[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: 42CFR482.51]



[Page 499]

 

                         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 D_Optional Hospital Services

 

Sec. 482.51  Condition of participation: Surgical services.





    If the hospital provides surgical services, the services must be 

well organized and provided in accordance with acceptable standards of 

practice. If outpatient surgical services are offered the services must 

be consistent in quality with inpatient care in accordance with the 

complexity of services offered.

    (a) Standard: Organization and staffing. The organization of the 

surgical services must be appropriate to the scope of the services 

offered.

    (1) The operating rooms must be supervised by an experienced 

registered nurse or a doctor of medicine or osteopathy.

    (2) Licensed practical nurses (LPNs) and surgical technologists 

(operating room technicians) may serve as ``scrub nurses'' under the 

supervision of a registered nurse.

    (3) Qualified registered nurses may perform circulating duties in 

the operating room. In accordance with applicable State laws and 

approved medical staff policies and procedures, LPNs and surgical 

technologists may assist in circulatory duties under the surpervision of 

a qualified registered nurse who is immediately available to respond to 

emergencies.

    (4) Surgical privileges must be delineated for all practitioners 

performing surgery in accordance with the competencies of each 

practitioner. The surgical service must maintain a roster of 

practitioners specifying the surgical privileges of each practitioner.

    (b) Standard: Delivery of service. Surgical services must be 

consistent with needs and resources. Policies governing surgical care 

must be designed to assure the achievement and maintenance of high 

standards of medical practice and patient care.

    (1) There must be a complete history and physical work-up in the 

chart of every patient prior to surgery, except in emergencies. If this 

has been dictated, but not yet recorded in the patient's chart, there 

must be a statement to that effect and an admission note in the chart by 

the practitioner who admitted the patient.

    (2) A properly executed informed consent form for the operation must 

be in the patient's chart before surgery, except in emergencies.

    (3) The following equipment must be available to the operating room 

suites: call-in-system, cardiac monitor, resuscitator, defibrillator, 

aspirator, and tracheotomy set.

    (4) There must be adequate provisions for immediate post-operative 

care.

    (5) The operating room register must be complete and up-to-date.

    (6) An operative report describing techniques, findings, and tissues 

removed or altered must be written or dictated immediately following 

surgery and signed by the surgeon.