[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR482.23]



[Page 488-489]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 482_CONDITIONS OF PARTICIPATION FOR HOSPITALS--Table of Contents

 

                   Subpart C_Basic Hospital Functions

 

Sec. 482.23  Condition of participation: Nursing services.



    The hospital must have an organized nursing service that provides 

24-hour nursing services. The nursing services must be furnished or 

supervised by a registered nurse.



[[Page 489]]



    (a) Standard: Organization. The hospital must have a well-organized 

service with a plan of administrative authority and delineation of 

responsibilities for patient care. The director of the nursing service 

must be a licensed registered nurse. He or she is responsible for the 

operation of the service, including determining the types and numbers of 

nursing personnel and staff necessary to provide nursing care for all 

areas of the hospital.

    (b) Standard: Staffing and delivery of care. The nursing service 

must have adequate numbers of licensed registered nurses, licensed 

practical (vocational) nurses, and other personnel to provide nursing 

care to all patients as needed. There must be supervisory and staff 

personnel for each department or nursing unit to ensure, when needed, 

the immediate availability of a registered nurse for bedside care of any 

patient.

    (1) The hospital must provide 24-hour nursing services furnished or 

supervised by a registered nurse, and have a licensed practical nurse or 

registered nurse on duty at all times, except for rural hospitals that 

have in effect a 24-hour nursing waiver granted under Sec. 405.1910(c) 

of this chapter.

    (2) The nursing service must have a procedure to ensure that 

hospital nursing personnel for whom licensure is required have valid and 

current licensure.

    (3) A registered nurse must supervise and evaluate the nursing care 

for each patient.

    (4) The hospital must ensure that the nursing staff develops, and 

keeps current, a nursing care plan for each patient.

    (5) A registered nurse must assign the nursing care of each patient 

to other nursing personnel in accordance with the patient's needs and 

the specialized qualifications and competence of the nursing staff 

available.

    (6) Non-employee licensed nurses who are working in the hospital 

must adhere to the policies and procedures of the hospital. The director 

of nursing service must provide for the adequate supervision and 

evaluation of the clinical activities of non-employee nursing personnel 

which occur within the responsibility of the nursing service.

    (c) Standard: Preparation and administration of drugs. Drugs and 

biologicals must be prepared and administered in accordance with Federal 

and State laws, the orders of the practitioner or practitioners 

responsible for the patient's care as specified under Sec. 482.12(c), 

and accepted standards of practice.

    (1) All drugs and biologicals must be administered by, or under 

supervision of, nursing or other personnel in accordance with Federal 

and State laws and regulations, including applicable licensing 

requirements, and in accordance with the approved medical staff policies 

and procedures.

    (2) All orders for drugs and biologicals must be in writing and 

signed by the practitioner or practitioners responsible for the care of 

the patient as specified under Sec. 482.12(c) with the exception of 

influenza and pneumococcal polysaccharide vaccines, which may be 

administered per physician-approved hospital policy after an assessment 

for contraindications. When telephone or oral orders must be used, they 

must be--

    (i) Accepted only by personnel that are authorized to do so by the 

medical staff policies and procedures, consistent with Federal and State 

law;

    (ii) Signed or initialed by the prescribing practitioner as soon as 

possible; and

    (iii) Used infrequently.

    (3) Blood transfusions and intravenous medications must be 

administered in accordance with State law and approved medical staff 

policies and procedures. If blood transfusions and intravenous 

medications are administered by personnel other than doctors of medicine 

or osteopathy, the personnel must have special training for this duty.

    (4) There must be a hospital procedure for reporting transfusion 

reactions, adverse drug reactions, and errors in administration of 

drugs.



[51 FR 22042, June 17, 1986, as amended at 67 FR 61814, Oct. 2, 2002]