Texas Register, Volume 30, Number 43, Pages 6973-7094, October 28, 2005 Page: 7,047
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(D) Preventive maintenance of all sterilizers shall be
completed according to manufacturers recommendations on a sched-
uled basis. A preventive maintenance record shall be maintained for
each sterilizer. These records shall be retained at least one year and
shall be available for review to the facility within two hours of request
by the department.
(13) Emergency power adequate for the type of surgery
performed shall be available in the operative and post operative recov-
ery areas.
(14) Periodic calibration and/or preventive maintenance of
all equipment shall be provided in accordance with manufacturer's
guidelines.
(15) The informed consent of the patient or, if applicable,
of the patient's legal representative, shall be obtained before an opera-
tion is performed.
(16) A written procedure shall be established for observa-
tion and care of the patient during the preoperative preparation and
postoperative recovery period.
(17) Written protocols shall be established for instructing
patients in self-care after surgery, including written instructions to be
given to patients who receive conscious sedation, regional and general
anesthesia.
(18) Patients who have received anesthesia shall only be al-
lowed to leave the facility in the company of a responsible adult unless
the operating surgeon, a physician or an advanced practice nurse writes
an order that the patient may leave without the company of a responsi-
ble adult.
(19) An effective written procedure for the immediate
transfer to a hospital of patients requiring emergency care beyond the
capabilities of the ASC shall be developed. The ASC must have a
written transfer agreement with a hospital or all physicians on staff at
the ASC must have admitting privileges at a local hospital.
135.15. Facility Staffing and Training.
(a) Nursing services.
(1) There shall be an organized nursing service under the
direction of a qualified registered nurse (RN). The ASC shall be staffed
to assure that the nursing needs of all patients are met.
(2) There shall be a written plan of administrative authority
for all nursing services with responsibilities and duties of each category
of nursing personnel delineated and a written job description for each
category. The scope of nursing service shall include, but is not limited
to, nursing care rendered to patients preoperatively, intraoperatively,
and postoperatively.
(A) The responsible individual for nursing services
shall be a qualified RN whose responsibility and authority for nursing
service shall be clearly defined and includes supervision of both
personnel performance and patient care.
(B) There shall be a written delineation of functions,
qualifications, and patient care responsibilities for all categories of
nursing personnel.
(C) Surgical technicians and licensed vocational nurses
may be permitted to serve as the scrub nurse under the direct super-
vision of an RN; they shall not be permitted to function as circulating
nurses in the operating rooms, except in ASCs where no general anes-
thesia is administered and when there is an adequate number of RNs
immediately available for an emergency situation. Licensed vocational
nurses and surgical technicians may assist in circulatory duties under
the direct supervision of a qualified RN during general anesthesia cases.(D) Nursing services shall be provided in accordance
with current recognized standards or recommended practices.
(3) There shall be an adequate number of RNs on duty to
meet the following minimum staff requirements: director of the depart-
ment (or designee), and supervisory and staff personnel for each service
area to assure the immediate availability of an RN for emergency care
or for any patient when needed.
(A) An RN shall assign the nursing care of each patient
to other nursing personnel in accordance with the patient's needs and
the preparation and qualifications of the nursing staff available.
(B) There shall be other nursing personnel in sufficient
numbers to provide nursing care not requiring the service of an RN.
(4) An RN qualified, at a minimum, with current certifica-
tion in basic cardiac life support, shall be on duty and on the premises
at all times whenever patients are present in the facility.
(b) Additional staffing requirements. In addition to meeting
the requirements for nursing staff under subsection (a) of this section,
facilities must comply with the following minimum staffing require-
ments.
(1) Facilities that provide only topical anesthesia, local
anesthesia and/or minimal sedation are required to have a second
individual on duty on the premises who is trained and currently
certified in basic cardiac life support until all patients have been
discharged from the facility.
(2) Facilities that provide moderate sedation/analgesia are
required to have the following additional staff:
(A) a second individual on duty on the premises who
is trained and currently certified in basic cardiac life support until all
patients have been discharged from the facility; and
(B) an individual trained and currently certified in ad-
vanced cardiac life support and, if surgery is performed on pediatric
patients, pediatric advanced life support, must be available until all pa-
tients have been discharged from the post anesthesia care unit.
(3) Facilities that provide deep sedation/analgesia, general
anesthesia, and/or regional anesthesia must have the following addi-
tional staff:
(A) a second individual on duty on the premises who
is trained and currently certified in basic cardiac life support until all
patients have been discharged from the facility; and
(B) an individual who is trained and currently certified
in advanced cardiac life support and, if surgery is performed on pedi-
atric patients, pediatric advanced life support, must be on duty on the
premises and sufficiently free of other duties to enable the individual
to respond rapidly to emergency situations until all patients have been
discharged from the post anesthesia care unit.
135.22. Renewal of Annual License.
(a) The department will send written notice of expiration of an
annual license to an applicant at least 60 days before the expiration date.
If the applicant has not received notice, it is the duty of the applicant to
notify the department and request a renewal application.
(b) Renewal license. The department shall issue a renewal li-
cense to an ASC that meets the minimum standards for a license set
forth in these sections.
(1) The ASC shall submit the following to the department
no later than 30 days prior to the expiration date of the license:
(A) a completed renewal application form;ADOPTED RULES October 28, 2005 30 TexReg 7047
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Texas. Secretary of State. Texas Register, Volume 30, Number 43, Pages 6973-7094, October 28, 2005, periodical, October 28, 2005; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth97316/m1/73/?q=%22%22~1&rotate=0: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.