1. (a) Any facility that includes inpatient beds with an organized medical staff, and with medical services including physician services and continuous nursing services to provide treatment for patients who are not in an acute phase of illness but who currently require primarily convalescent or restorative services, shall:

   1. (1) Be considered a recuperation center; and
   2. (2) Comply with applicable sections, 20 CAR §§ 43-101 – 43-171.

2. (b) Quality assurance/performance improvement, infection prevention and control, pharmacy and therapeutics, and utilization review.

   1. (1)

      1. (A) The recuperation center shall maintain a Quality Assurance/Performance Improvement Committee consisting of the nurse manager, medical director, and at least three (3) other members of the center's staff that shall meet at least quarterly to provide oversight and direction for the center's quality assurance/performance improvement activities.
      2. (B) Minutes of the Quality Assurance/Performance Improvement Committee shall be maintained.

   2. (2)

      1. (A) QA/PI activities shall include ongoing monitoring with:

3. (i) Identification of opportunities for improvement;

   1. (ii) Actions taken; and

      1. (iii) Evaluation of the results of actions.
      2. (B) QA/PI activities shall be reported at least quarterly to the medical staff and governing body through the hospital-wide QA/PI program.

   2. (3)

      1. (A) Reporting of all infection prevention and control, medication, and utilization review issues specific to the center shall be evident in the minutes of the hospital-wide Infection Prevention and Control, Pharmacy and Therapeutics, and Utilization Review Committees.

      2. (B) Frequency of reporting shall be defined in policies and procedures consistent with state laws.

         1. (c) Patient identification.
   3. (1) Patient armbands shall not be routinely used.

   4. (2) Reasonable measures shall be used to identify patients.

      1. (d) Restraints. See 20 CAR § 43-112, restraints.

4. (e) Documentation requirements.

   1. (1) An assessment of the patient's needs shall be completed by a registered nurse on admission.
   2. (2) Each assessment shall be coordinated with all health professionals.

   3. (3)

      1. (A) The interdisciplinary team shall develop a comprehensive care plan based on the patient's:

         1. (i) Identified needs;
         2. (ii) Measurable goals of treatment;
         3. (iii) Methods of intervention; and
         4. (iv) Documentation of resolution or continuance.
      2. (B) There shall be documentation of the patient’s and family's participation in the development of the care plan.

   4. (4) Verbal/telephone orders shall be:

      1. (A) Reduced to writing; and
      2. (B) Countersigned by the physician.

5. (f) Physical environment. The requirements in 20 CAR § 43-143, physical facilities — patient accommodations — adult medical, surgical — communicable or pulmonary disease, shall apply to recuperation centers with the following exceptions:

   1. (1) The patient dining, recreation, and day room or rooms:

      1. (A) May be in separate or adjoining rooms; and
      2. (B) Shall have a total of thirty-five square feet (35 sq. ft.) per patient bed; and

   2. (2)

      1. (A) Patient corridors shall have handrails on both sides of the corridors.
      2. (B) A clear distance of one and one-half inches (1 1/2”) shall be provided between the handrail and the wall.
      3. (C) The top of the gripping surface of handrails shall be thirty-two inches (32”) minimum and thirty-six inches (36”) maximum above the finish floor.
      4. (D) Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of patients.
      5. (E) Exception. Special care areas such as those serving children.

6. (g) Health Information Services. Applicable parts of:

   1. (1) 20 CAR § 43-113(d), Health Information Services; and
   2. (2) 20 CAR § 43-114, medical record requirements for outpatient services, emergency room, and observation services.
7. (h) Nursing services. A registered nurse shall observe each patient at least once per shift and the observations shall be documented in the patient's medical record.

Codification Notes: “QA/PI” means quality assurance/performance improvement.