Section 22-B2710. INTENSIVE CARE UNITS (ICU) FOR TRAUMA PATIENTS

 

2710.1A hospital designated as a Level I trauma center shall have a surgically directed and staffed Intensive Care Unit (ICU).

 

2710.2In each adult trauma care facility, there shall be designated a surgical director or surgical co-director for the ICU.

 

2710.3The trauma service that assumes initial responsibility for the care of an injured patient shall maintain that responsibility as long as the patient remains critically ill. The surgeon in charge shall remain in that role even if the patient requires admission to an intensive care unit (ICU).

 

2710.4Medical and surgical specialists shall be consulted as needed to provide specific expertise in the care of the patient in the ICU. The Surgical Intensive Care Unit (SICU) service physician must be in-house twenty-four (24) hours per day for Level I facilities.

 

2710.5The surgeon team leader in an adult trauma care facility shall have obtained critical care training during residency or fellowship and must have expertise in the perioperative and postinjury care of the critically injured patient. The surgeon team leader shall possess a Certificate of Added Qualifications in Surgical Critical Care from the American Board of Surgery, or have documented active participation during the preceding twelve (12) months in ICU administration and quality improvement activities and direct involvement in the ICU care of trauma patients.

 

2710.6Each ICU shall have a physician with privileges in critical care and approved by the Surgical Critical Care Service Director on duty in the ICU twenty-four (24) hours a day or immediately available in the hospital.

 

2710.7The clinical nurse manager for an ICU shall be responsible for those aspects of administration that pertain to nursing in the unit and for quality improvement in nursing. He or she shall hold certification as a Critical Care Nurse (CCRN) or have evidence of equivalent critical care training.

 

2710.8Each nurse assigned to trauma patients shall be a registered nurse, and shall hold certification as a CCRN or have evidence of equivalent critical care training from the American Association of Critical Care Nurses. Before assuming responsibility for patients in the ICU, each nurse shall be oriented to the care of the critically ill trauma patient. Each nurse shall complete at least eight (8) hours of Continuing Medical Education (CME) each year.

 

2710.9The course work for nurses identified in §§ 2710.7 and 2710.8 shall cover mechanisms of injury in traumatized individuals, fluid and electrolyte balance, pressure monitoring, ventilator management, and infection control. It shall also provide an overview of aspects of the operative treatment of specific injuries.

 

2710.10ICU nursing staff shall be maintained at a level that insures a nurse-patient ratio of one to two (1:2) on each shift and shall be increased above this as dictated by patient acuity.

 

2710.11Each ICU shall have support personnel available as follows:

 

(a)Respiratory therapists;

 

(b)Physical therapists;

 

(c)Discharge planners;

 

(d)Social workers;

 

(e)Interpreters;

 

(f)In-house radiology technologist;

 

(g)In-house acute hemodialysis;

 

(h)In-house Computerized Tomographic (CT) technician; and

 

(i)Angiographer, sonographer, magnetic resonance imaging (MRI) technician.

 

2710.12Equipment in the ICU shall include, at a minimum, the following:

 

(a)Cardiopulmonary resuscitation cart;

 

(b)Electrocardiograph machine;

 

(c)Defibrillator with internal and external paddles; and

 

(d)Sets of instruments for the following procedures:

 

(1)Tracheostomy;

 

(2)Thoracostomy;

 

(3)Venous cut-down;

 

(4)Central venous puncture;

 

(5)Tracheal intubation;

 

(6)Intracranial monitoring equipment; and

 

(7)Pulmonary artery monitoring equipment.

 

2710.13Each adult trauma care facility shall provide an ICU physician on duty twenty-four (24) hours per day. This coverage may be provided by the patient's primary physician or by a physician who is credentialed in critical care by the hospital. This coverage for emergencies is not intended to replace the primary surgeon in caring for the patient in the ICU; it is to ensure that the patient's immediate needs will be met while the primary surgeon is being contacted.

 

2710.14Each adult trauma care facility ICU shall provide or have immediately available the following equipment:

 

(a)Scale;

 

(b)Volume - cycled and pressure - cycled ventilators;

 

(c)Temporary transvenous pacemakers;

 

(d)Vascular and intracranial pressure monitors;

 

(e)Pulse or venous oximeters;

 

(f)Infusion devices;

 

(g)Thermodilution cardiac output computers;

 

(h)Blood warmers;

 

(i)Equipment for rapid warming and cooling off of patients;

 

(j)Orthopedic traction devices;

 

(k)Beds designed for care of patients with spinal cord injuries and for patients at high risk for decubitus ulcers;

 

(l)Sets for arterial cannulation and peritoneal lavage; and

 

(m)Adjustable chairs for mobilization of patients.

 

2710.15Each ICU in an adult trauma care facility shall be concentrated in a single unit or in contiguous units. Trauma ICU beds on floors different from the operating rooms must have ready access to a nearby elevator that is immediately available for emergency transport. The elevator facilities shall be adequate to ensure immediate transport of the patient and all needed ancillary equipment between the operating rooms and the ICU, and shall be situated to facilitate the transport of the critically ill patient to special procedure departments.

 

2710.16All ICU beds shall have bedside monitoring capabilities for central venous, pulmonary arterial, systemic arterial, and intracranial pressure monitoring. All beds shall have piped-in air and oxygen and adequate space for a mechanical ventilator, and at least every other bed shall have a sink. At least one bed shall have the space and water drainage capabilities adequate to support a bedside hemodialysis unit. All beds shall have lighting adequate for performance of minor operative procedures such as chest-tube insertion and central venous puncture.

 

2710.17Sleeping quarters for the physician who is immediately responsible for the patients in the trauma ICU shall be located near or within the unit. A quiet room nearby, separate from the unit, shall be available for discussions with family members. Space also shall be available near the ICU for educational activities for physicians, nurses, and support personnel.

 

2710.18Each adult trauma care facility shall have access to clinical diagnostic services for blood gases measurements, hematocrit levels, serum potassium values, and chest X-rays within thirty (30) minutes of a request. This capability shall be continuously monitored by the quality improvement program.

 

2710.19Each Level I facility shall investigate the pathophysiology and treatment of the critically injured patient.

 

source

Notice of Final Rulemaking published at 46 DCR 8741 (October 29, 1999); as amended by Notice of Emergency and Proposed Rulemaking published at 51 DCR 3915 (April 16, 2004) [EXPIRED]; as amended by Final Rulemaking published at 51 DCR 7260 (July 23, 2004).