reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61144 - Required emergency electrical power

Current through June 11,
				2024
An obstetric center must have adequate emergency electrical
				  power:
1. By procuring batteries or an
				electricity-producing generator with sufficient fuel which is capable of
				providing power for 2 hours or more to support:
(a) Emergency lighting in the obstetric
				center; and
(b) All clinical
				equipment in the obstetric center with the exception of the wall outlets
				located in a reception or waiting area.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61145 - Protection from fire and other disasters: Written plan; fire drills; training of staff

Current through June 11,
				2024
The director of an obstetric center shall ensure that the
				  obstetric center, members of its staff and patients are protected from fire and
				  other disasters. The director of an obstetric center shall:
1. Prepare a written plan prescribing the
				actions to be taken by members of the staff and patients in the event of a fire
				or other disaster. This plan must be approved by the governing body of the
				obstetric center and the local fire department within whose jurisdiction the
				obstetric center is located and must include:
(a) Procedures and routes for evacuation,
				which must be posted prominently in the obstetric center;
(b) Assignments of specific tasks and
				responsibilities to members of the staff;
(c) Instructions on how to use alarm stations
				and the location of alarm signals;
(d) Instructions on methods for containing a
				fire and the location of equipment for fighting fires; and
(e) Procedures for the notification of
				appropriate state and local governmental entities and appropriate persons,
				including the family members of patients and staff.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61146 - Requirements for birth room, toilet and bathing facilities, hallways and doors, water supply and office-based facilities

Current through June 11,
				2024
1. Each birth room
				in an obstetric center must:
(a) Be
				maintained in a condition which is adequate and appropriate to provide for the
				equipment, staff, supplies and any emergency procedures required during the
				period of labor, delivery and recovery for the physical and emotional care of
				the maternal patient, any person accompanying the maternal patient for support
				and the newborn baby; and
(b) Be
				located so as to provide unimpeded, rapid access to an exit of the building
				which will accommodate emergency transportation vehicles and equipment
				.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61148 - Governing body of obstetric center; duties

Current through June
				11, 2024
1. Except as
				otherwise provided in NAC
				449.6115, each obstetric center
				must have a governing body that is chaired by a principal in the organization
				which is operating the obstetric center or the licensee with legal authority
				for the operation of the obstetric center.
2. The governing body shall ensure that:
(a) Each maternal patient of the obstetric
				center receives care from:
(1) A licensed
				physician currently practicing in obstetrics or a licensed advanced practice
				registered nurse currently practicing in obstetrics; and
(2) A registered nurse licensed pursuant to
				chapter 632 of NRS whom the director of the obstetric center has deemed as
				clinically competent to provide pre- and postdelivery care;
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.6115 - Physician operator or advanced practice registered nurse operator as licensee

Current through June 11,
				2024
1. If the licensee
				is a physician operator or an advanced practice registered nurse operator, the
				obstetric center operated by the licensee is not required to have a governing
				body or an administrator. In such a case, the licensee is responsible for
				complying with the provisions of NAC 449.6113 to 449.61178,
				inclusive.
2. As used in this
				section:
(a) "Advanced practice registered
				nurse operator" means a licensed advanced practice registered nurse who is
				operating an obstetric center for the purpose of delivering the babies of and
				providing medical care to his or her own maternal patients.
(b) "Physician operator" means a licensed
				physician who is operating an obstetric center for the purpose of delivering
				the babies of and providing medical care to his or her own maternal
				patients.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61152 - Designation and responsibilities of medical director; privileges of members of medical staff; provision of consultation services with specialists

Current through June 11, 2024
1. An obstetric center shall designate a
				licensed physician who is currently certified by the American Board of
				Obstetrics and Gynecology, or an equivalent organization, and who is currently
				practicing obstetrics including the delivery of newborn babies and providing
				care to maternal clients, or a licensed advanced practice registered nurse who
				is currently practicing obstetrics including the delivery of newborn babies and
				providing care to maternal clients, to serve as the director of the obstetric
				center. The director is responsible for:
(a)
				The development and implementation of policies related to the care of a
				maternal patient;
(b) The
				coordination of clinical care at the obstetric center; and
(c) The development of, the maintenance of
				and the assurance of compliance with a written plan to provide , in a licensed
				hospital, a higher level of care to each maternal patient and newborn baby
				under the care of the obstetric center when the needs of the maternal patient
				or newborn baby exceed the capability of the obstetric center.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61154 - Medical records: Maintenance; access

Current through June 11,
				2024
1. An obstetric
				center shall maintain the records for each maternal patient admitted for care
				in the obstetric center in accordance with accepted professional
				practice.
2. Only authorized
				personnel may have access to medical records of the obstetric center.
				Information contained in a medical record of a maternal patient must not be
				released without the written consent of the maternal patient or guardian
				except:
(a) As required by law; or
(b) As otherwise provided by the agreement on
				admission.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61156 - Medical records: Contents

Current through June 11,
				2024
The medical record of a patient which is on file with the
				  obstetric center must be completed, authenticated, accurate and current, and
				  must include:
1. A complete
				identification of the patient including information about the next of kin of
				the patient and the person or agency legally or financially responsible for the
				patient.
2. A statement concerning
				the admission and diagnosis of the patient.
3. The medical history of the
				patient.
4. Evidence of informed
				consent given for the care of the patient.
5. Any clinical observation of the patient,
				including, but not limited to, the notes of all clinical staff in
				attendance.
6. A report of all
				prescribed tests and examinations.
7. Confirmation of the original diagnosis, or
				the diagnosis at the time of discharge.
8. A summary of discharge prepared in
				accordance with the established policy of the obstetric center, and any
				provisions made for continuing care or follow-up of the patient after
				discharge.
9. If the patient has
				died while under the care of the obstetric center, documentation of the death
				which must be signed by a physician .
Added to NAC by Bd. of
				  Health, eff. 7-19-96; A by
				  R059-16A,
				  eff. 12/21/2016
NRS
				  NRS
				  449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61158 - Program for review of quality of care

Current through June 11,
				2024
1. An obstetric
				center shall establish a program for the review of the quality of care provided
				by the obstetric center. The program must include, without limitation:
(a) Documentation in the medical records of
				each patient of the care provided as appropriate to the condition of the
				patient and the results or outcome of that care;
(b) The time of admission and the time that
				the patient was examined by a licensed physician or a licensed advanced
				practice registered nurse;
(c) A
				statement which describes the condition of the patient at the time that the
				patient is discharged from the obstetric center;
(d) The instructions given to the patient
				upon discharge and documentation of the patient's understanding of those
				instructions;
(e) For each patient
				who is transferred to another hospital or medical facility, the reason for the
				transfer, the method of transfer, the time that the transfer was requested and
				the time that the patient was discharged from the obstetric center;
(f) Documentation of any incident of unusual
				occurrence or deviation from the usual standards of practice of patient care,
				any error in the administration of medications, any intrapartum infection of a
				patient , and any morbidity or mortality; and
(g) Documentation about the newborn babies
				delivered at the obstetric center, including, but not limited to:
(1) The number of deliveries;
(2) Any birth weight of less than 2500
				grams;
(3) Any Apgar scores of
				newborn babies delivered at the obstetric center which are less than 7 after 5
				minutes;
(4) Any congenital defect
				of a newborn baby; and
(5) Any
				perinatal complication.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.6116 - Miscellaneous requirements concerning staff, provision of service and equipment

Current through June 11,
				2024
An obstetric center must:
1. Have on the premises at least one
				registered nurse licensed pursuant to chapter 632 of NRS with experience
				providing pre-and postdelivery care when a maternal patient is on the premises
				receiving pre- and postdelivery care .
2. Have at least two attendants present at
				all times during each delivery, one of whom must be a licensed physician
				currently practicing obstetrics, including routinely delivering newborn babies
				and caring for maternal patients, or a licensed advanced practice registered
				nurse currently practicing obstetrics, including routinely delivering newborn
				babies and caring for maternal patients. At least one of the attendants must be
				a member of the clinical staff of the obstetric center who is approved by the
				director of the obstetric center to serve as an attendant. An obstetric center
				shall notify each maternal patient in writing if the obstetric center does not
				require a licensed physician to be on the premises while a patient is in labor
				or during birth.
3. Have the
				capacity of providing initial evaluation of risk status, appropriateness of
				admission and support of patients in labor .
4. Maintain on-site equipment, drugs, oxygen
				and appropriately trained and educated personnel needed to provide obstetric
				care to a maternal patient and newborn baby .
5. Have appropriate clinical laboratory
				services available for use to provide safe obstetric care according to the
				needs of the maternal patient and clinical staff of the obstetric center
				.
6. Have at least two persons who
				are currently certified in basic life support and neonatal resuscitation on the
				premises and immediately available during each delivery.
Added to NAC by Bd. of
				  Health, eff. 7-19-96; A by
				  R059-16A,
				  eff. 12/21/2016
NRS
				  NRS
				  449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61161 - Policies and procedures for control of infection: Manufacturer's guidelines; training and evaluation of employees; notification to employees upon adoption

Current through June 11,
				2024
1. An obstetric
				center shall develop and implement written policies and procedures to be
				followed by the employees of the obstetric center for the control of infection
				that are in accordance with nationally recognized guidelines. Acceptable
				guidelines include, without limitation, the most recent version of
Guidelines for Perioperative Practice
published by the
				Association of periOperative Registered Nurses, the most recent version of
				the
Guidelines for Environmental Infection Control in Health-Care
				Facilities
published by the Centers for Disease Control and Prevention
				of the United States Department of Health and Human Services and the
2007 Guideline for Isolation Precautions: Preventing Transmission of
				Infectious Agents in Healthcare Settings
published by the Centers for
				Disease Control and Prevention, or a combination of guidelines that address the
				control of infection at the obstetric center.
2. The policies and procedures developed
				pursuant to subsection 1 must prescribe the procedures for:
(a) Hand hygiene;
(b) The disposal of all waste that
				constitutes a biohazard, including, without limitation, needles, syringes,
				medical waste, microbial waste and specimens;
(c) The proper use of syringes, needles,
				vials and lancets; and
(d) The
				proper sterilization and disinfection of all reusable equipment.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61162 - Requirements for transfer or discharge of patient

Current through
				June 11, 2024
1. A
				maternal patient or newborn baby may not be transferred from an obstetric
				center unless the transfer is appropriate based on the risk assessment of the
				maternal patient or newborn baby and the member of the clinical staff
				determines that:
(a) The maternal patient is
				at high risk for a complicated labor or delivery and does not meet the criteria
				for a low-risk, uncomplicated labor and delivery; or
(b) The medical needs of the maternal patient
				or newborn baby exceed the capability of the obstetric center to provide the
				necessary care.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61164 - Written protocol for discharge of patient

Current through
				June 11, 2024
An obstetric center shall establish written protocols for the
				  discharge of a maternal patient from the obstetric center which must include,
				  without limitation:
1. Instructions to
				the maternal patient regarding care and feeding of the newborn baby.
2. Examination of the maternal patient and
				newborn baby after discharge from the obstetric center.
3. Instructions regarding the availability of
				consultation services by telephone as needed or desired by the maternal
				patient.
Added to NAC by Bd. of
				  Health, eff. 7-19-96
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61166 - Policies and procedures for control of infectious agents and diseases; program to monitor health of employees

Current through June 11,
				2024
An obstetric center shall establish a program to monitor the
				  health of each employee of the obstetric center. The program must include, but
				  not be limited to:
1. Maintaining a
				separate personnel file for each employee of the obstetric center that must
				include documentation that the employee has had the tests or obtained the
				certificates required by NAC
				441A.375; and
2. Documentation as to whether the employee
				has had:
(a) Rubella and, if so, when the
				employee had rubella.
(b) A
				vaccination for rubella and, if so, when the employee had the
				vaccination.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61168 - Laboratory services; transfer of maternal patient who needs blood or blood products

Current through June 11,
				2024
1. An obstetric
				center must maintain or have available adequate laboratory services to meet the
				needs of its maternal patients, newborn babies and clinical staff. The
				obstetric center shall ensure that all laboratory services provided to its
				maternal patients and newborn babies are provided by a medical laboratory
				licensed pursuant to chapter 652 of NRS.
2. Laboratory services must be available
				during all hours of operation of the obstetric center as necessary to meet the
				needs of the maternal patients, newborn babies and clinical staff.
3. If work is performed by an outside
				laboratory, the original report must be from a laboratory licensed pursuant to
				chapter 652 of NRS and contained in the medical record of the maternal patient.
				If services are provided by an outside laboratory, the conditions, procedures
				and availability of work performed must be in writing and available within the
				obstetric center.
4. Upon the
				receipt of a laboratory report, an obstetric center shall promptly:
(a) File a laboratory report in the
				appropriate medical record; and
(b)
				Notify the physician or advanced practice registered nurse who requested the
				report that the report has been received and filed in the medical record of the
				maternal patient.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.6117 - Possession, distribution, administration and storage of drugs and controlled substances

Current through June 11,
				2024
1. An obstetric
				center shall ensure that drugs and controlled substances are possessed,
				distributed and administered by members of the clinical staff in the obstetric
				center in conformance with all applicable federal, state and local
				laws.
2. All drugs and controlled
				substances distributed at an obstetric center must be possessed and distributed
				by a licensed physician or a licensed advanced practice registered nurse in
				accordance with his or her registration from the State Board of Pharmacy and
				the Drug Enforcement Administration of the Department of Justice. The licensed
				physician or licensed advanced practice registered nurse shall establish and
				maintain a list of drugs and controlled substances which are available for use
				by the licensed physician or licensed advanced practice registered nurse for
				maternal patients and newborn babies in the obstetric center.
3. An obstetric center shall establish a
				policy to ensure quality control and dispensing of drugs and controlled
				substances. The obstetric center must have a specific area for storing the
				drugs and controlled substances which include, without limitation, locked
				storage for drugs, double-locked storage for controlled substances and locked
				refrigerated storage. A facility for washing hands must be provided near the
				area in which the drugs and controlled substances are to be
				distributed.
4. A drug or
				controlled substance may not be administered at an obstetric center without an
				order from a licensed physician or a licensed advanced practice registered
				nurse. An order for the administration of a drug or controlled substance must
				be entered into the medical record of the maternal patient and be signed by the
				physician or advanced practice registered nurse who made the order. The order
				must include the name of the drug, dosage, time or frequency of administration,
				and if other than oral, the route of administration.
5. The obstetric center shall provide a
				separate refrigerator for the storage of drugs and controlled substances. The
				temperature in the refrigerator must be maintained between 36 degrees
				Fahrenheit, or 2 degrees Centigrade, and 46 degrees Fahrenheit, or 8 degrees
				Centigrade. The temperature of the room in which the drugs and controlled
				substances that are not refrigerated are stored must not exceed 86 degrees
				Fahrenheit, or 30 degrees Centigrade.
Added to NAC by Bd. of
				  Health, eff. 7-19-96; A by
				  R059-16A,
				  eff. 12/21/2016
NRS
				  NRS
				  449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61172 - Anesthesia

Current through June 11, 2024
1. An obstetric center may have the
				capability of providing anesthesia limited to local anesthesia for pudendal
				blocks and episiotomy repair.
2. A
				local anesthetic may be administered only by a licensed physician or a licensed
				advanced practice registered nurse.
Added to NAC by Bd. of
				  Health, eff. 7-19-96
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61174 - Transfer of patient to hospital or medical facility licensed to provide high-risk perinatal care

Current through June 11,
				2024
1. Except as
				otherwise provided in subsection 2, an obstetric center must have a written
				agreement with at least:
(a) One licensed
				hospital that is capable of providing a higher level of obstetrical and
				neonatal care than the obstetric center; and
(b) One transportation service which can
				provide a vehicle with equipment appropriate to the needs of a maternal patient
				or newborn baby during a transfer for the obstetric center,
that assures the expedient transfer of a maternal patient or
				  newborn baby in accordance to established written protocols of the obstetric
				  center when a maternal patient or newborn baby requires care beyond the
				  capability of the obstetric center or a maternal patient is deemed to have a
				  condition or the potential for such a condition that would result in an
				  abnormal or complicated delivery.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61176 - Death of patient; notification of Division; provision of counseling

Current through June 11, 2024
1. An obstetric center shall notify the
				Division of the death of any maternal patient or newborn baby which occurs at
				the obstetric center. The notification must be made not later than 24 hours
				after the death of a maternal patient or newborn baby.
2. An obstetric center shall establish a
				process pursuant to which appropriate counseling will be provided to staff of
				the obstetric center, a maternal patient and the family of a maternal patient
				when a death occurs within the obstetric center.
Added to NAC by Bd. of
				  Health, eff. 7-19-96
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Obstetric Care › Section 449.61178 - Required information to be provided or made available to patient; complaints

Current through June 11,
				2024
1. The obstetric
				center shall take such action as is necessary to inform the maternal patient,
				both orally and in writing, in language which the maternal patient understands,
				of the rights of the maternal patient as listed in
				NRS
				449.700,
				449.710
				and
				449.720,
				risks, alternatives of care and benefits in using the obstetric
				center.
2. The maternal patient has
				a right to be fully informed in a language the maternal patient understands
				about her health status, her medical conditions, the health status of her baby,
				and the existence of any known complications or risks.
3. A maternal patient may inspect her medical
				record, or any portion of the record, and, upon request, purchase standard
				photocopies of the record at a cost not to exceed 60 cents per page.
4. An obstetric center shall provide, within
				its written policies, a procedure for the registration of complaints by the
				maternal patient without threat of discrimination or reprisal. A complaint may
				include, but is not limited to, a grievance concerning the treatment that was
				received by the maternal patient and a grievance concerning treatment that was
				not provided.
5. The obstetric
				center must inform the maternal patient that she has the right to file a
				complaint relating to the care which the patient receives from the obstetric
				center with:
(a) The Division;
(b) The Board of Medical Examiners;
				and
(c) The State Board of
				Nursing.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.612 - Definitions

Current through June 11, 2024
As used in NAC 449.612 to 449.61256, inclusive, unless the
				  context otherwise requires, the words and terms defined in NAC 449.612011 to
				  449.612017, inclusive, have the meanings ascribed to them in those
				  sections.
Added to NAC by Bd. of
				  Health, eff. 8-31-89; A 8-1-91; R107-98, 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.612011 - "Approval" defined

Current through June 11,
				2024
"Approval" means the approval granted by the Division to a
				  hospital authorizing the hospital to perform open-heart surgery.
Added to NAC by Bd. of
				  Health by R107-98, eff. 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.612012 - "Approved hospital" defined

Current through June 11,
				2024
"Approved hospital" means a hospital that has obtained
				  approval from the Division to perform open-heart surgery.
Added to NAC by Bd. of
				  Health by R107-98, eff. 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.612014 - "Cardiac surgery" defined

Current through June 11,
				2024
"Cardiac surgery" means an operation performed on the heart
				  or on the blood vessels connected to the heart in which access to the area of
				  interest is provided by means of an incision in the wall of the thorax or for
				  which the use of a heart-lung bypass machine is required.
Added to NAC by Bd. of
				  Health by R107-98, eff. 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.612017 - "Open-heart surgery" defined

Current through June 11,
				2024
"Open-heart surgery" means any cardiac surgery requiring the
				  use of a heart-lung bypass machine.
Added to NAC by Bd. of
				  Health by R107-98, eff. 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61202 - Prerequisites to initial provision of service

Current through June
				11, 2024
A hospital that desires to provide a new service for the
				  performance of open-heart surgery must make application to the Division
				  requesting approval of the service. A hospital shall not provide such a service
				  until the Division has given its approval in writing.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61204 - Form and contents of application for approval to provide service

Current through June 11, 2024
1. The application for approval must include
				a statement describing:
(a) The
				qualifications of the personnel of the hospital to perform open-heart
				surgery;
(b) The facilities and
				equipment to be used in performing open-heart surgery; and
(c) The manner in which the facilities and
				personnel of the hospital meet or exceed the requirements of NAC 449.612 to
				449.61256, inclusive.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61206 - Notification of applicant upon review of application; site inspection required

Current through June 11,
				2024
1. Within 10 days
				after it receives an application for approval from a hospital, the Division
				shall notify the hospital, in writing, whether the application is complete. If
				the application is incomplete, the Division shall inform the applicant which
				parts of the application are deficient. If the application is complete, the
				Division shall notify the applicant of the composition of the site inspection
				team, the date of the team's visit to the site and the scheduled date for the
				team to present its findings to the Division. The Division shall notify the
				applicant of any changes in this timetable as they occur.
2. The application must not be approved by
				the Division until the findings of the site inspection team verify that the
				hospital complies with the requirements of NAC 449.612 to 449.61256,
				inclusive.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61208 - Composition and duties of site inspection team

Current through
				June 11, 2024
The site inspection team:
1. Must be composed of:
(a) A cardiothoracic surgeon;
(b) A cardiologist;
(c) A cardiac intensive care nurse;
(d) An administrator of a hospital at which
				open-heart surgery is currently performed;
(e) A surveyor of health facilities from the
				Division; and
(f) If the hospital
				indicated in its application that it would perform open-heart surgery on
				infants or children, a pediatric cardiologist.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.6121 - Hospital to pay costs of inspection

Current through June 11,
				2024
The costs incurred in connection with any inspection required
				  by the provisions of NAC 449.612 to 449.61256, inclusive, must be paid by the
				  hospital affected.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61212 - Approval or denial of application; period of validity of approval; cessation of performance of surgeries

Current through June 11,
				2024
1. Within 15
				working days after it receives the findings of the site inspection team, the
				Division shall approve or notify the hospital of its intention to disapprove
				the application.
2. An approval
				issued pursuant to this section is valid until it is revoked or suspended
				pursuant to NAC 449.61256.
3. A
				hospital that ceases to perform open-heart surgeries shall notify the Division
				in writing within 30 days after the last surgery is performed. If a hospital
				has notified the Division in writing that it is ceasing to perform open-heart
				surgeries and subsequently decides that it desires to begin performing
				open-heart surgery again, it must reapply for approval pursuant to the
				provisions of NAC 449.612 to 449.61256, inclusive.
Added to NAC by Bd. of
				  Health, eff. 8-31-89; A by R107-98, 3-18-99
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61214 - Amount of surgery required following approval

Current through
				June 11, 2024
After approval of a service for open-heart surgery is
				  granted, such surgeries must be performed in an approved hospital at the
				  following rates:
1. Not less than 80
				operations during the first 12 months after approval.
2. Not less than 150 operations during the
				second 12-month period after approval.
3. Not less than 200 operations during the
				third and each succeeding 12-month period after approval.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61216 - Provision of patient with preoperative instruction

Current through
				June 11, 2024
On specific orders from the patient's physician, a cardiac
				  surgical nurse shall provide each nonemergent cardiac surgical patient with
				  preoperative instruction concerning the proposed surgical procedure and the
				  general course of his or her treatment.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61218 - Surgical team: Composition; privileges and qualifications of members; participation of qualified nurses

Current through June 11,
				2024
1. A surgical team
				assigned to each open-heart surgery at an approved hospital must be composed of
				a cardiovascular surgeon who will be the primary surgeon and at least one other
				person chosen by the primary surgeon who must be a:
(a) Cardiovascular surgeon;
(b) Vascular surgeon;
(c) General surgeon;
(d) Person who is authorized by the medical
				staff of the approved hospital to assist in such surgeries; or
(e) A senior surgical resident who is
				enrolled in a medical training program accredited by the Accreditation Council
				for Graduate Medical Education.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.6122 - Qualifications of anesthesiologist

Current through June 11,
				2024
Anesthesia during open-heart surgery at an approved hospital
				  must be administered by an anesthesiologist who:
1. Is certified by or who is eligible for
				certification by the American Board of Anesthesiologists; and
2. Has special training or experience in the
				administration of anesthesia in open-heart surgery.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61222 - Qualifications of nurse in charge of service

Current through June
				11, 2024
The registered nurse in charge of the service for open-heart
				  surgery at an approved hospital must:
1. Have not less than 2 years of operating
				room nursing experience and not less than 1 year of current experience in
				open-heart surgery; and
2. Be
				permanently assigned to that service.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61224 - Perfusion team: Use required; qualifications; approval of members by surgeon of record

Current through June 11,
				2024
1. An approved
				hospital shall use a perfusion team, which must include a senior perfusionist
				who is responsible for the supervision of all perfusion services provided by
				the team.
2. The senior
				perfusionist must be certified by the American Board of Cardiovascular
				Perfusionists. The other perfusionists of the heart-lung bypass machine must be
				certified or eligible for certification by the Board.
3. The senior perfusionist and the other
				perfusionists must:
(a) Be trained in:
(1) Aseptic techniques required in an
				operating room;
(2) Perfusion
				physiology; and
(3) The use of
				monitoring equipment; and
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61226 - Operating rooms: General requirements

Current through June 11,
				2024
1. An approved
				hospital shall maintain two fully equipped operating rooms, one dedicated to
				and another available for services for open-heart surgery. Each operating room
				must have a minimum clearance of 400 square feet, exclusive of fixed cabinets
				and built-in shelves. Entry to the operating rooms must be limited to persons
				participating in the service.
2.
				The ventilation and temperature control systems of each operating room must be
				able to provide a minimum of 15 air changes per hour in the operating room and
				maintain the air temperature between 70°F and 75°F, with a relative
				humidity between 50 and 60 percent.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61228 - Operating rooms: Equipment and staff

Current through June 11,
				2024
1. Each operating
				room designated or available for open-heart surgery must be equipped with:
(a) A heart-lung bypass machine.
(b) Proper suction and plumbing outlets for
				heat exchangers for the heart-lung bypass machine.
(c) An adequate supply of electrical power,
				including, without limitation, standby emergency electrical power.
(d) Surgical instruments.
(e) A device to conserve blood.
(f) An electronic warmer for blood.
(g) Monitors to review the electrocardiogram
				and the pressure in two channels of blood flow.
(h) Operating lights which are sufficiently
				bright to illuminate the inside of body cavities and sufficiently maneuverable
				to illuminate two operating fields on a patient simultaneously.
(i) A defibrillating apparatus.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.6123 - Intensive care facility: General requirements

Current through
				June 11, 2024
1. An
				approved hospital shall maintain an intensive care facility within the
				hospital. The facility must:
(a) Have
				accommodations which can isolate patients;
(b) Have a sufficient system for controlling
				temperature to maintain comfortable conditions for the patients and members of
				the hospital's staff; and
(c) Be
				equipped to provide continuous electrocardiographic monitoring of each patient
				in the facility.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61232 - Intensive care facility: Staff

Current through June 11,
				2024
1. The
				administration of intensive care units in an approved hospital for patients
				recovering from or awaiting open-heart surgery must be under the direction of a
				qualified physician approved by the cardiac surgeon.
2. A nursing supervisor must be permanently
				assigned to the intensive care units designated for cardiac surgery patients.
				The supervisor must have not less than 2 years of experience in intensive care
				nursing and not less than 1 year of current experience in intensive care
				nursing of patients recovering from open-heart surgery.
3. The nursing supervisor and the surgical
				team shall:
(a) Provide organized training
				and continuing in-service education to each nurse; and
(b) Determine that each nurse is qualified to
				perform services related to postcardiac surgery,
before assigning the nurse without direct supervision to
				  full-time or periodic duty in the intensive care units.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61234 - Intensive care facility: Equipment and supplies

Current through
				June 11, 2024
1. The
				following equipment must be immediately available to the intensive care
				facility:
(a) A laryngoscope.
(b) Endotracheal tubes.
(c) Respirators.
(d) Hypothermia equipment.
(e) Tracheostomy sets.
(f) Thoracotomy sets.
(g) A board for massaging a closed
				chest.
(h) An external
				pacemaker.
(i) An external
				defibrillator.
(j) Respiratory
				support equipment.
(k) Intravenous
				drip counters.
(l) An intravenous
				diffusion pump.
(m) Equipment which
				can remotely monitor, record and play back electrocardiographs and count extra
				systole pulses.
(n) An open-heart
				set with sternal spreader, staple remover, internal defibrillatory paddles,
				wire cutters and sufficient sutures and clamps.
(o) An intra-aortic balloon pump.
(p) An ambu bag.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61236 - Orientation and continuing education of personnel

Current through
				June 11, 2024
An approved hospital shall provide, under the direction of
				  the cardiac surgeon, an orientation program and a program of continuing
				  education for surgical nurses, technicians and any personnel who participate in
				  the service for open-heart surgery.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61238 - Maintenance of blood bank

Current through June 11,
				2024
An approved hospital shall maintain a blood bank which
				  operates 24 hours a day under the direction of qualified specialists. These
				  persons must be able to supply blood and blood derivatives to surgical teams
				  assigned to open-heart surgery.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.6124 - Maintenance of cardiac catheterization laboratory

Current through
				June 11, 2024
1. An
				approved hospital shall maintain a cardiac catheterization laboratory which
				operates 24 hours a day under the direction of a qualified
				specialist.
2. The laboratory must
				be located in the hospital and must have sufficient equipment to perform:
(a) Hemodynamic studies;
(b) Preoperative elective studies;
(c) Postoperative elective studies;
				and
(d) Emergency
				procedures.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61242 - Maintenance of medical laboratory

Current through June 11,
				2024
An approved hospital shall maintain a medical laboratory
				  which operates 24 hours a day. The laboratory must have sufficient equipment
				  to:
1. Perform standard laboratory
				tests;
2. Make pH determinations;
				and
3. Analyze samples for
				blood-gas and electrolytes.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61244 - Maintenance of facilities to perform contrast studies and equipment to review films of operations

Current through June 11,
				2024
An approved hospital shall maintain:
1. Facilities in which contrast studies of
				the cardiovascular system may be performed.
2. Film projectors and a proper filing system
				so that surgeons may review films of cardiac catheterization operations at any
				time.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61246 - Maintenance of registry to record results for each patient

Current through June 11, 2024
A registry must be maintained at an approved hospital and
				  used for recording the results of open-heart surgery for each patient. This
				  registry must include or indicate, for each such patient:
1. The patient's patient identification
				number.
2. The patient's
				race.
3. The patient's
				age.
4. The patient's
				sex.
5. Any history of
				hypertension, smoking, diabetes mellitus, cerebrovascular disease, coronary
				bypass, myocardial infarction, chronic obstructive pulmonary disease or renal
				disease.
6. The period during which
				the surgery is performed.
7. The
				period during which the heart-lung bypass machine is used.
8. The period during which a crossclamp is in
				place.
9. The patient's ASA acquity
				classification.
10. The patient's
				New York Heart Association functional classification.
11. A record of any angioplasty performed or
				thrombolytic therapy.
12. A record
				of any use of an intra-aortic balloon pump.
13. Whether the patient is an elective,
				emergency or transfer case.
14. The
				number of days he or she is intubated.
15. The number of days he or she is in the
				cardiac surgery unit.
16. The
				length of the patient's hospital stay.
17. The location to which he or she is
				discharged.
18. A record of his or
				her 30-day follow-up examination.
19. A record of his or her ventricular
				function (ejection fraction).
20.
				The description of the surgical procedure and, if applicable, the number of
				vessels involved and the type of graft (mammary or saphenous).
21. A record of any complications, including:
(a) Additional surgery for
				bleeding;
(b) Peri-operative
				myocardial infarction;
(c)
				Infections of the sternum, leg or intra-aortic balloon pump site; or
(d) Stroke.
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.61248 - Maintenance of program to follow recovery of patient

Current
				through June 11, 2024
An approved hospital shall maintain a comprehensive program
				  for following the recovery and progress of the patient toward his or her
				  optimum condition of health. The condition of the patient must be assessed
				  after discharge from the hospital by the surgeon or his or her designee.
Added to NAC by Bd. of
				  Health, eff. 8-31-89
NRS
					 449.0302
Nevada Administrative Code › Chapter 449 - Medical and Other Related Facilities › PROVISION OF CERTAIN SPECIAL SERVICES › Open-Heart Surgery › Section 449.6125 - Annual review and inspection of hospital

Current through June 11,
				2024
Unless the hospital has notified the Division that it has
				  ceased to perform open-heart surgeries, a surveyor of health facilities from
				  the Division shall review each approved hospital annually to verify that the
				  hospital is complying with the provisions of NAC 449.612 to 449.61256,
				  inclusive.
Added to NAC by Bd. of
				  Health, eff. 8-31-89; A by R107-98, 3-18-99
NRS
					 449.0302