Mo. Code Regs. Ann. tit. 19, § 30-24.020
PURPOSE: The Department of Health has the authority to establish standards for the operation of psychiatric hospitals to meet the needs of mentally ill patients.
(1) Organization, Administration, Medical Staff, Nursing and Services Provided.
(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.
and adopt bylaws by which it shall abide in conducting all business of the hospital.
to the Department of Health for its records.
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.
ted to the Department of Health for its records.
competent, experienced administrator.
necessary authority to the administrator for the administration of the hospital in all its activities and departments subject only to 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 the hospital and medical staff abide by acceptable professional ethical standards.
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.
be in keeping with accepted principles of hospital administration.
administrative functions of the facility, delegate duties and establish formal means of accountability on the part of subordinates. S/he shall provide for department and interdepartment meetings and attend or be represented at these meetings.
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).
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.
ten policies governing visiting hours in the hospital.
cies protecting the children admitted to or discharged from the hospital in accordance with current Missouri statutes.
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 twelve (12) times annually. Provision should be made for the local fire department to visit and inspect the hospital.
ing 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.
ble for the development and enforcement of written policies which prohibit smoking throughout the psychiatric 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 ventilation system is not required to permit occasional authorized smoking by a patient.
shall be posted throughout the psychiatric hospital.
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.
written disaster plan for the care of mass casualties resulting from any local or regional catastrophe.
policies and procedures which protect the patients and the general public against the commission of any illegal acts within the institution and for the conduct therein of any practice that is detrimental to the welfare and to the interest of its patients and to the general public.
over the professional staff in the exercising of their professional judgment. S/he is required 19 CSR 30-24
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.
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.
see that all patients admitted to the hospital are under the care of a physician who is a member of the staff. Each patient admitted shall have a physical examination by a member of the medical staff unless an authenticated physical examination has been given by a licensed physician within the last thirty (30) days.
individual duly qualified to act in his/her capacity during his/her absence.
quate equipment, in good repair, within the hospital to assure efficient services and protection to the patient and the community.
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.
program consisting of orientation, in-service education and continuing education under the direction of a qualified person.
see that each department provides written job descriptions, policies and procedures and ongoing in-service education programs. An average of one (1) hour per week of in-service education should be provided for all employees.
tained on each employee and shall include job applications, professional licensing information and health information.
health facility or agency, written information concerning the care of the patient shall be transmitted prior to transfer or at the time of the transfer of the patient. Information transmitted should include current medical findings, diagnosis, summary of the course of treatment followed in the hospital and other nursing, dietary and social service information pertinent to continuity of care.
(C) Medical Staff.
its bylaws for the appointment of an adequate and competent medical staff to provide the necessary psychiatric and medical care and supervision as required by the program.
pital 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.
tice in the hospital in accordance with their competence as recommended by the professional staff and authorized by the governing body.
and care of patients shall rest with the attending physician, who is accountable to the governing body.
shall be a physician who is a graduate of an approved school of medicine or osteopathy, legally licensed accordingly to practice in Missouri and who is competent in his/her respective field and is professionally ethical. Staff appointments shall be according to the approved bylaws.
shall submit a written application for staff membership on the approved form to the governing body.
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.
dent (chief) of staff, acceptable to the governing body and such other officers and committees as is deemed necessary to meet the goals of the hospital. The president (chief) of staff shall have training and experience in psychiatry and preferably be a diplomat of the American Board of Psychiatry, in psychiatry.
ly and complete minutes are to be kept of these meetings.
professional consultation in writing.
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.
complete and adequate records on each patient.
acceptable professional ethical standards with regard to advertising, commissions, division of fees, secret remedies, extravagant claims, commercialization and in all other respects.
policies for the recommendation of discharge of a member by the governing body.
staff, consisting of medical practitioners of recognized professional ability, who have accepted appointment to the consulting staff.
(D) Nursing Services.
service commensurate with the size and program of patient care of the hospital.
the direction of a director of nursing who shall have a graduate degree in psychiatric nursing or shall have at least three (3) years’ experience in psychiatric nursing.
authority over all nursing personnel. 4. The department of nursing service shall be organized to provide high quality nursing care in meeting the patient’s emotional, psychological, physical, social and health teaching needs and shall be responsible to the administrator or medical director for the high standard of performance of nursing personnel. 5. There shall be written policies and procedures for the direction and guidance of nursing personnel. These are to be consistent with generally accepted nursing practices 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. The director of nursing education shall serve as a member of the overall education committee to plan in-service and staff development for total staff. 8. Registered professional nurses and other nursing personnel shall actively participate in interdisciplinary meetings affecting the planning or implementation of nursing care plans for patients including diagnostic conferences, treatment planning sessions, and meetings held to consider alternative facilities and community resources. 9. 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. 10. Appropriate drugs and treatment shall be administered only on the written orders of a member of the medical staff except that telephone orders may be used in case of emergency and they shall only be given to a licensed nurse and shall be signed by the physician within twenty-four (24) hours. 11. Only a licensed physician, a regis- tered professional nurse, a licensed practical nurse or a professionally supervised student nurse in an approved school of nursing is permitted to administer medications. 12. New employees shall attend appro- priate orientation, in-service and staff development programs prior to being considered part of the staff required to meet the minimum standards of patient care. 13. 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. 14. Written policies shall be established regarding the use of restraints or seclusion. These restraints or seclusion shall be used only on the order of a physician. In the absence of a physician, a registered professional nurse shall make the decision that the use of a mechanical restraint or seclusion is the least restrictive procedure appropriate at the time of the emergency situation. The physician shall be notified immediately and a physician’s order obtained as soon as possible after the occurrence of such an emergency. Physicians’ orders for use of mechanical restraints or seclusion shall be rewritten every twenty-four (24) hours. A full record of any restriction of activity for any patient shall be recorded on the nurse’s notes and shall include the reason for restriction, the type of restriction used, the time of starting and ending the restrictions and regular observations of the patient while restricted. 15. A registered professional nurse with a minimum of one (1)-year experience in psychiatric nursing shall be on duty twenty-four (24) hours each day for direct patient care, for supervision of care performed by other nursing personnel and for assigning nursing care activities. 16. The nursing service departments shall have the following minimum number of administrative and educational positions. These positions are to be above and beyond patient care and program staffing requirements: A. Registered nurse director of nurs- ing; B. Registered nurse director of in-ser- vice education program in hospitals of one hundred fifty (150) beds or more. In facilities of less than one hundred fifty (150) beds, there shall be a registered nurse director of in-service education on duty a minimum of twenty (20) hours per week; C. Registered nurse assistant director of nursing for the evening shift (evening supervisor); D. Registered nurse assistant director of nursing for the night shift (night supervisor) for any facility that has three (3) nursing units or more; and E. In facilities of two (2) nursing units or less, the RN assistant director of nursing on the night shift (night supervisor) is the only RN required to be on duty to meet minimum care requirements. 17. The minimum personnel require- ments for patient care in acute intensive care units shall be as set forth in Table II. 18. The minimum personnel require- ments for patient care in general psychiatric nursing units shall be as set forth in Table III. 19. The minimum personnel require- ments for patient care in children and adolescent units shall be as set forth in Table IV. 20. The minimum personnel require- ments for patient care in geriatric units shall be as set forth in Table V. (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. A medical record shall be maintained for all patients admitted to the hospital or outpatient department to provide documented evidence of ordered treatments, observations of the patients’ responses to treatment and of his/her behavior. 3. All records shall be legibly prepared in ink or typewritten. (Above and beyond administrative and educational personnel listed in subparagraphs (1)(D)16.A.—E.) Acute intensive care unit (includes children, adolescent and adult areas where special precautions must be taken because of threat to self or others. A closed unit with special security measures. Patients have limited privileges and require close supervision). Persons doing patient care: Number of Patients 1—16 17—20 21—24 25—28 29—32 And up to 36 (Above and beyond administrative and educational personnel listed in subparagraphs (1)(D)16.A.—E.) General psychiatric nursing unit (Continued Care—Anything past ninety (90) day-treatment program). Persons doing patient care: Number of Patients 1—16 17—20 21—24 25—28 29—32 And up to 36 Table II—Minimum Personnel Requirements for Patient Care RNs LPNs Table III—Minimum Personnel Requirements for Patient Care RNs LPNs Day Aides RNs 1 4 1 4 1 4 Day Aides RNs Evening LPNs Aides 1 1 1 1 1 1 Evening LPNs Aides RNs 3 1 4 1 4 1 4 1 4 1 1 RN per 3 nursing units 2 RN per 4 nursing units 2 RN per 5 nursing units 3 RN per 6 nursing units 3 RN per 7 nursing units 4 RN per 8 nursing units 4 RN per 9 nursing units 5 RN per 10 nursing units RNs 1 1 2 1 2 1 3 1 3 1 1 RN per 3 nursing units 2 RN per 4 nursing units 2 RN per 5 nursing units 2 RN per 6 nursing units 3 RN per 7 nursing units 3 RN per 8 nursing units 3 RN per 9 nursing units 4 RN per 10 nursing units Night LPNs Aides 1 1 1 1 1 2 1 2 1 2 Night LPNs Aides (Above and beyond administrative and educational personnel listed in subparagraphs (1)(D)16.A.—E.) Number of Patients 1—16 17—20 No children and adolescent units larger than 20 patients allowed (Above and beyond administrative and educational personnel listed in subparagraphs (1)(D)16.A.—E.) Number of Patients 1—16 17—20 21—24 25—28 29—32 And up to 36 Table IV—Minimum Personnel Requirements for Patient Care Children and adolescent units. Persons doing patient care: RNs LPNs Table V—Minimum Personnel Requirements for Patient Care RNs LPNs Day Aides RNs 1 2 1 2 Geriatric unit. Persons doing patient care: Day Aides RNs 1 2 1 2 1 3 1 4 Evening LPNs Aides 1 1 1 2 Evening LPNs Aides 1 1 1 1 1 1 19 CSR 30-24 RNs 2 1 2 1 1 RN per 3 nursing units 2 RN per 4 nursing units 2 RN per 5 nursing units 3 RN per 6 nursing units 3 RN per 7 nursing units 4 RN per 8 nursing units 4 RN per 9 nursing units 5 RN per 10 nursing units RNs 2 1 2 1 2 1 3 1 4 1 1 RN per 3 nursing units 2 RN per 4 nursing units 2 RN per 5 nursing units 2 RN per 6 nursing units 3 RN per 7 nursing units 3 RN per 8 nursing units 3 RN per 9 nursing units 4 RN per 10 nursing units Night LPNs Aides 1 1 1 1 Night LPNs Aides 1 1 1 1 1 2 1 2 1 2 4. All physicians’ orders shall be signed or initialed and dated by the physician as soon as possible after the order and in no case longer than twenty-four (24) hours after the order. 5. All physicians’ orders shall be pre- served on the patient’s record. 6. 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 readyaccess can be had. 7. 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’ orders, nursing records, progress notes, final diagnosis, conditions on discharge and certification as to accuracy and completeness by the attending physician. 8. All physicians and employees shall be prompt in completing any required medical record. 9. No records or excerpts 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. Patient records shall be removed from the hospital only by court order. 10. Immediately after a death, the hos- pital shall prepare a death certificate for each person who dies on its premises or is to provide data from its files for the preparation of the death certificate. 11. The hospital shall record on each deceased patients’ record the name and address of the funeral home or person to whom the body was released for disposition and the date of such release and by whom released. 12. An annual report for each calendar year shall be filed with the Department of Health within sixty (60) days after the end of the year on forms provided by the Department of Health. 13. Reports of patient discharges shall be submitted as directed by the Department of Health. 14. Records are to be stored to prevent damage by water or fire and safeguarded from unauthorized use. (F) Adjunctive Services. 1. There shall be an organized occupa- tional and recreational therapy department preferably under the direction of a registered therapist. 2. All therapy shall be given on the writ- ten order of a member of the medical staff. 3. Complete and accurate records of treatment shall be maintained with copies being attached to the patient’s record. 4. 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. 5. The department shall participate in the overall training and orientation of hospital staff. 6. The scholastic education staff shall meet all appropriate local and state certification requirements. (G) 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 psychiatric 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 psychiatric hospital and the community which are needed by patients. 2. The department shall be directed by a qualified social worker. The director of the department should have a masters 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 treatment team, exchanging information and evaluations with the physician and other professional disciplines in order to insure a comprehensive treatment 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 treatment team and other disciplines in understanding the patient and developing an appropriate plan of treatment. 6. The social service department shall participate within the hospital and in identifying and developing programs which would benefit patients in realization of their rehabilitation goals. (H) Outpatient Services. 1. If an outpatient department is provid- ed it shall be organized and equipped to provide diagnostic evaluation, individual or group therapy, consultation and rehabilitation. Outpatient services shall be in an integral segment of the total psychiatric treatment program. There are to be written policies and procedures from all outpatient functions. These policies and procedures are to define the relationship with other hospital departments, with private physicians and with outside agencies. 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. (I) Emergency Services. 1. The hospital shall develop a well- defined written plan for evaluation, care, treatment or referral of individuals requiring emergency services. The plan shall be based on the capability of the psychiatric facility. (J) Radiology Services. 1. Radiology services shall be provided by the psychiatric hospital either on its premises or by contractual agreement with a general hospital with acceptable facilities. The contract shall be acceptable to the Department of Health. 2. If radiology services are provided on the premises, space is to be provided to accommodate the following: radiographic room with adjoining darkroom; office; toilet and storage space for records and film. (K) Pathology Services. 1. Pathology services shall be provided by the psychiatric hospital either on its premises or by contractual agreement with a general hospital with acceptable laboratory services or an independent laboratory approved by the Commission of Inspection and Accreditation of the College of American Pathologists. 2. If pathology services are provided by a contractual agreement, the contract shall be submitted to the Department of Health for approval. 3. If necropsy services are provided in the hospital, space and equipment shall comply with 19 CSR 30-24.010. 4. If necropsy services are provided by a contractual agreement with an outside facility, the contract shall be acceptable to the Department of Health. (L) 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 every two (2) weeks. This department shall process, assemble, sterilize, store and distribute patient care supplies and equipment as needed. (M) Anesthesia Services. 1. When anesthetic agents are utilized in electroconvulsive therapy or in other psychiatric procedures, practices employed in the administration of anesthesia shall be consistent with the written policies of the medical staff. 2. Cardiopulmonary resuscitation equip- ment and supplies shall be available on the premises for emergency procedures. 3. When anesthetic agents are utilized in conjunction with surgical or obstetrical services within the psychiatric hospital, facilities and regulations for administration of anesthetic agents shall comply with the current Standard for the Use of Inhalation Anesthetics (No. 56A) of the National Fire Protection Association and Requirements for Surgical or Obstetrical Services in 19 CSR 30- 20.021(4)(B). (N) Dietary Department. 1. There shall be an organized dietary department. 2. The dietary department shall be directed by a full-time person qualified by training and experience in organization and administration of food service. 3. The dietary department shall be under the supervision of a full-time or part-time 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. 4. 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; shall be responsible for quality food production and service; and shall participate in conferences concerning the overall psychiatric treatment program. 5. Food-service personnel shall be directly available to the kitchen over a period of twelve (12) or more hours each day. 6. 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. 7. There shall be written job descrip- tions for all dietary positions. 8. There shall be work assignments and duty schedules posted. 9. There shall be an in-service training program for all dietary employees. The program shall include basic information on the psychiatric treatment program of the hospital and on the psychological aspects of food. 10. 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. 11. Orders for all diets shall be given to the dietary department in writing. 12. 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. 13. Regular menus and menus for mod- ified 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. 14. The dietitian shall record in the patient’s medical chart pertinent information related to the patient’s diet. 15. The dietitian shall visit and counsel patients regarding their diets. Orders for all diet instructions shall be ordered by the physician. Teaching material for diet counseling shall comply with the established principles of the approved current diet manual used. 16. 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) meal 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. 17. Recipes standardized for the hospital 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. 18. 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. 19. All food handling facilities, person- nel and procedures shall comply with 19 CSR 20-2.010. 20. Foods or beverages being transport- ed from the dietary department to the patient area shall be protected from contamination and maintained at proper temperatures. 21. Only meat, meat products, poultry and poultry products from a state or federally inspected slaughterhouse or processing 19 CSR 30-24 plant may be served in a hospital. The meat shall bear an official stamp indicating that it was “inspected and passed.” 22. All milk sold, offered for sale, or served for human consumption shall comply with 2 CSR 80-2.010. Only Grade A pasteurized fluid milk and fluid milk products 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. 23. Dishwashing facilities shall comply with 19 CSR 20-1.010(13). 24. Routine bacterial counts shall be made at least once a month of dishes, utensils and other equipment used to store or prepare food. (O) 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. 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. (P) Laundry Facilities. 1. If linens for the hospital are processed commercially, adequate and properly maintained space shall be provided for clean linen storage and for the storing and sorting of soiled linens. This space shall be located so as not to disturb the patients nor endanger their safety. 2. If the laundry is processed in the hos- pital, 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. 3. 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); and laundry processing room. 4. Commercial-type equipment shall be sufficient to take care of seven (7) days’ needs within the workweek. (Q) 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 controlled substances 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 patient’s medications and for their preparation and administration. 4. There shall be a locked drug room or pharmacy provided for the storage of stock drugs. 5. 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. 6. Hospitals shall obtain a state-con- trolled substances registration before applying to the Federal Drug Enforcement Administration for a federal registration and shall place the state number on the federal application. 7. A hospital shall purchase Schedule II substances only from licensed manufacturers or wholesalers. These substances are to be used by or in the hospital. An official written order for the purchase is to be signed, in triplicate, by the person ordering same, and both buyer and seller must preserve their copy of the order for two (2) years. These drugs may be administered or dispensed only for scientific and medical purposes. 8. Controlled substances shall be secure- ly locked in a safe or double-locked cabinet at all times and accessible only to authorized personnel. 9. Reporting the loss, theft, destruction or obsolescence of controlled substances shall be accomplished in accordance with the regulations of the Federal Drug Enforcement Administration and the Department of Health. 10. A record of all drugs dispensed in the hospital shall be properly maintained. 11. Drugs shall be administered only on the written order of a physician duly licensed to prescribe drugs. 12. 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. 13. Arrangements shall be made to pro- vide emergency service to the institution when the pharmacy is closed. 14. All containers shall be clearly labeled as to the name of drug and strength. Drugs shall be administered from the original container or one (1) properly labeled by a licensed pharmacist. 15. Each dose of a controlled substance administered from stock shall be recorded on a permanent record where is listed the date, name of patient, name of physician who ordered the drug, kind of drug, dose and by whom administered. 16. If the institution does not maintain a stock supply of drugs, 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. 17. All drugs classed as controlled sub- stances by the Federal Drug Enforcement Administration or by the Department of Health shall be handled in compliance with all current applicable state and federal laws and regulations. (R) 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. The committee shall meet at least monthly. 2. An environmental control program governing aseptic techniques and procedures in all areas of the hospital shall be developed. These procedures and techniques, particularly those concerning food handling, laundry 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. (S) Employee Health Information. 1. Information of an employee’s health is to be included in the employee’s records. 2. Personnel absent from duty because of any communicable disease or exposure to any communicable disease 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. (T) Water Supply. 1. An adequate supply of water, the source of which is approved by the Department of Health, under sufficient pressure to properly serve the establishment, shall be provided at each hospital. 2. The safety of the supply shall be sub- stantiated by satisfactory bacteriological analysis in the Department of Health laboratory. 3. Water shall be obtained only from an approved public supply, if such is available. 4. 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. 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. 7. Cool drinking water shall be available in adequate quantities for all residents at all times. 8. Drinking fountains, if provided, shall be of angle jet-type approved by the Department of Health. (U) 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. (V) 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 Supp. 1993.* This rule was previously filed as 13 CSR 50-24.020 and also 19 CSR 10-24.020. Original rule filed Jan. 31, 1974, effective March 1, 1974. 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.