Health, Family Health and Preparedness, Licensing

Rule R432-11

Orthopedic Hospital Construction

Notice of Proposed Rule

(Amendment)

DAR File No.: 35466
Filed: 11/18/2011 04:18:26 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R432-11-4, coordinates with the revised title of federal accessibility standards and change in technical terms. In Section R432-11-5, updates a referenced standard that is out of date and out of print. Reduces selected requirements to reflect shorter patient stays that are typical today. In Section R432-11-6, coordinates with the reformatted referenced standard. These changes have been vetted in two meetings with providers and interested parties and have been approved by the Health Facilities Committee.

Summary of the rule or change:

In Section R432-11-4, changes the title of the federal accessibility standard to match the revised federal title. In Section R432-11-5, updates the adopted reference from the 2001 Guidelines for Design and Construction of Hospital and HealthCare Facilities to the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities. Reduces bathing requirements to reflect shorter patient stays that are typical today. Clarifies door hardware requirements. In Section R432-11-6, coordinates with reformatting of a referenced standard.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

This rule or change incorporates by reference the following material:

• Updates Guidelines for Design and Construction of Health Care Facilities, published by ASHE (American Society of Healthcare Engineering), 2011 edition

Anticipated cost or savings to:

the state budget:

The cost of purchasing the new referenced standard and the cost of printing and distribution of the revised rule is covered in Rule R432-4, General Construction, which is being amended concurrent with this rule. No other costs are expected. (DAR NOTE: The proposed amendment to Rule R432-4 is under DAR No. 35459 in this issue, December 15, 2011, of the Bulletin.)

local governments:

The rule change has no impact on local government because these standards are enforced at the state level.

small businesses:

Architects and engineers that design new or replacement rehabilitation specialty hospitals buildings will have the cost of purchasing the new standards. The cost to purchase the new standards is $168.

persons other than small businesses, businesses, or local governmental entities:

Orthopedic Specialty Hospitals that build new buildings or remodel existing facilities will have the cost of purchasing the new referenced standards. The cost of the new referenced standard is $168. There are currently two Orthopedic Specialty Hospitals in Utah. Assuming that each Orthopedic Specialty Hospital purchases a copy of the updated standard the aggregate cost to business is $336.

Compliance costs for affected persons:

The cost to Orthopedic Specialty Hospitals constructing or remodeling buildings and architects and engineers designing them for the purchase of the new referenced standards is $168. The rule change will not increase compliance costs for providers.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule has been extensively discussed with the regulated businesses and they appear to concur that updating the rule to adopt updated federal accessibility standards and the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities is appropriate. Public comment received will be carefully evaluated for any unforeseen fiscal impact.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at jhoffman@utah.gov
• Andrew Baxter at the above address, by phone at 801-538-6140, by FAX at 801-538-6325, or by Internet E-mail at andrewbaxter@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/17/2012

This rule may become effective on:

01/24/2012

Authorized by:

David Patton, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-11. Orthopedic Hospital Construction.

R432-11-1. Legal Authority.

This rule is adopted pursuant to Title 26, Chapter 21.

 

R432-11-2. Purpose.

The purpose of this rule is to establish construction standards for a specialty hospital for orthopedic services.

 

R432-11-3. General Design Requirements.

(1) See R432-4-1 through R432-4-22.

(2) All fixtures in resident toilet and bathrooms shall be wheelchair accessible with wheelchair turning space within the room.

 

R432-11-4. General Construction.

See R432-4-23 with the following modifications:

(1) Corridors in patient use areas shall be a minimum eight feet wide.

(2) Handrails shall be provided on both sides of corridors and hallways used by patients and meet the Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines requirements. The top of the rail shall be 34 inches above the floor except for areas serving children and other special care areas.

(3) Plumbing, including medical gas and suction systems are required.

(4) An emergency electrical service is required. An on-site emergency generator shall be provided and the following services shall be connected to the emergency generator:

(a) life safety branch, as defined in section 517-32 of the National Electric Code NFPA 70, which is adopted and incorporated by reference;

(b) critical branch as defined in 517-33 of the National Electric Code NFPA 70, which is adopted and incorporated by reference;

(c) equipment system, as defined in 517-34 of the National Electric Code NFPA 70, which is adopted and incorporated by reference;

(d) telephone;

(e) nurse call;

(f) heating equipment necessary to provide adequate heated space to house all patients under emergency conditions;

(g) one duplex [convenience outlet]receptacle in each patient room;

(h) one duplex [convenience outlet]receptacle at each nurse station;

(i) duplex [convenience outlets]receptacles in the emergency heated area at a ratio of one for each ten patients;

(j) fuel storage capacity shall permit continuous operation for at least 48 hours.

(5) If installed, fixed and mobile X-ray equipment shall comply with Articles 517 and 660 of NFPA 70, which is adopted and incorporated by reference.

 

R432-11-5. General Construction. Patient Service Facilities.

(1) Requirements of R432-4-24 and the requirements of Sections [7 including the Appendix]2.1 and 2.2 of Guidelines for Design and Construction of [Hospital and] Health Care Facilities, [2001]2010 edition (Guidelines) shall be met. Where a modification is cited, the modification supersedes conflicting requirements of the Guidelines.

(2) Nursing Units shall meet the following:

(a) At least two single-bed rooms, with private toilet rooms, shall be provided for each nursing unit.

(b) Minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, shall be 140 square feet in single-bed rooms and 125 square feet per bed in multiple-bed rooms. The listed areas are minimum and do not prohibit larger rooms.

(3) Imaging Suites. Imaging facilities for diagnostic procedures, include the following: radiology, mammography, computerized scanning, ultrasound and other imaging techniques.

(a) Imaging facilities may be provided within the facility or through contractual arrangement with a qualified radiology service or nearby hospital.

(b) If imaging facilities are provided in-house, they shall meet the requirements for an imaging suite defined in Guidelines for Design and Construction of [Hospital and] Health Care Facilities, section [7.10]2.2-3.4.

(4) Laboratory Services.

(a) Laboratory space and equipment shall be provided in-house for testing blood counts, urinalysis, blood glucose, electrolytes, blood urea nitrogen (BUN), and for the collection, processing, and storage of specimens.

(b) In lieu of providing laboratory services in-house, contractual arrangements with a Department-approved laboratory [shall]may be provided. Even when contractual services are arranged, the facility shall maintain space and equipment to perform [the tests listed in R432-105-5(7)(a)]on-site rapid testing.

(5) Pharmacy Guidelines.

(a) The size and type of services provided in the pharmacy shall depend on the drug distribution system chosen and whether the facility proposes to provide, purchase, or share pharmacy services. A description of pharmacy services shall be provided in the functional program.

(b) There shall be a pharmacy room or suite, under the direct control of staff, which is located for convenient access and equipped with appropriate security features for controlled access.

(c) The room shall contain facilities for the dispensing, basic manufacturing, storage and administration of medications, and for handwashing.

(d) In lieu of providing pharmacy services in-house, contractual arrangements with a licensed pharmacy shall be provided. If contractual services are arranged, the facility shall maintain space and basic pharmacy equipment to prepare and dispense necessary medications in back-up or emergency situations.

(e) If additional pharmacy services are provided, facilities shall comply with requirements of Guidelines section [7.17]2.2-4.2.

(6) Linen Services shall comply with R432-4-24[(7)](8).

[(7) Patient bathing facilities shall be provided in each nursing unit at a ratio of one bathing facility for each eight beds not otherwise served by bathing facilities within individual patient rooms.

(a) Each bathtub or shower shall be in an individual room or enclosure adequately sized to allow staff assistance and designed to provide privacy during bathing, drying, and dressing.

(b) Showers in central bathing facilities shall have a floor area of at least four feet square, be curb free, and be designed for use by a wheelchair patient in accordance with ADAAG.

(c) At least one island-type bathtub shall be provided in each nursing unit.

(8)](7) Toilet Facilities. A toilet room, with direct access from the bathing area shall be provided at each central bathing area.

(a) Doors to toilet rooms shall [comply with ADAAG. The doors shall] be equipped with hospital privacy locks or other hardware that protects patient privacy and permit s access from the outside without the use of keys or special tools in case of an emergency.

(b) A handwashing fixture shall be provided for each toilet in each toilet room.

(c) Fixtures shall be wheelchair accessible.

[(9)](8) Patient Day Spaces.

(a) The facility shall include a minimum total inpatient space for dining, recreation, and day use computed on the basis of 30 square feet per bed for the first 100 beds and 27 square feet per bed for all beds in excess of 100.

(b) In addition to the required space defined for inpatients, the facility shall include a minimum of 200 square feet for outpatient and visitors when dining is part of a day care program. If dining is not part of a day care program, the facility shall provide a minimum of 100 square feet of additional outpatient day space.

(c) Enclosed storage space for recreation equipment and supplies shall be provided[in addition to the requirements of R432-105-4].

[(10)](9) Examination and Treatment Room. An examination and treatment room shall be provided except when all patient rooms are single-bed rooms.

(a) An examination and treatment room may be shared by multiple nursing units.

(b) When provided, the room shall have a minimum floor area of 120 square feet, excluding space for vestibules, toilet, closets, and work counters, whether fixed or movable.

(c) The minimum floor dimension shall be ten feet.

(d) The room shall contain a lavatory or sink equipped for handwashing, work counter, storage facilities, and a desk, counter, or shelf space for writing.

[(11)](10) Consultation Room. A consultation room, arranged to permit an evaluation of patient needs and progress, shall be provided. The room shall include a desk and work area for the evaluators, writing and work space for patients, and storage for supplies.

[(12)](11) Surgical Unit. If surgical services are offered, facilities shall be provided in accordance with the Guidelines.

 

R432-11-6. Excluded Guideline Sections.

The following sections of the Guidelines do not apply:

[ (1) Parking, section 7.1.D.

] (1) Oncology Nursing Unit, Section 2.2-2.3

(2) Pediatric and Adolescent Oncology Nursing Unit, Section 2.2-2.4

(3) Intermediate Care Unit, Section 2.2-2.5.

[(2)](4) Critical Care Unit, Section [7.3]2.2-2.6.

(5) Coronary Critical Care Unit, Section 2.2-2.7.

(6) Combined Medical/Surgical Critical Care and Coronary Care Unit, Section 2.2-2.8.

(7) Pediatric Critical Care Unit, Section 2.2-2.9.

[(3)](8) Newborn [Nurseries]Intensive Care Unit, Section [7.4]2.2-2.10.

[(4) Psychiatric Nursing Unit, Section 7.6.

(5)](9) Obstetrical [Facilities]Unit, Section [7.8]2.2-2.11.

(10) Nursery Unit, Section 2.2-2.12.

(11) Pediatric and Adolescent Unit, Section2.2-2.13.

(12) Psychiatric Nursing Unit, Section 2.2-2.14.

(13) In-Hospital Skilled Nursing Unit, Section 2.2-2.15.

(14) Bariatric Care Unit, Section 2.2-2.16.

(15) Freestanding Emergency Care Facility, Section 2.2-3.2.

(16) Interventional Imaging Services, Section 2.2-3.5.

(17) Nuclear Medicine Services, Section 2.2-3.6.

(18) Renal Dialysis Services, Section 2.2-3.9.

(19) Cancer Treatment/Infusion Therapy Service, Section 2.2-3.10.

(20) Gastrointestinal Endoscopy Service, Section 2.2-3.11.

(21) Hyperbaric Suite, Section 2.2-3.12.

(22) Linen Services, Section 2.2-5.2.

[(6) Emergency Services, Section 7.9.

(7) Nuclear Medicine, Section 7.11.

(8)](23) Morgue Facilities, Section [7.16]2.2-5.7.

[ (9) Linen Services, Section 7.23.

]

R432-11-7. Penalties.

The Department may assess a civil money penalty of up to $10,000 and deny approval for patient utilization of new or remodeled areas if a health care provider does not submit architectural drawings to the Bureau of Licensing. The Department may assess a civil money penalty of up to $10,000 if the licensee fails to follow Department-approved architectural plans. The Department may assess a civil money penalty of up to $1,000 per day for each day a new or renovated area is occupied prior to licensing agency approval.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [January 5, 2010]2012

Notice of Continuation: November 24, 2009

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-2.1; 26-21-20