and factually accurate written and oral information about emergency contraception; (b) Promptly orally inform the victim of her option to be provided emergency contraception at the hospital; and (c) If requested by the victim and not medically contraindicated, provide the victim of any child bearing age with emergency contraception immediately at the hospital, notwithstanding ORS 147.397 (defining the availability of the Sexual Assault Victims' Emergency Medical Response fund "SAVE Fund"). (d) For purposes of this rule, "emergency contraception" means the use of a drug or device that is approved by the United States Food and Drug Administration to prevent pregnancy after sexual intercourse. (2) A hospital shall post a written notice, approved by the Oregon Health Authority (Authority), to inform victims of their right to be provided emergency contraception at the hospital. (3) Pursuant to ORS 109.640, anyone under the age of 18 has the right to consent to birth control information and services, including emergency contraception. (4) A hospital shall document in writing that the information required to be given to a female victim of sexual assault in section (1) of this rule, was provided. Failure to have such documentation may result in the issuance of a civil penalty. (5) A hospital may only provide the victim informational materials about emergency contraception that has been approved by the Authority. (6) The Authority shall investigate complaints of violations of sections (1) or (2) of this rule in accordance with ORS 441.044. (7) In addition to investigating complaints, the Authority shall monitor compliance with ORS 435.254 and this rule during scheduled visits to hospitals. (8) The Authority may impose a civil penalty, not to exceed $1000, against a hospital for each violation of ORS 435.254 or these rules. In addition to the assessment of a civil penalty, the Authority will require corrective actions from the hospital. (a) For the first violation the civil penalty shall be $250; (b) For the second violation the civil penalty shall be $500; (c) For the third and any subsequent violations, the civil penalty shall be $1000. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 183.745, 435.254, 435.256, 441.044 & 441.025 History: PH 39-2024, minor correction filed 04/08/2024, effective 04/08/2024 PH 12-2023, minor correction filed 02/07/2023, effective 02/07/2023 PH 11-2009, f. & cert. ef. 10-1-09
333-510-0001 Applicability These rules apply to all hospitals, regardless of classification. Statutory/Other Authority: ORS 413.042 & 441.055 Statutes/Other Implemented: ORS 441.055 & 442.015 History: PH 11-2009, f. & cert. ef. 10-1-09 HD 21-1993, f. & cert. ef. 10-28-93
333-510-0002 Definitions As used in OAR chapter 333, division 510, the following definitions apply: (1) "Hospital" means a hospital as described in ORS 442.015 and an acute inpatient care facility as defined in ORS 442.470. (2) "Nurse manager" means a registered nurse who has administrative responsibility 24 hours a day, 7 days a week for a patient care unit, units or hospital and who is not replaced for short-term scheduled or unscheduled absences. Statutory/Other Authority: ORS 413.042 & ORS 441.055 Statutes/Other Implemented: ORS 441.179 - 441.192, ORS 441.055, ORS 441.025 & ORS 441.064 History: PH 46-2024, amend filed 05/15/2024, effective 05/15/2024 PH 59-2023, temporary amend filed 12/21/2023, effective 01/01/2024 through 06/28/2024 PH 22-2016, f. & cert. ef. 7-1-16 PH 11-2009, f. & cert. ef. 10-1-09 PH 21-2006, f. & cert. ef. 10-6-06
333-510-0010 Patient Admission and Treatment Orders (1) No patient, including patients admitted for observation status, shall be admitted to a hospital except on the order of an individual who has admitting privileges. The admitting physician, physician associate or nurse practitioner shall provide sufficient information at the time of admission to establish that care can be provided to meet the needs of the patient. Admission medical information shall include a statement concerning the admitting diagnosis and general condition of the patient. Other pertinent medical information, orders for medication, diet, and treatments shall also be provided, as well as a medical history and physical. (2) Within 24 hours of a patient’s admission, a hospital shall ensure that: (a) The patient’s medical history is taken and a physical examination performed, unless: (A) A medical history and physical examination has been completed within 30 days prior to admission, as provided in the medical staff rules and regulations; or (B) The patient is readmitted within a month's time for the same or related condition, as long as an interval note is completed. (b) The patient is given a provisional diagnosis. (3) Even if a medical history or physical examination at the time of admission is not required under section (2) of this rule, a hospital shall ensure that any changes crucial to patient care are noted in an admission note. (4) Visits from licensed health care providers shall be according to patient's needs. Initial and ongoing assessments shall be performed for each patient and the results and observations recorded in the medical record. (5) A Doctor of Medicine (MD), Doctor of Osteopathy (DO), Physician Associate (PA) or nurse practitioner with admitting privileges shall be responsible, as permitted by the individual's scope of practice for the care of any medical problem that may be present on admission or that may arise during an inpatient stay. (6) No medication or treatment shall be given except on the order of a licensed healthcare professional authorized to give such orders within the State of Oregon. Statutory/Other Authority: ORS 441.025 Statutes/Other Implemented: ORS 441.025 & 441.064 History: PH 58-2024, minor correction filed 06/06/2024, effective 06/06/2024 PH 210-2018, amend filed 05/17/2018, effective 05/17/2018 PH 11-2009, f. & cert. ef. 10-1-09 HD 2-2000, f. & cert. ef. 2-15-00 HD 30-1994, f. & cert. ef. 12-13-94 HD 21-1993, f. & cert. ef. 10-28-93 HD 2-1993, f. & cert. ef. 3-11-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89, Renumbered from 333-072-0015(1) HD 5-1981, f. & cert. ef. 3-30-81, Renumbered from 333-023-0172 HD 11-1980, f. & cert. ef. 9-10-80 HB 209, f. & cert. ef. 12-18-68 HB 183, f. & ef. 5-26-66
333-510-0020 Nursing Care Management (1) The nursing care of each patient, including patients admitted for observation status, in a hospital shall be the responsibility of a registered nurse (RN). (2) The RN will only provide services to the patients for which the RN is educationally and experientially prepared and for which competency has been maintained. (3) The RN shall be responsible and accountable for managing the nursing care of the RN’s assigned patients. The RN shall only assign the nursing care of each patient to other nursing personnel in accordance with the patient's needs and the specialized qualifications and competence of the nursing staff available. The responsible RN shall ensure that the following activities are completed: (a) Document the admission assessment of the patient within four hours following admission and initiate a written plan of care. This shall be reviewed and updated whenever the patient's status changes. (b) Develop and document within eight hours following admission a plan of care for nursing services for the patient, based on the patient assessment and realistic, understandable, achievable patient goals consistent with the applicable rules in OAR chapter 851, division 045. (c) Observe and report to the nurse manager and the patient's physician or other responsible health care provider authorized by law, when appropriate, any significant changes in the patient's condition that warrant interventions that have not been previously prescribed or planned for: (A) When the RN questions the efficacy, need or safety of continuation of medications being administered to a patient, the RN shall report that question to the physician or other responsible health care provider authorized by law authorizing the medication and shall seek further instructions concerning the continuation of the medication. (4)(a) A hospital shall maintain documentation of certification of certified nursing assistants (CNAs), which shall be available on request to Oregon Health Authority (Authority) personnel. (b) A nursing assistant who works in a hospital must be certified prior to assuming nursing assistant duties in accordance with OAR chapter 851, division 062. (c) A hospital shall maintain documentation that CNAs whose functions include administration of non-injectable medications, are qualified. This documentation shall be available on request to Authority personnel. Statutory/Other Authority: ORS 441.055 Statutes/Other Implemented: ORS 441.055 & 442.015 History: PH 40-2024, minor correction filed 04/08/2024, effective 04/08/2024 PH 17-2012, f. 12-20-12, cert. ef. 1-1-13 PH 11-2009, f. & cert. ef. 10-1-09 HD 2-2000, f. & cert. ef. 2-15-00 HD 21-1993, f. & cert. ef. 10-28-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89, Renumbered from 333-072-0015(7) HD 5-1981, f. & cert. ef. 3-30-81, Renumbered from 333-023-0172 HD 11-1980, f. & cert. ef. 9-10-80 HB 209, f. & cert. 12-18-68 HB 183, f. & cert. ef. 5-26-66
333-510-0030 Nursing Services (1) The hospital shall provide a nursing service department, which provides 24-hour onsite registered nursing care, 7 days per week. (2) The nursing services department shall be under the direction of a nurse executive who is a registered nurse, licensed to practice in Oregon. (3) All nursing personnel shall maintain current certification in cardiopulmonary resuscitation. Statutory/Other Authority: ORS 413.042 & 441.055 Statutes/Other Implemented: ORS 441.160 - 441.192 History: PH 7-2016, f. & cert. ef. 2-24-16 PH 11-2009, f. & cert. ef. 10-1-09 PH 21-2006, f. & cert. ef. 10-6-06 HD 2-2000, f. & cert. ef. 2-15-00 HD 21-1993, f. & cert. ef. 10-28-93 HD 29-1988, f. 12-29-88, cert. ef. 1-1-89, Renumbered from 333-072-0015(2) HD 5-1981, f. & cert. ef. 3-30-81, Renumbered from 333-023-0172 HD 11-1980, f. & cert. ef. 9-10-80 HB 209, f. 12-18-68 HB 183, f. & ef. 5-26-66