Mo. Code Regs. Ann. tit. 19, § 30-22.020
PURPOSE: The Department of Health has the authority to establish standards for the operation of rehabilitation hospitals. This rule provides standards for the administration, medical staff, nursing staff and supporting departments to assist in the restoration of individuals to maximum physical, mental, social, vocational and economic usefulness.
PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.
(1) Organization, Administration, Medical Staff, Nursing Staff and Records.
(A) Governing Body.
individual owner or ownership, partnership, corporation or other legally established authority owning or operating a hospital.
to be a legally organized board of directors, board of trustees or similar governing body.
organized and shall establish and adopt bylaws by which it shall abide in conducting all business of the hospital.
the supreme legal authority in the hospital and is responsible for the overall planning, directing, control and management of the activities and functions of the hospital.
medical staff in accordance with the bylaws of the hospital after reviewing the individual applications for membership.
medical staff to establish and adopt bylaws acceptable to them. Bylaws so adopted are to be submitted to the Department of Health for its records.
competent, experienced administrator. It is desirable that the administrator be a graduate of an accredited school of hospital administration.
necessary authority to the administrator for the administration of the hospital in all its activities and departments subject only to the policies as may be adopted and orders as may be issued by the governing body in accordance with its bylaws.
the Department of Health the name and address of its administrative officer within thirty (30) days after his/her appointment.
its bylaws that a qualified individual be designated by the administrator to act in his/her absence.
its bylaws that the hospital and medical staff abide by acceptable professional ethical standards with regard to advertising, commissions, division of fees, secret remedies, extravagant claims and commercialization.
its bylaws that the professional staff, hospital personnel and all auxiliary organizations are directly or indirectly responsible to the governing body through its administrator.
administrator that any duly appointed representative of the Department of Health is to be allowed to inspect the hospital during normal working hours.
ularly in accordance with their established bylaws. Minutes are to reflect the business transacted.
plementation or revision of the bylaws of the governing body or its medical staff shall be submitted to the Department of Health for its records.
(B) Administrative Services.
shall state that the administrator is the direct executive representative of the governing body for the management of the hospital and shall serve as a liaison between the governing body and the medical staff.
authority and held responsible for the administration of the hospital in accordance with the bylaws established by the governing body. 3. The duties of the administrator shall be in keeping with accepted principles of hospital administration. 4. The administrator shall employ suffi- cient qualified personnel to operate properly the various departments of the hospital and all services necessary to meet the needs of the program. Personnel policies shall be written and made available to all employees. 5. The administrator is responsible for the admission and discharge of all patients and has the right to call upon the medical staff or a member of it to certify to the necessity or advisability of admitting or discharging a patient(s). 6. The administrator is responsible for all accounting methods and procedures and maintaining methods in accordance with a recognized system of accounting which will permit a satisfactory annual audit and an accurate determination of the costs of operation and the cost per patient day. 7. The administrator shall establish writ- ten policies governing visiting hours in the hospital. 8. The administrator shall maintain poli- cies protecting the children admitted to or discharged from the hospital. 9. The hospital shall not release any child of any age to other than the child’s parent(s) or legal guardian or custodian. 10. The hospital shall not admit a well child not in custody of his/her own parents for the purpose of board and room other than for the purpose of temporary medical or psychiatric observation. 11. The administrator shall provide a written plan for the evacuation of hospital patients, visitors and personnel in the event of fire, explosion or any other disaster within the hospital. This plan and its execution shall provide an alarm system to notify hospital personnel of the disaster. The plan shall provide for execution drills to acquaint personnel with their duties and stations at least three (3) times annually. Provision should be made for the local fire department to visit and inspect the hospital. 12. The administrator shall report in writing all fires occurring on the hospital premises to the Department of Health within one (1) week giving the cause, location and extent of damage and personal injury, if any. 13. The administrator shall provide a written disaster plan for the care of mass casualties resulting from any local or regional catastrophe. 14. The administrator shall be responsi- ble for the development and enforcement of written policies which prohibit smoking 19 CSR 30-22 throughout the rehabilitation hospital except specific designated areas where smoking may be permitted. Lobbies and dining rooms having an area of at least one thousand (1000) square feet, which are enclosed and separated from the access of exit corridor systems, may have a designated smoking area. This designated smoking area may not exceed twenty percent (20%) of the total area of the room and shall be located to minimize the spread of smoke into the nonsmoking areas. Lobbies, dining rooms and other rooms of less than one thousand (1000) square feet which are enclosed and separated from the access to exit corridor systems may be designated smoking areas provided one hundred percent (100%) of the air supplied to the room is exhausted. Individual patients may be permitted to smoke in their rooms with the consent of any other patients occupying the room and with the permission of his/her attending physician. If a patient is confined to bed or classified as not being responsible, smoking is permitted only under direct supervision of an authorized individual. Modification of the patient room ventilization system is not required to permit occasional authorized smoking by a patient. 15. Written smoking control policies shall be posted throughout the rehabilitation hospital. 16. Smoking shall be prohibited in any room, ward or compartment where flammable liquids, combustible gases or oxygen are used or stored and in any other hazardous location. Such areas shall be posted with NO SMOKING signs. 17. The administrator shall establish policies and procedures which protect the patients and the general public against the commission of any illegal acts within the institutions and for the conduct of any practice that is detrimental to the welfare and to the interest of its patients and to the general public. 18. The administrator has no control over the professional staff in the exercising of their professional judgment. S/he is required to bring to the attention of the president or chief of the professional staff any failure by members of that staff to conform with established hospital policies regarding administrative matters, professional standards and the maintenance of adequate clinical records. 19. The administrator shall organize a joint conference (or advisory) committee composed of representatives from the governing body and medical staff, together with the hospital administrator, to meet at regular intervals to discuss medico-administrative problems pertaining to the hospital. 20. The administrator is responsible to see that all patients admitted to the hospital are under the care of a physician or dentist or podiatrist. Required physical examinations of patients admitted are to be made and entered on the medical record by physicians who are members of the medical staff. 21. The administrator shall delegate an individual duly qualified to act in his/her capacity during his/her absence. 22. The administrator shall provide ade- quate equipment, in good repair, within the hospital to assure efficient services and protection to the patient and the community. 23. If the hospital has an organized out- patient department, the administrator is responsible for its integration with the inpatient service and the maintenance of adequate medical, laboratory, nursing, social service and clerical assistance. 24. The administrator is responsible to see that each department provides written job descriptions, policies and procedures and ongoing in-service education programs. (C) Medical Staff. 1. The governing body shall provide in its bylaws for the appointment of an adequate and competent medical staff to provide the necessary medical care and supervision as required by the program. 2. The medical staff of a rehabilitation hospital shall be an organized group which shall initiate and adopt, with approval of the governing body, bylaws, rules and policies governing their professional activities in the hospital. 3. Physicians will be permitted to prac- tice in the hospital in accordance with their competence as recommended by the professional staff and authorized by the governing body. 4. Each member of the medical staff shall be a physician, dentist or podiatrist who is a graduate of an approved school of medicine, osteopathy, dentistry or podiatry legally licensed accordingly to practice in Missouri and who is competent in his/her respective field and is of good moral character and is professionally ethical. Each member is to be reappointed to the staff annually at the discretion of the governing body. 5. Each member of the medical staff shall submit a written application for staff membership on the approved form to the governing body. 6. The governing body, after considering recommendations of the medical staff, shall determine the privileges extended to each member of the staff according to his/her qualifications and standards of performance. 7. Annually the medical staff shall elect a chief of staff, acceptable to the governing body and other officers and committees as is deemed necessary to meet the goals of the hospital. 8. The medical staff shall meet monthly and complete minutes are to be kept of these meetings. 9. The staff shall adopt policies for pro- fessional consultation in writing. 10. The medical staff shall develop and utilize appropriate procedures for continuing review and evaluation of the practice of medicine in the hospital by its individual members. Complete records shall be kept of these reviews and evaluations. 11. The medical staff shall maintain complete and adequate records on each patient. 12. The medical staff shall comply with acceptable professional ethical standards with regard to advertising, commissions, division of fees, secret remedies, extravagant claims, commercialization and in all other respects. 13. The medical staff shall establish policies for the recommendation of discharge of a member by the governing body. (D) Nursing Staff. 1. There shall be an organized nursing staff commensurate with the size and program of care of the hospital. 2. There shall be a director of nursing, who is a registered professional nurse, who has had special training for the position and who is responsible to the administrator for all nursing services. 3. The director of nursing shall have authority over all registered professional and licensed practical nurses as well as all nursing aides and nursing assistants employed by the hospital. 4. The department of nursing shall be organized for safety, efficiency and economy as recommended by competent nursing authorities and is to provide complete and efficient care to each patient. 5. There shall be written procedures and policies for the guidance of nursing service personnel. These are to be consistent with generally accepted practice and are to be reviewed and revised as necessary to keep pace with best practice and new knowledge. 6. A job description shall be written for each position in the nursing department to clearly define the responsibility, authority and functioning of the position. The description is to include personal and professional qualifications, educational preparation and experience necessary. 7. There shall be a planned in-service educational program in rehabilitation nursing to provide efficient patient care. 8. There shall be a registered profes- sional nurse on duty on the premises at all times. 9. Nursing care plans shall be kept cur- rent daily and are to indicate care needed and how it is to be accomplished to insure best results for the patient. 10. Nursing personnel are to participate in interdepartmental conferences regarding patient care. 11. Nursing notes are to be informative and descriptive of the nursing care given and observations of significance so that they contribute to the continuity of patient care. 12. Drugs and treatments shall be administered only on the signed order of a member of the medical staff. 13. Only a registered professional nurse, a licensed practical nurse or a professionally supervised student nurse in an approved school of nursing is permitted to administer medications. 14. Meetings of the registered profes- sional nursing staff shall be held at least monthly to review and analyze the nursing service and to develop plans for improved programs and proficiency. Minutes are to be kept of each meeting. (E) Records. 1. The administrator of the hospital shall be charged by the governing body with the responsibility of employing an individual who shall have the responsibility for supervision, filing and indexing of all medical records of the hospital. 2. The department shall be under the direction of a registered medical record librarian or a person who has had special training in the field. 3. The director of the department shall see that all records are complete and properly prepared, filed and preserved. 4. There shall be a medical record kept on all patients admitted to the hospital or outpatient department. 5. All records shall be legibly prepared in ink or typewritten. This is to include doctors’ orders which shall be written in ink for permanence. 6. All physicians’ or dentists’ orders shall be signed or initialed and dated by the physician or dentist as soon as possible after the order and in no case longer than twentyfour (24) hours after the order. 7. All physicians’ or dentists’ orders shall be preserved on the patient’s record. 8. All records prepared throughout the entire hospital and relating to one (1) patient shall be consolidated in one (1) file or folder readily available to properly authorized personnel or are cross-indexed so that ready access can be had. 9. All medical records shall include identification data, history of present illness, past history, family history, physical examination, special reports (such as clinical laboratory, X-ray, consultations, physical therapy, psychological and others) provisional diagnosis, physicians’ or dentists’ orders, nursing records, progress notes, final diagnosis, condition on discharge and certification as to accuracy and completeness by the attending physician or dentist. 10. All physicians or dentists and employees shall be prompt in completing any required medical record. 11. No records or excerpt from any record shall be released from the record room except upon written order of the patient or by due process of law. Records may be removed from the record room only upon the order of the administrator by duly qualified persons for the purposes of study or research. 12. The hospital shall prepare a death certificate for each person who dies on its premises immediately after death or is to provide data from its files for the preparation of certificate. 13. The hospital shall record on each deceased patient’s record the name and address of the funeral home or person to whom the body was released for disposition and the date of the release and by whom released. 14. An annual report shall be filed with the Department of Health within three (3) months after termination of each fiscal year on forms provided by same. 15. There shall be personnel records maintained on each employee. These are to include application, with preparation and qualifications, performance record and health record. (2) Services. (A) Rehabilitation Medicine. 1. There shall be an organized depart- ment of rehabilitation medicine under the direction of a physician who is a member of the medical staff and trained in this specialty who shall be responsible for the direction and supervision of the sections of physical therapy, occupational therapy, speech and hearing therapy and other services necessary to carry out the patient’s program of rehabilitation. A. There shall be an organized physi- cal therapy department under the supervision of a registered therapist or physiatrist. All therapy shall be given on the written order of a member of the medical staff. Complete and accurate records of treatment are to be maintained with copies being attached to the patient’s record. The physical therapy staff shall cooperate with members of all the other professional disciplines of the hospital staff to accomplish maximum rehabilitation of the patient. The department is to participate in the overall training and orientation of hospital staff. B. There shall be an organized occu- pational therapy department under the direction of a registered therapist. All therapy shall be given on the written order of a member of the medical staff. Complete and accurate records of treatment shall be maintained with copies being attached to the patient’s record. The occupational therapy staff shall cooperate with members of all the other professional disciplines of the hospital staff to accomplish maximum rehabilitation of the patient. The department is to participate in the overall training and orientation of hospital staff. C. If the hospital provides speech pathology and audiology service, the department shall be organized and under the supervision of a certified speech pathologist. The service shall provide for the evaluation, counseling and rehabilitation of those patients with disorders of speech, hearing and language, upon request or referral of the attending physician. The section staff shall cooperate with members of all of the other professional disciplines of the hospital staff to accomplish maximum rehabilitation of the patient. There are to be records kept of all evaluations and therapy given and these are to be placed on the patient’s chart. D. If the hospital does not provide speech pathology and audiology service, services must be readily available to patients and a plan for consultation, or part-time service or referral to the service be in effect. (B) Social Service. 1. There shall be a social service depart- ment whose purpose shall be to—identify and help resolve personal and social problems interfering with the rehabilitation process; enhance the social functioning of patients; help patients understand and effectively use medical and rehabilitation services; help families of patients adjust to the patient’s disability and participate effectively in the rehabilitation program; and identify and develop resources within the rehabilitation hospital and the community which are needed by patients. 2. The director of the department should have a master’s degree from an accredited school of social work or be a member of the Academy of Certified Social Workers. 3. The director of social service is responsible for the organization and services of the department. 4. The social service staff should partic- ipate as members of the rehabilitation team, 19 CSR 30-22 exchanging information and evaluations with the physician and other professional disciplines in order to insure a comprehensive rehabilitation program for patients. 5. Essential information regarding the patient’s social situation and social service activity shall be recorded in the patient’s chart to aid the rehabilitation team and other disciplines in understanding the patient and developing an appropriate rehabilitation plan. 6. The social service department shall participate within the hospital and in the community in identifying and developing programs which would benefit patients in realization of their rehabilitation goals. (C) Psychological Service. 1. The hospital shall provide psycholog- ical services. 2. The department shall be organized and directed by a qualified psychologist. 3. The service shall provide psychologi- cal evaluations in order to identify and appraise specific problems in rehabilitation. 4. The psychologist shall participate in patient care conferences. 5. Reports of the psychological services shall contribute information for the practical management of the patient and are to become a part of the patient’s record. 6. The psychologist is to participate in the overall training and orientation of hospital personnel. (D) Vocational Service. 1. The hospital shall provide vocational services. 2. The department shall be organized and under the direction of a person qualified to supervise, administer and direct vocational rehabilitation programs. 3. The vocational services shall provide vocational evaluation to include counseling, vocational testing and a simulated work environment. 4. The vocational services personnel shall work with all other services in the total rehabilitation of the patient. 5. There shall be records maintained on the services to each patient and these shall become a part of the patient’s medical record. 6. The vocational services personnel shall cooperate with outside agencies as necessary to meet the individual patient needs and shall make referrals to the state vocational rehabilitation agency as indicated by the patient’s needs. (E) Organized Outpatient Service. 1. The outpatient department shall be equipped to promote the health, through diagnosis, treatment and health education of those individuals referred to it by licensed physicians, dentists or podiatrists in the community. 2. The professional staff of the outpa- tient service shall be closely integrated with and part of the professional staff of the hospital. 3. There are to be written policies and procedures for all outpatient functions. 4. These policies and procedures are to define the relationship with other hospital departments and with private physicians, dentists, podiatrists and with outside agencies. 5. Complete and accurate patient records shall be maintained in the outpatient service and shall be made available to the other professional departments of the hospital. (F) Radiology Service. 1. The hospital shall have at least one (1) radiographic room with adjoining darkroom, office, toilet and adequate storage space for records and film. 2. The service shall be under the direc- tion of a physician especially trained and qualified in radiology who is to be responsible for all film interpretation. 3. Technologists in the department are to be particularly trained in X-ray techniques and preferably be registered technologists. 4. The written interpretation of all X-ray films or fluoroscopy shall become a part of the patient’s record. 5. Monthly and yearly reports shall be maintained on the number of examinations done. 6. Protection requirements of X-ray and gamma ray installations shall conform to 19 CSR 20-10.010–19 CSR 20-10.200 and the National Bureau of Standards Handbooks No. 76 and 73. (G) Hospital Laboratory Service. 1. The hospital shall provide as a mini- mum the following laboratory services: bacteriology, chemistry, serology and urinalysis. Other laboratory services shall be provided as needed. 2. Provisions shall be made for emer- gency laboratory service on a twenty-four (24)-hour basis. 3. The laboratory shall be under the supervision and direction of a physician licensed to practice medicine and surgery in Missouri, who preferably has had special training in pathology and who is a member of the professional staff of the hospital. 4. Interpretations of electrocardiograms and other specialty laboratory reports are to be made by a licensed physician trained in the applicable specialty field. 5. Monthly and yearly reports shall be delivered to the administrator giving the number and type of laboratory tests and examinations performed. 6. Technical personnel shall be qualified by education, training and experience. (H) Central Sterilization Supply. 1. There shall be an organized central sterile supply department under the supervision of the department of nursing or a person trained in the basic principles of sterilization and aseptic techniques and the procedures required to apply these principles. 2. There shall be inventory records maintained and laboratory proof of the sterilization process is to be made at least monthly. 3. This unit shall process, assemble, sterilize, store and distribute patient care supplies and equipment as needed. (I) Dietary Department. 1. Organization. A. The dietary department shall be under the supervision of a full-time or parttime registered dietitian or there shall be consultation from a registered dietitian on a regularly scheduled basis of a minimum of four (4) hours per week. B. In the absence of a full-time dieti- tian, there shall be a full-time food-service supervisor or cook manager who is responsible for the daily management of the department. C. The person in charge of the dietary department—shall participate in regular conferences with the administrator and heads of departments; shall be responsible for the selection, orientation, training and supervision of food-service employees; make recommendations concerning the quantity, quality and variety of food purchased; and shall be responsible for quality food production and service. D. Food-service personnel shall be directly available to the kitchen over a period of twelve (12) or more hours each day. Foodservice employees should not be assigned duties outside the dietary department and non-dietary employees should not be assigned duties in the dietary department. E. There shall be written policies and procedures for food purchasing and storage, preparation, service sanitation and safety. These shall be available to all dietary personnel. F. There shall be written job descrip- tions for all dietary positions available. G. There shall be work assignments and duty schedules posted. H. There shall be an in-service train- ing program for all dietary employees. 2. Menu planning and diets. A. The food and nutritional needs of patients shall be met in accordance with the current Recommended Dietary Allowances of the Food and Nutrition Board, National Research Council and in accordance with physicians’ orders. B. Orders for all diets shall be given to the dietary department in writing. C. A current diet manual approved by the medical staff and the dietary department shall be used by the medical staff in prescribing diets and by the dietary department in fulfilling the diet order. D. Regular menus and menus for modified diets shall be written at least one (1) week in advance, posted in the kitchen and followed. They shall provide for a variety of foods served in adequate amounts at each meal. Records of menus as served shall be kept on file for one (1) month. E. Pertinent information related to the patient’s diet is to be recorded in the patient’s medical chart. F. The dietitian shall visit and counsel patients. In the absence of a full-time dietitian, the consultant shall train the food-service supervisor or cook manager to visit and give diet instruction to patients. Teaching material for diet counseling shall comply with the established principles of the approved current diet manual used. 3. Food preparation and service. A. At least three (3) meals shall be served daily approximately five (5) hours apart and no longer than fourteen (14) hours between a substantial evening meal and breakfast. If the “four (4) or five (5) meals a day” plan is in effect, meals and snacks shall provide nutritional value to meet the Recommended Dietary Allowances of the Food and Nutrition Board, National Research Council. B. Recipes standardized for the hospi- tal shall be provided and used for all food preparation. Food shall be prepared by methods that conserve nutritional value, flavor and appearance and shall be attractively served at the proper temperature. C. Food shall be prepared and served in a manner which meets individual patient’s needs; for example, ground meat or pureed foods are to be served only to those who need it and salt is to be omitted in food preparation only for those who are on sodium-restricted diets. 4. Sanitation. A. All food handling facilities, per- sonnel and procedures shall comply with 19 CSR 20-1.010. B. Foods or beverages being trans- ported from the dietary department to the patient area shall be protected from contamination and maintained at proper temperatures. C. Only meat, meat products, poultry and poultry products from a stateor federally-inspected slaughterhouse or processing plant may be served in a hospital. The meat must bear an official stamp indicating that it was “inspected and passed.” D. All milk sold, offered for sale or served for human consumption shall comply with 2 CSR 80-2.010. Only Grade A pasteurized milk shall be served. Milk shall be maintained at a temperature of not more than forty-five degrees Fahrenheit (45° F) while on the premises and shall be stored in such a manner as to protect it from possible contamination. All milk and fluid milk products shall be served to the consumer in the original container in which they were received from the distributor or from a bulk container and dispensing device approved by the Department of Health. Condensed milk and pasteurized, evaporated or dried milk may be used for cooking. E. Routine bacterial counts shall be made at least once a month on dishes, flatware, utensils, glasses and equipment. (J) Housekeeping Department. 1. There shall be an organized house- keeping department. 2. A Housekeeping Procedure Manual shall be written and followed for appropriate cleaning of all areas in the hospital. Special emphasis shall be given to procedures applying to control of infections in hospitals. 3. All parts of the establishment and its premises shall be kept neat, clean, free of litter and rubbish. 4. Walls and ceilings shall be free from cracks and falling plaster and shall be cleaned regularly and properly maintained. 5. Floors shall be cleaned regularly. Cleaning shall be performed in a manner which shall minimize the spread of pathogenic organisms in the hospital atmosphere. Dry dusting and sweeping is prohibited. 6. Suitable equipment and supplies shall be provided for cleaning of all surfaces. The equipment shall be maintained in a safe, sanitary condition. 7. Solutions, cleaning compounds and hazardous substances shall be properly labeled and stored in safe places. (K) Laundry Facilities. 1. If linens for the hospital are processed commercially, adequate and properly maintained space shall be provided for the storage and sorting of soiled linens. The space shall be located so as not to disturb the patients nor endanger their safety. If the laundry is processed in the hospital, facilities for this purpose shall be separate from nursing units or food preparation and serving areas. Processing of all linens shall comply with accepted commercial laundry practices. 2. If laundry is processed in the facility, the following shall be provided: soiled linen room; clean linen and mending room; linen cart storage; lavatories (accessible from soiled, clean and processing room); laundry processing room; and commercial-type equipment shall be sufficient to take care of seven (7) days’ needs within the workweek. (L) Pharmacy Facilities and Services. 1. The pharmacy operating in connec- tion with a hospital shall comply with the provisions of 4 CSR 220-2.020 requiring registration of drugstores and pharmacies and with the appropriate federal and state drug laws and regulations. 2. The pharmacy or drug room shall be under the full-time or part-time supervision of a licensed pharmacist. The pharmacist, with the approval of the administrator of the hospital, shall initiate procedures to provide for the administrative and technical guidance in all matters pertaining to the handling and dispensing of drugs. 3. There shall be at, or close by, each nurses’ station a medicine cabinet with one (1) or more sections for poisons and medications. There shall be a compartment for the storing of medications for external use only. The medication cabinet shall be provided with a lock and key; shall be kept locked when not in use; and the key shall be available only to authorized personnel. The medicine cabinet shall provide adequate space for the storing of individual patients’ medications and for their preparation and administration. There shall be a locked drug room or pharmacy provided for the storage of stock drugs. 4. All individual medications, including narcotics, shall be returned to the pharmacy or proper agency for disposition when orders have been discontinued or the patient has been dismissed or is deceased. 5. Hospitals shall obtain a state narcotic permit before applying to the Federal Bureau of Narcotics for a federal permit and are to place the number of the state permit on the federal permit application. 6. A hospital possessing a narcotic license shall purchase narcotics only from licensed manufacturers or wholesalers. The narcotics are to be used by or in the hospital. An official written order for the purchase of narcotics is to be signed, in duplicate, by the person ordering the narcotics and both buyer and seller must preserve their copy of the order for two (2) years. Narcotics may be administered or dispensed only for scientific and medical purposes. 7. Narcotics shall be securely locked in a safe or double-locked cabinet at all times and accessible only to authorized personnel. 8. Reporting the loss, theft, destruction or obsolescence of narcotics shall be accom- 19 CSR 30-22 plished in accordance with the regulations of the Federal Bureau of Narcotics and the Department of Health. 9. A record of all drugs dispensed in the hospital shall be properly maintained. 10. Drugs shall be administered only on the written order of a physician, dentist or podiatrist duly licensed to prescribe drugs. 11. No drugs shall be administered beyond the expiration date indicated on each package. Drugs requiring refrigeration are to be refrigerated in an area separate from food and drink. 12. Arrangements shall be made to pro- vide emergency service to the institution when the pharmacy is closed. 13. All containers shall be clearly labeled as to the name of drug and strength. Drugs shall be administered from the original container or one properly labeled by a licensed pharmacist. 14. Each dose of a narcotic administered from stock shall be recorded on a permanent narcotic record wherein is listed the date, hour, name of patient, name of physician or dentist who ordered the narcotics, kind of narcotic, dose and by whom administered. 15. If the institution does not maintain a stock supply of narcotics, administration shall be by prescription only, each dose is to be recorded on the clinical record of the patient and signed by the person who administered the drug. 16. All drugs classed as depressant or stimulant drugs by the Federal Bureau of Narcotics and Dangerous Drugs or listed as barbiturates, stimulants or hallucinogenic drugs by the Department of Health shall be handled in compliance with all current applicable state and federal laws and regulations. (M) Infection Control. 1. An infection control committee shall be established and be responsible for reporting, recording, investigating, controlling and preventing the occurrence and transmission of hospital acquired infections. 2. An environmental control program governing aseptic techniques and procedures in all areas of the hospital shall be developed. The procedures and techniques, particularly those concerning food handling, laundry and practices, disposal of environmental and patient wastes, traffic control and visiting rules in high risk areas shall be regularly reviewed by the infection control committee. 3. All equipment and areas where con- tamination could be a source of infection shall be sampled routinely. 4. Patients admitted with, or who are suspected of having, infectious disease or who later are found to have an infectious disease shall be properly isolated. (N) Employee’s Examination. 1. Personnel absent from duty because of any communicable disease or exposure thereto shall be excluded from duty until examined and certified by a physician that the employee is not suffering from any condition that may endanger the health of patients or other employees. The certification shall be provided in writing to the administrator or the employee’s supervisor. (O) Water Supply. 1. An adequate supply of fresh, potable water from a source approved by the Department of Health shall be available to all patients. 2. Cool, potable drinking water shall be available to all patients at all times and shall be dispensed in a manner approved by the Department of Health. 3. Water shall be under sufficient pres- sure to properly serve all areas of the hospital. 4. The safety of the supply shall be sub- stantiated by satisfactory bacteriological analyses in the Department of Health laboratory. Water shall be obtained only from an approved public supply if such is available. If an approved public supply is not available, the private water supply shall be constructed in accordance with the Department of Health standards on public water supply. 5. No unsafe water supply shall be avail- able on the premises for drinking purposes by patients. 6. Containers for dispensing drinking water shall be for individual use only and shall be properly sanitized at least daily and properly protected between periods of usage. Paper cups, if provided, shall be for individual use only and shall be dispensed in approved dispensers. Cool drinking water shall be available in adequate quantities for all residents at all times. Drinking fountains, if provided, shall be of angle-jet type approved by the Department of Health. (P) Sewage Disposal. 1. Sewage wastes from medical facilities shall be disposed of in such a manner that no nuisance will result. 2. If a facility does not have available a public sewage disposal system, the facility shall provide a private disposal system acceptable to the Department of Health or the Clean Water Commission of the Department of Natural Resources. (Q) Garbage and Refuse Disposal. Garbage and refuse shall be stored and disposed of in a manner acceptable to the Department of Health. AUTHORITY: section 197.080, RSMo 1986.* This rule previously filed as 13 CSR 50- 22.020 and also 19 CSR 10-22.020. Original rule filed Nov. 21, 1969, effective Jan. 21, 1970. Amended: Filed June 14, 1988, effective Oct. 13, 1988. *Original authority 1953, amended 1993. Op. Atty. Gen. No. 40, Graham (4-23-75). The State Board of Health is authorized by law to adopt and enforce regulations requiring hospitals licensed by the state to submit reports containing certain data relating to hospital discharges.