New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 2 - Hospitals › Part 405 - Hospitals-Minimum Standards › Section 405.22 - Critical care and special care services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
General provisions.
Critical care and special care services are those
						services which are organized and provided for patients requiring care on a
						concentrated or continuous basis to meet special health care needs. Each
						service shall be provided with a concentration of professional staff and
						supportive services that are appropriate to the scope of services
						provided.
(1) The direction of each
					 service, unless otherwise specified in this section, shall be provided by a
					 designated member of the medical staff who has received special training and
					 has demonstrated competence in the service related to the care
					 provided.
(2) The provision of all
					 critical care and special care services shall be in accordance with generally
					 accepted standards of medical practice. The hospital shall ensure that written
					 policies are developed by the medical staff and the nursing service and
					 implemented for all special care and critical care services.
(i) The written policies and procedures shall
					 be reviewed at least annually and revised as necessary and shall include at a
					 minimum the following: infection control protocols, safety practices,
					 admission/discharge protocols and an organized program for monitoring the
					 quality and appropriateness of patient care, with identified problems reported
					 to the hospital- wide quality assurance program and resolved.
(ii) The written protocols for patient
					 admission to and discharge from a critical care or special care unit shall
					 include:
(a) criteria for priority
					 admissions;
(b) alternatives for
					 providing specialized patient care to those patients who require such care but
					 who, due to lack of space, or other specified reasons such as infection or
					 contagious disease, are not eligible for admission according to unit policy;
					 and
(c) guidelines for the timely
					 transfer and referral of patients who require services that are not provided by
					 the unit.
(3)
					 Each critical care unit shall be organized as a physically and functionally
					 distinct entity within the hospital.
(i)
					 Access shall be controlled in order to regulate traffic, including visitors, in
					 the interest of infection control.
(ii) Emergency equipment and an emergency
					 cart within each unit shall contain appropriate drugs and equipment, as
					 determined by the medical staff and pharmacy service.
(4) When critical or special care services
					 are provided to pediatric patients, opportunities shall be provided for
					 education, socialization, and play pertinent to the growth and development
					 needs of these patients, unless medically contraindicated.
(5) Minimum nurse to patient ratios for
					 intensive care and critical care patients. There shall be a minimum of one
					 registered professional nurse assigned to care for every two patients that an
					 attending practitioner determines to require intensive or critical care.
(i) The minimum registered professional
					 nurse-to-patient ratio set forth in this subdivision shall apply whenever the
					 attending practitioner determines that the condition and medical needs of the
					 patient requires admission to an intensive care unit (ICU) or critical care
					 unit (CCU), and considers the continued need for that level of care based on
					 ongoing assessments. The minimum staffing standard or ratio provided to a
					 patient in an ICU or CCU shall be based on patient acuity, as determined by the
					 attending practitioner and not solely based on the location of the
					 patient.
(ii) The minimum staffing
					 requirements of this subdivision shall not apply to a patient when:
(a) the attending practitioner has determined
					 that a patient in the ICU or CCU no longer requires intensive or critical care
					 or the patient is awaiting transfer to a lower level of care unit; or
(b) a patient is placed in the ICU or CCU
					 when an acute care or other inpatient service bed is not available and the
					 attending practitioner has determined that the patient in the ICU or CCU does
					 not require intensive or critical care;
(iii) Complaints of potential violations of
					 this subdivision shall be made to the clinical staffing committee. Complaints
					 of potential violations of this subdivision, that have first been submitted to
					 the clinical staffing committee, may be made to the department if they remain
					 unresolved by the clinical staffing committee after 90 days have
					 elapsed.