reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-41 - Storage and handling of food

Current through June, 2024
(a) All food shall
				  be procured, stored, prepared, distributed, and served under sanitary
				  conditions.
(1) Dry or staple food items shall
				  be stored above the floor in a ventilated room not subject to seepage or
				  wastewater backflow, or contamination by condensation, leakages, rodents, or
				  vermin; and
(2) Perishable foods
				  shall be stored at the proper temperatures to conserve nutritive value and
				  prevent spoilage.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-42 - Physician services

Current through June, 2024
(a) Admission
				  orders and ongoing orders by a physician, physician assistant, or APRN and plan
				  of treatment shall be in writing and carried out by the staff of the facility
				  including arrangement for transfer to other facilities when
				  indicated.
(b) Each resident
				  admitted to the facility shall be under the care of a physician selected by the
				  resident, legal guardian, or surrogate.
(c) The facility shall ensure that
				  arrangements have been made for all physician, physician assistant, or APRN
				  visits and services.
(d)
				  Physicians, physician assistants, or APRNs shall visit the facility as
				  necessary to assure that adequate medical care is being provided, review plan
				  of care, make pertinent recommendations, and determine appropriate level of
				  care of resident.
(e) Physician
				  visits shall be made at least once every thirty days for the first ninety days
				  of stay. After ninety days, a schedule of no less than quarterly visits may be
				  adopted; however, this does not apply to residents who require specialized
				  rehabilitative services. APRN, physician assistant, and physician visits may be
				  alternated after the initial physician visit.
(f) Physicians, physician assistants, or
				  APRNs shall provide an annual health evaluation of each resident.
(g) Each resident shall have a physical
				  examination by a physician, physician assistant, or APRN within five days prior
				  to admission or within one week after admission, and shall have had a
				  tuberculosis clearance within the previous year, pursuant to section
				  11-164-10.
(h) The facility shall promptly notify the
				  physician, physician assistant, or APRN of any accident, injury, or change in
				  the resident's condition.
(i) The
				  physician, physician assistant, or APRN shall write a discharge summary to
				  ensure adequate continuing care when a resident is transferred to another
				  primary care provider.
(j) Each
				  resident shall receive age-appropriate immunizations or vaccinations including
				  but not limited to pneumococcal and annual influenza vaccines and any necessary
				  immunizations following the recommendations of the Advisory Committee of
				  Immunization Practices unless otherwise contraindicated, or refused by the
				  resident, legal guardian, or surrogate. All immunizations provided shall be
				  documented in each resident's medical record.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-43 - Interdisciplinary care process

Current through June, 2024
(a) A comprehensive
				  assessment shall be completed for each resident by an interdisciplinary team at
				  least annually and updated as appropriate, based on the resident's
				  condition.
(b) An individualized,
				  interdisciplinary overall plan of care shall be developed to address
				  prioritized resident needs including nursing care, social work services,
				  medical services, rehabilitative services, restorative care, preventative care,
				  dietary or nutritional requirements, and resident/family education.
(c) The overall plan of care shall be
				  reviewed periodically by the interdisciplinary team to determine if goals have
				  been met, if any changes are required to the overall plan of care, and as
				  necessitated by changes in the resident's condition.
(d) Implementation of the overall plan of
				  care shall be documented in each resident's medical record.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-44 - Specialized rehabilitation services

Current through June, 2024
(a) The facility
				  shall provide for specialized and supportive rehabilitation services, including
				  occupational therapy, physical therapy, and speech therapy, according to the
				  needs of each resident, either directly by qualified staff or through
				  arrangements with qualified outside resources. Services shall be programmed to:
(1) Preserve and improve the resident's
				  maximal abilities for independent function;
(2) Prevent, insofar as possible,
				  irreversible or progressive disabilities; and
(3) Provide for the procurement and
				  maintenance of assistive devices as needed by the resident to adapt and
				  function within the resident's environment.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-45 - Dental services

Current through June, 2024
(a) Emergency and
				  restorative dental services shall be available to each resident.
(b) Each resident or resident's legal
				  guardian, or surrogate shall select the dentist of his or her choice, and the
				  facility shall assist each resident to obtain necessary dental care by making
				  arrangements for appointment and transportation, as requested.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-46 - Pharmaceutical services

Current through June, 2024
(a) Each facility
				  shall employ a licensed pharmacist or shall have a written contractual
				  arrangement with a licensed pharmacist, to provide consultation on methods and
				  procedures for ordering, storing, administering, disposing, and recordkeeping
				  of drugs and biologicals, and provisions for emergency service.
(b) A facility shall have a current pharmacy
				  policy manual consistent with current pharmaceutical practices developed and
				  approved by the pharmacist, medical director/medical advisor, and director of
				  nursing that:
(1) Includes policies and
				  procedures, and defines the functions and responsibilities relating to pharmacy
				  services, including the safe administration and handling of all drugs and
				  self-administration of drugs. Policies and procedures shall include pharmacy
				  functions and responsibilities, formulary, storage, administration,
				  documentation, verbal and telephone orders, authorized personnel,
				  recordkeeping, and disposal of drugs;
(2) Is reviewed at least every two years and
				  revised as necessary to keep abreast of current developments in overall drug
				  usage; and
(3) Has a drug recall
				  procedure that can be readily implemented.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-47 - Adult day health services

Current through June, 2024
(a) If a nursing
				  facility chooses to provide adult day health services in its facility, the
				  space and staff requirements for the adult day health service activities shall
				  not reduce the space and staff requirements of the nursing facility.
(b) Client records in adult day health
				  services shall include a pertinent medical history, nursing assessment,
				  emergency telephone numbers, and a plan of care. Adult day health service
				  client records shall be kept separate from the medical records of the nursing
				  facility residents.
(c) All care
				  and services provided to the adult day health service client shall be
				  consistent with the assessment and plan of care and physician orders, as
				  applicable.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-53 - Infection control

Current through June, 2024
(a) There shall be
				  appropriate policies and procedures written and implemented for the prevention
				  and control of infectious diseases that shall be in compliance with all
				  applicable laws of the State, rules of the department relating to infectious
				  diseases and infectious waste, and national standards such as the Centers for
				  Disease Control and Prevention and Centers for Medicare &Medicaid
				  Services.
(b) The facility shall
				  have provisions for isolating residents with infectious diseases until
				  appropriate transfers can be made.
(1) The
				  facility shall have a written policy that outlines proper isolation and
				  infection control techniques and practices;
(2) At least one single bedroom shall be
				  designated as an isolation room as needed and shall have:
(A) An adjoining toilet room with nurses'
				  call system, a lavatory, and a toilet;
(B) Appropriate hand-washing facilities
				  available to all staff; and
(C)
				  Appropriate methods for cleaning and disposing of contaminated materials and
				  equipment;
(3) The
				  facility shall ensure that visual observations of the resident can be made in
				  each isolation room:
(A) By means of the view
				  window in each isolation room; or
(B) By an approved mechanical system e.g.,
				  closed circuit television monitoring;
(4) The facility shall have documented
				  evidence that every employee has both an initial employment evaluation and an
				  annual health evaluation. These evaluations shall be specifically oriented to
				  determine the presence of any infectious disease liable to harm a
				  resident;
(5) Skin lesions,
				  respiratory tract symptoms, and diarrhea shall be considered presumptive
				  evidence of infectious disease. Any employee who develops evidence of an
				  infection must be immediately excluded from any duties relating to food
				  handling or direct resident contact until such time as a physician certifies it
				  is safe for the employee to resume such duties;
(6) There shall be a documented record that
				  every employee and resident have an initial and an annual tuberculosis (TB)
				  clearance. Facilities shall comply with the most current and updated guidelines
				  as set forth in chapter
				  11-164, Exhibit A; and
(7) When a known negative tuberculin skin
				  test on an employee or resident converts to a positive test, it shall be
				  considered a new case of tuberculosis infection and shall be reported to the
				  department.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-54 - Sanitation

Current through June, 2024
(a) The facility shall comply with all
				  applicable laws of the State and rules of the department relating to
				  sanitation.
(b) Written summary
				  reports of inspections by state or county health authorities, and records of
				  action taken in response to deficiencies and recommendations shall be kept on
				  file at the facility.
(c) Every
				  facility shall provide a sufficient number of watertight receptacles of metal
				  or other material acceptable to the department for rubbish, garbage, refuse,
				  and other discarded matter. An area shall be provided for the washing and
				  cleaning of garbage containers and the storage of garbage, trash, and solid
				  waste.
(d) Every facility shall
				  maintain an effective pest control program so that the facility is free of
				  pests and rodents.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-55 - Housekeeping

Current through June, 2024
(a) Each facility shall have a plan for
				  routine periodic cleaning of the entire building and premises.
(b) After discharge of any resident, the
				  resident's bedroom and equipment shall be thoroughly cleaned prior to
				  reuse.
(c) Floors, sinks, toilets,
				  and showers in resident areas shall be cleaned at least once daily.
(d) The facility shall be kept free of
				  unreasonable accumulation of personal possessions.
(e) All floors, walls, ceilings, windows, and
				  fixtures shall be kept clean and in good repair,
(f) All areas that have contained infectious
				  residents and materials shall be thoroughly cleaned with appropriate sanitizing
				  methods.
(g) All combustible,
				  potentially hazardous, or poisonous agents used for the cleaning of the
				  facility shall be stored in a secured and locked area.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-56 - Laundry service

Current through June, 2024
(a) Laundry service
				  shall be managed so that daily clothing and linen needs are met without delay
				  and in compliance with facility policies and procedures for infection
				  control,
(b) Personnel must handle,
				  store, process, and transport linens so as to prevent the spread of infection.
(1) Provisions shall be made for the
				  handling, storage, and transportation of soiled and clean laundry and for
				  satisfactory cleaning procedures;
(2) Provisions may be made for contract
				  service outside the facility in a laundry approved by the department;
(3) Laundry contaminated with blood, blood
				  products, or infectious waste shall be handled in accordance with U.S.
				  Department of Labor, Occupational Safety and Health Administration (OSHA)
				  regulation 29 C.F.R., Part 1910.1030;
(4) Clean linen shall be stored in enclosed
				  areas; and
(5) Hampers shall be
				  provided for soiled linen.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-57 - Life safety

Current through June, 2024
(a) Facilities
				  licensed under this chapter shall be inspected by appropriate fire authorities
				  for compliance with the current state and county life safety rules and
				  ordinances.
(b) Smoking rules shall
				  be adopted in accordance with applicable state, federal, and county laws,
				  statutes, and regulations. "No Smoking" signs shall be posted where flammable
				  liquids, combustible gases, or oxygen are used or stored. Smoking by residents
				  shall be permitted only under supervision in designated areas, and ashtrays
				  shall be provided.
(c) Electric
				  heating pads shall be prohibited.
(d) Facilities shall have written procedures
				  in case of fire, disasters, and emergencies.
(e) The facility evacuation plan shall be
				  posted in prominent locations on each floor.
(f) Fire drills shall be conducted at least
				  quarterly, for each shift, under varied conditions. At least twelve drills
				  shall be held every year and reports filed in the facility and available for
				  review by the department.
(g) All
				  employees shall be instructed and kept informed regarding their duties under
				  the fire, disaster, and emergency programs.
(h) The facility shall establish procedures
				  to ensure that water is available to essential areas when there is a loss of
				  normal water supply.
(i) The
				  facility shall ensure the availability of emergency power;
(1) An emergency electrical power system
				  shall be available and shall, at a minimum, supply power adequate for lighting
				  all entrances and exits and the equipment to maintain the fire detection,
				  alarm, and extinguishing systems, and life support systems in the event the
				  normal electrical supply is interrupted; and
(2) When life support systems are used, the
				  facility must provide emergency electrical power to those life support systems
				  with an emergency generator (as defined in the most current National Fire
				  Protection Association Code, Health Care Facilities) that is located on the
				  premises.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 6 - ENVIRONMENTAL HEALTH STANDARDS › Section 11-94.2-58 - Emergency preparedness

Current through June, 2024
(a) There shall be
				  written policies and procedures to follow in an emergency that shall include
				  provisions for the following:
(1) Arranging
				  for rapid primary care provider assistance;
(2) Transportation arrangements for
				  hospitalization or other services that are appropriate;
(3) Maintenance of an appropriate emergency
				  preparedness kit for all emergencies or disasters; and
(4) Preparedness for all hazards to include
				  but not be limited to:
(A) Natural disasters
				  such as tropical storm, hurricane, flooding, tsunami, earthquake, and any
				  island-specific disaster such as volcanic eruption and lava flow;
(B) Fire;
(C) Medical emergencies;
(D) Terrorist threat;
(E) Pandemic flu; and
(F) Public health emergencies.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 7 - PHYSICAL FACILITY STANDARDS › Section 11-94.2-64 - Engineering and maintenance

Current through June, 2024
(a) The facility
				  shall maintain all essential mechanical, electrical, and resident care
				  equipment in safe operating condition.
(b) The facility shall have an appropriate
				  written preventive maintenance program.
(c) The facility shall provide sufficiently
				  trained and experienced personnel to accomplish the required engineering and
				  maintenance functions within the facility or available through contract with an
				  appropriate provider(s).
(d) The
				  facility shall maintain records that document that inspection of all devices
				  essential to the health and safety of residents and personnel shall be carried
				  out at sufficient intervals to ensure proper operational performance.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 7 - PHYSICAL FACILITY STANDARDS › Section 11-94.2-65 - Construction requirements

Current through June, 2024
(a) The facility's
				  buildings shall be constructed and equipped to protect the health and assure
				  the safety of residents, personnel, and visitors.
(b) The facility shall be fully accessible
				  to, and functional for, physically disabled residents, personnel, and the
				  public.
(1) Resident living areas shall be
				  designed and equipped for the comfort and privacy of the resident;
(2) Temperature and humidity shall be
				  maintained within a normal comfort range;
(3) There shall be provisions within the
				  facility for one or more areas of resident dining, diversional, and social
				  activities. Total area for recreational and dining activities shall be not less
				  than thirty-seven and one-half square feet per bed;
(A) Day rooms shall be equipped with reading
				  lamps, adequate lighting, tables, chairs, or their equivalent, for the use and
				  comfort of the residents;
(B)
				  Dining areas shall be equipped with tables and safe chairs. A sufficient number
				  of tables shall be of proper height to accommodate wheelchair residents. As
				  possible, residents shall be transferred from wheelchairs to safe chairs during
				  meals;
(C) If a multi-purpose room
				  is used for dining, diversional, and social activities, there shall be
				  sufficient space to accommodate all activities and prevent their interference
				  with each other; and
(D) In the
				  event that adult nonresidents (including adult day health services) use part of
				  the facility twenty-four hours or more a week on a regular basis, additional
				  space must be provided on the following basis for those persons;
(i) Twenty square feet per person in dining
				  areas;
(ii) Thirty square feet per
				  person in recreational areas;
(iii)One conveniently located toilet for each
				  eight persons; and
(iv) Sufficient
				  additional staff shall be provided to care for the needs of the
				  persons;
(4)
				  Illumination shall be provided for the comfort and safety of residents and
				  personnel; and
(5) Wall or door
				  mirrors shall be provided and placed at convenient heights for resident
				  use.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 8 - ADMINISTRATIVE ENFORCEMENT › Section 11-94.2-69 - Enforcement

Current through June, 2024
(a) If the department determines that any
				  person has violated any provision of this chapter, any provision of chapter
				  321, HRS, or any term or condition of a license issued pursuant to this
				  chapter, the department may do one or more of the following:
(1) Issue an order assessing an
				  administrative penalty for any past or current violation;
(2) Require compliance immediately or within
				  a specific time; or
(3) Suspend or
				  revoke a license to operate a nursing facility.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 8 - ADMINISTRATIVE ENFORCEMENT › Section 11-94.2-70 - Penalties and remedies

Current through June, 2024
In addition to any other action to enforce these rules, the
					 director may initiate either administrative or judicial proceedings as provided
					 in chapter
					 321, HRS.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 8 - ADMINISTRATIVE ENFORCEMENT › Section 11-94.2-75 - Severability

Current through June, 2024
If any provision of this chapter or the application thereof
					 to any person or circumstance is held invalid, the remainder of this chapter,
					 or the application of the provision to other persons or circumstances shall not
					 be affected.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 8 - ADMINISTRATIVE ENFORCEMENT › Section 11-94.2-76 - Transition

Current through June, 2024
A nursing facility licensed at the time of adoption of
					 these rules shall have a period of six months after July 1, 2022, to institute
					 required changes to meet the requirements set forth in this
					 chapter.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-1 - Purpose

Current through June, 2024
The purpose of this chapter is to establish minimum
				  requirements for the protection of the health, welfare, and safety of patients,
				  personnel, and the public in freestanding surgical outpatient facilities. This
				  chapter shall not be construed as lowering standards, ordinances, or rules
				  established by other agencies of government. In all instances the more
				  stringent rules shall apply.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-3 - Licensing

Current through June, 2024
(a) No person, or group of persons, shall
				operate a freestanding surgical outpatient facility unless it is licensed by
				the director.
(b) Any person, or
				group of persons desiring to operate a freestanding surgical outpatient
				facility shall apply to the director for a license on forms provided by the
				department. The director shall issue a license if the proposed facility meets
				the requirements of this chapter.
(c) A license, unless abandoned or revoked
				for just cause, shall be renewed every two years, on date of issue, or of such
				other interval of time as may be decided by the director. Application for
				renewal of license shall be made by governing body of the freestanding surgical
				outpatient facility sixty days prior to expiration date as determined from the
				license. If application for renewal is not filed, the license shall be
				cancelled automatically as of the expiration date determined from the license.
				After receiving notice of deficiencies following an inspection, the facility
				shall file a plan of correction with the department within ten days.
				Deficiencies shall be corrected within a reasonable time; failure to do so may
				result in failure to renew the license.
(d) A provisional license may be issued for a
				specified period of time at the discretion of the director, should additional
				time for correction of deficiencies be deemed advisable. Not more than two
				successive provisional licenses shall be issued to a particular
				facility.
(e) With respect to a
				particular facility, a specific rule may be waived for a period of one year at
				the discretion of the director.
(f)
				Each license shall be issued to a physical facility and to a governing body. A
				change in either requires that the department be notified. A new license, at
				the discretion of the director, may be required.
(g) The department shall be notified within
				fifteen days if a new administrator or a new medical director is appointed. A
				change of administrators or medical directors, at the discretion of the
				director, may require that a new license be issued.
(h) The license issued by the director shall
				be posted in a conspicuous place visible to the public on the premises of the
				freestanding outpatient surgical facility.
(i) Appropriate fees, if any, as determined
				by the director, shall be charged by the department for obtaining a new license
				or obtaining a license renewal. Prior notice of the amount of the fee shall be
				provided the licensee.
(j)
				Inspection visits may be made to a licensed freestanding surgical outpatient
				facility at any reasonable time without prior notice by authorized staff of the
				department.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-4 - License revocation

Current through June, 2024
(a) The director,
				after due notice, and after suitable opportunity for a hearing, may suspend,
				revoke, or refuse to issue or renew a license to any governing body because of
				failure to meet:
(1) The requirements of this
				chapter; or
(2) The conditions
				under which the license was issued.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-5 - Administration

Current through June, 2024
(a) The administrative personnel under the
				direction of an administration shall develop and carry out such administrative
				procedures as are necessary to achieve the objectives and policies of the
				governing body.
(b) The
				administrator shall establish policies and develop procedures to ensure thai
				all employees are free of infectious diseases. These policies shall include:
(1) Pre-employment and an annual health
				evaluation specifically oriented to rule out infectious diseases shall be
				conducted by a licensed physician;
(2) A tuberculin skin test shall be done. If
				the tuberculin skin test is significant, a standard chest x-ray and appropriate
				medical follow-up shall be obtained. A yearly chest x-ray thereafter shall be
				required for three successive years;
(3) If the tuberculin skin test is negative,
				a second tuberculin skin test shall be done after one week, but not later than
				three weeks after the first test. The result of the second test shall be
				considered the baseline and used to determine appropriate follow-up. If the
				second test is negative, it shall be repeated once yearly thereafter until it
				becomes significant;
(4) Any
				employee who develops evidence of an infectious disease shall be immediately
				excluded from any duties relating to food handling and direct patient contact
				and shall remain excluded until such time as a physician certifies that it is
				safe for this individual to resume his or her duties. Skin lesions, respiratory
				tract symptoms and diarrhea shall be considered presumptive, evidence of
				infectious disease;
(5) There shall
				be adequate documentation that all employees have been fully informed about,
				and understand, paragraphs (1) and (2).
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-6 - Anesthesia

Current through June, 2024
(a) General, local, or regional anesthesia
				shall be administered to patients only by a certified registered nurse
				anesthetist or by a qualified physician. The anesthesia shall be administered
				only under the supervision of a licensed physician.
(b) Flammable anesthetics shall be prohibited
				except when construction, storage and equipment meet the standards of the
				National Fire Protection Association Bulletin No. 56G "Standards for the Use of
				Inhalation Anesthetics in Ambulatory Care Facilities" 1980.
(c) A person with training and experience in
				cardiopulmonary resuscitation shall be on the premises of the facility until
				all patients have been discharged.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-7 - Arrangement for services

Current through June, 2024
Where the facility does not employ a qualified person to
				  render a required and necessary service, it shall have a written contract with
				  an appropriately qualified outside person or provider to perform such
				  service.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-8 - Communication

Current through June, 2024
(a) Arrangements shall be made to quickly
				summon additional personnel to any area when needed in an emergency
				situation.
(b) There shall be
				sufficient telephones (not pay telephones) located in separate areas so that at
				least one is quickly accessible in any part of the facility for emergency
				use.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-10 - Dietetic service

Current through June, 2024
A consultive dietitian shall supervise the preparation and
				  service of whatever special diets may be deemed necessary for the patients to
				  meet the objectives of the facility. There shall be written policies covering
				  whatever dietetic services are deemed necessary by the governing
				  board.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-11 - Disaster planning

Current through June, 2024
Appropriate policies shall be written to provide for
				  cooperation with civil and military authorities in the event of a disaster for
				  disaster relief under chapter 127, HRS which would require use of the equipment
				  and personnel of the facility staff.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-12 - Engineering and maintenance

Current through June, 2024
(a) The facility
				shall have an appropriate written preventive maintenance program which
				documents compliance with all life safety codes of the state and
				county.
(b) Inspection of all
				devices essential to the health and safety of patients, personnel, and visitors
				shall be carried out at sufficiently frequent intervals to ensure operational
				performance.
(c) Maintenance and
				routine repairs to the facility shall not require reviews or approval by the
				department.
(d) Appropriate
				facilities for routine building cleaning shall be provided.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-13 - Governing body

Current through June, 2024
(a) The governing
				body shall be the supreme authority of the facility, responsible for the
				management, control and operation of the facility, including the appointment of
				an administrator and the appointment of a medical director.
(b) The governing body shall appoint the
				medical staff and delineate surgical privileges for each physician and
				dentist.
(c) The governing body
				shall specify which of the permitted procedures may be done in the
				facility.
(d) The governing body
				shall specify which procedures may be done in specific areas of the
				facility.
(e) The governing body
				shall be formally organized in accordance with a written constitution and
				by-laws.
(f) The governing body
				shall meet regularly, at least once a year, and the minutes of these meetings
				shall be kept as a permanent record in the facility.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-14 - Infection control

Current through June, 2024
(a) Definitive
				policies and procedures governing sterilization techniques shall be developed.
				All equipment shall be sterilized either by pressurized steam sterilization or
				gas sterilization. The procedures shall be written and shall include:
(1) The technique to be used for a particular
				instrument or group of instruments;
(2) The length of time to accomplish
				sterilization;
(3) Termperature,
				time and pressure control levels established for steam sterilization;
(4) Proper methods of preparation of items
				for sterilization;
(5) Shelf
				storage time for sterile items established;
(6) Use of sterilizer indicators;
(7) Use of routine (at least monthly)
				bacteriological sterilization culture controls.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-15 - Inservice education

Current through June, 2024
There shall be an appropriate inservice education program.
				  This shall include, but not be limited to, annual training in fire prevention,
				  infection control, and accident prevention. There shall be adequate
				  documentation of these educational procedures.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-16 - Laboratory

Current through June, 2024
Sufficient laboratory facilities shall be made available to
				  carry out the objectives of the facility. the laboratory procedures shall be
				  carried out by qualified medical technologists, at least one of whom shall be
				  available as long as a patient is in the facility. Such a laboratory shall be
				  under the supervision of an appropriately qualified
				  physician.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-17 - Laundry service

Current through June, 2024
(a) Provision shall
				be made for the handling, storage, and transportation of soiled and clean
				laundry and for satisfactory cleaning procedures.
(b) Infectious laundry shall be handled in
				accordance with section
				325-7, HRS, relating
				to potentially infectious laundry.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-18 - Life safety

Current through June, 2024
(a) Facilities
				licensed under this chapter shall be inspected at least annually by appropriate
				fire authorities for compliance with state and county laws.
(b) A written and posted fire control and
				evacuation plan shall be maintained and kept current.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-19 - Medical director

Current through June, 2024
(a) It shall be the
				responsibility of the medical director to develop appropriate written policies
				and procedures to provide the necessary preventive, diagnostic, and therapeutic
				services to patients in order to achieve the objectives of the
				facility.
(b) In cooperation with
				the administrator, the medical director shall:
(1) Develop appropriate staff professional
				educational programs; and
(2)
				Recommend to the governing body the names of physicians and dentists to be
				appointed to the medical staff.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-20 - Medical records

Current through June, 2024
(a) There shall be
				available sufficient, appropriate qualified staff and necessary supporting
				personnel to facilitate the accurate processing, checking, indexing, filing,
				and prompt retrieval of records and record data.
(b) All patient records shall be considered
				confidential and the property of the facility which shall secure them against
				loss, destruction, defacement, tampering, or use by unauthorized
				persons.
(c) Patient records shall
				contain, but not necessarily be limited to, the following information:
(1) Prior to surgery, the patient record
				shall contain the following:
(A) Sufficient
				history, physical examination, x-ray and laboratory data to support the
				admitting diagnosis and the decision to carry out the proposed
				procedure;
(B) Sufficient history,
				physical examination, and laboratory data to support the decision as to which
				anesthetic techniques and medications are to be used during the
				procedure;
(C) Results of all
				pertinent consultation reports, laboratory and x-ray reports shall be recorded
				on the chart by the patient's physician. Originals or photocopies of the
				originals shall be on the chart within forty-eight hours of admission to the
				facility;
(D) Documentation that
				sufficient attention has been given to:
(i)
				Preventing and preparing for the customary complications of the proposed
				surgical procedure and the proposed anesthetic procedure;
(ii) Preventing and preparing for any special
				hazards confronting a particular patient;
(E) An informed consent form shall be signed
				by the patient or the patient's guardian, or patient's parents, and be filed in
				the chart;
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-21 - Medical staff

Current through June, 2024
(a) There shall be
				an organized medical staff that has overall responsibility for the quality of
				medical care provided to the patients and for the ethical conduct and
				professional practice of its members.
(b) The facility shall not permit interns,
				residents, fellows, graduates of foreign medical schools, or medical students
				in an appropriate training program to perform a service for which a license is
				required by the State of Hawaii unless they are at that time licensed by the
				State of Hawaii as a physician, or else under the direct control and direct
				supervision of a licensed physician.
(c) Each member of the medical staff shall
				have the same surgical privileges at a local licensed hospital as the member
				seeks at the freestanding surgical outpatient facility. Maintenance of those
				surgical privileges shall be certified biennially by a local licensed
				hospital.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-22 - Nuclear medical service

Current through June, 2024
A nuclear medical service, when provided by the facility,
				  shall be under the direction of an appropriately qualified physician. There
				  shall be written policies covering procedures, and ongoing training, in
				  handling radioactive materials. Where applicable, provisions of chapter 331,
				  HRS, shall apply.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-23 - Nursing service

Current through June, 2024
(a) Each facility
				shall have a nursing staff which shall be directed by the director of nursing.
				The director of nursing shall be a qualified registered professional nurse who
				shall be appointed by the administrator with the approval of the governing
				body. The director of nursing shall develop such nursing service policies and
				procedures, recruit such nursing personnel, and provide such supervision as is
				necessary to achieve the objectives of the facility.
(b) Each facility shall have nursing staff
				sufficient in number and qualifications to meet the nursing needs of the
				patients in the facility. There shall be at least one registered nurse present
				and on duty at all times the facility is open and a patient is present in the
				facility.
(c) There shall be an
				organized written departmental plan which includes objectives, administrative
				authority, staffing patterns, job descriptions, and responsibilities for each
				category of nursing personnel.
(d)
				There shall be appropriate nursing policies and procedures delineating the
				scope of services.
(e) Working
				personnel in each operating room must include at least one registered
				professional nurse who shall serve as the circulating nurse.
(f) If a general anesthetic is used, working
				personnel in each recovery area shall include at least one registered
				professional nurse. At least one such person must be physically present and on
				duty at all times as long as any patients are present in the
				facility.
(g) There shall be
				sufficient personnel on duty, as long as a patient is present in the facility,
				to provide emergency assistance in any area of the facility without violating
				subsections (e) and (f).
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-24 - Pathology

Current through June, 2024
Examination of all tissues removed at the time of operation
				  shall be performed by a pathologist. A report of the examination shall be
				  placed in the patient's medical record. Certain permitted procedures may be
				  exempt from this examination at the discretion of the
				  director.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-25 - Patients' rights and patients' care

Current through June, 2024
(a) All patients
				admitted to the facility shall be under the care of a medical staff
				member.
(b) An appropriate medical
				history and physical examination shall be obtained within seventy-two hours
				prior to admission of the patient. A record of these procedures shall be on the
				patient's medical record within the facility prior to induction of any
				anesthesia or to the performance of any surgical procedure.
(c) Patients shall be observed in this
				facility for a reasonable period of time to ensure that no immediate
				post-operative complications are present. Thereafter, patients shall be
				discharged at the discretion of the patient's physician. If the patient's
				physician determines that the post-operative observation period should extend
				beyond the closing time of the facility, the patient shall be transferred to a
				hospital.
(d) At the time of the
				discharge from the facility, each patient shall be provided with a document
				including as a minimum the following information.
(1) The exact procedure which was performed
				using accepted medical terminology;
(2) The precise names, both generic and
				proprietory, of the anesthetic used, as well as all other drugs administered in
				the facility, or given to the patient at the time of discharge;
(3) Symptoms of complications which might
				ensue from the procedures carried on in the facility prior to
				discharge;
(4) Activities to be
				avoided by the patient;
(5)
				Specific telephone number, or numbers, of the operating physician or dentist,
				as well as the telephone numbers of at least one suitable back-up physician or
				dentist;
(6) The telephone number
				and locations of the nearest hospital, or hospitals, to be used by the patient
				should complications arise. It shall be the responsibility of the operating
				physician to provide this information;
(7) The date and location of the first
				post-operative check-up to be required.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-26 - Penalty

Current through June, 2024
In addition to any other appropriate action to enforce this
				  chapter, the director may initiate procedures for invoking penalties as
				  provided in chapter
				  321, HRS.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 95 - FREESTANDING SURGICAL OUTPATIENT FACILITIES › Section 11-95-27 - Pharmaceutical service

Current through June, 2024
(a) Medicines shall
				not be administered to patients unless ordered by a physician. The orders shall
				be in writing or, if given orally, shall be promptly reduced to writing and
				signed by the physician prior to discharge of the patient.
(b) Medicines maintained in the facility
				shall be appropriately stored and safeguarded against access by unauthorized
				persons. Appropriate records shall be kept of the disposition of all
				medications.
(c) If medications are
				dispensed by the facility, the dispensing shall be under the supervision of a
				pharmacist who shall be employed either full time or part time as deemed
				appropriate by the director.
(d)
				Each facility shall maintain reference sources for identifying and describing
				medications.
(e) Medicine shall be
				administered only by a licensed nurse or physician.
(f) Blood, blood products, and parenteral
				solutions shall be administered only by physicians, or registered
				nurses.
(g) Adverse drug reactions
				shall be reported immediately to the physician responsible for the patient and
				this report shall be documented in the medical record.