Section 22-B3215. VENTILATOR CARE SERVICES

 

3215.1The facility may care for ventilator patients in a ventilator care area upon compliance with Title III of the Nursing Home and Community Residence Facility Residents' Protections Act of 1985, effective April 18, 1986, D.C. Law 6-108, D.C. Code § 32-1431 et seq.

 

3215.2Ventilator care shall be supervised by a physician who has special training and experience in diagnosing, treating and assessing problems related to ventilator patients.

 

3215.3The facility shall ensure that ventilator care services are provided by a sufficient number of qualified staff and that personnel provide ventilator care services commensurate with their documented training, experience, and competence.

 

3215.4As appropriate, ventilator care personnel shall be competent in the following:

 

(a)The fundamentals of cardiopulmonary physiology and of fluids and electrolytes;

 

(b)The recognition, interpretation and recording of signs and symptoms of respiratory dysfunction and medication side effects, particularly those that require notification of a physician;

 

(c)The initiation and maintenance of cardiopulmonary resuscitation and other related life-support procedures;

 

(d)The mechanics of ventilation and ventilator function;

 

(e)The principles of airway maintenance, including endotracheal and tracheotomy care;

 

(f)The effective and safe use of equipment for administering oxygen and other therapeutic gases and providing humidification, nebulization, and medication;

 

(g)Pulmonary function testing and blood gas analysis when these procedures are performed within the ventilator care unit;

 

(h)Methods that assist in the removal of secretions from the bronchial tree, such as hydration, breathing and coughing exercises, postural drainage, therapeutic percussion and vibration, and mechanical clearing of the airway through proper suctioning technique;

 

(i)Procedures and observations to be followed during and after extubation; and

 

(j)Recognition of and attention to the psychosocial needs of residents and their families.

 

3215.5The facility shall ensure that each ventilator is equipped with an alarm, designed to alert the nursing station, on both the pressure valve and the volume valve.

 

3215.6In order to operate a ventilator unit, a facility shall develop and the Department of Health shall approve, a plan of operation which shall include:

 

(a)A description of the services to be provided;

 

(b)A description of the staffing pattern;

 

(c)A description of the qualification, duties and responsibilities of personnel;

 

(d)A quality assurance plan which shall include:

 

(1)Assignment of responsibility for monitoring and evaluation activities;

 

(2)Identification of indicators and appropriate clinical critical criteria for monitoring the most important aspects; and

 

(3)Establishment of thresholds (levels or trends) for the indicators that will trigger evaluation of care;

 

(e)Policies and procedures on the following:

 

(1)The transfer or referral of residents who require services that are not provided by the nursing facility;

 

(2)The administration of medicines unique to the needs of the special care residents;

 

(3)Infection control measures to minimize the transfer of infection in the ventilator unit;

 

(4)Pertinent safety practices, including the control of fire and medical hazards; and

 

(5)Protocols for emergency situations.

 

3215.7When the ventilator care services are provided by an outside contractor, the facility shall:

 

(a)Approve the contractor based on the contractor's credentials, qualifications and experience; and

 

(b)Ensure that all contractors:

 

(1)Provide services twenty-four hours a day;

 

(2)Meet all safety requirements;

 

(3)Abide by all pertinent policies and procedures of the facility;

 

(4)Provide services in accordance with the law governing the facility;

 

(5)Participate in the monitoring and evaluation of the appropriateness of services provided as required by the facility's quality assurance program; and

 

(6)Ensure that all contractural services are under the supervision of the facility's medical director or the physician employed by the facility to coordinate ventilator care services.

 

source

Notice of Final Rulemaking published at 49 DCR 473 (January 18, 2002).