Requirements for all Pediatric Services (Levels I-III)

Pediatric services (Levels I-III) shall comply with the following requirements: (A) Hospitals providing inpatient care to children younger than 15 years old must admit these patients to a level I pediatric area as described in 105 CMR 130.730(C) or a level II pediatric unit or sub-unit, or a level III pediatric unit, with the exception of those patients who require specialized care that cannot be provided in such a pediatric area, unit or sub-unit, such as obstetrics or other care designated by the Department. (B) (1) Any patient 21 years of age or older may be admitted to a pediatric service when in the opinion of the Chiefs of Pediatrics, and the Director of Nursing or their designees, he or she has a condition most appropriately treated on a pediatric service. (2) When a temporary medical emergency fills the medical/surgical service, and the admission to a pediatric unit or sub-unit of certain medical/surgical patients 21 years of age or older poses no danger to pediatric patients, such a medical/surgical patient may be admitted to a pediatric unit or sub-unit with the approval of the Chief of Pediatrics and the Director of Nursing or their designees, provided: (a) No such patient occupies a bed in the same room as a pediatric patient, and (b) The hospital keeps a log of each such admission, which is available for the Department’s inspection. (C) A pediatric service shall establish an advisory multidisciplinary Pediatric Committee, chaired by the Chief of Pediatrics, that meets regularly to advise it on issues related to the service. (D) A pediatric service shall develop and implement written policies and procedures for patients, including but not limited to, requiring transfer and/or consultation, parental involvement to the extent practicable, known or suspected child abuse or neglect, and behavioral health issues. (E) At least one pediatric patient room shall be available for isolation use. (F) A pediatric service shall have appropriately sized equipment and supplies and be responsible for appropriate maintenance per hospital policy, including, but not limited to, resuscitation equipment readily available in all areas and services providing care to pediatric patients (G) The clinical laboratory services available for pediatric patients shall be defined by the Director of Laboratory Services in consultation with the Chief of Pediatrics, the chiefs of other services caring for pediatric patients, and hospital administration. (H) The diagnostic radiological procedures available for pediatric patients shall be defined by the Chief of Radiology in consultation with the Chief of Pediatrics, the chiefs of other services caring for pediatric patients, and hospital administration. (I) All personnel providing direct care to pediatric patients shall participate in a pediatric orientation program that meets the needs of the hospital and its patients. (J) Only Level III pediatric services may have pediatric intensive care units. Ordinarily, patients younger than 15 years old requiring intensive care shall be admitted to pediatric intensive care units in hospitals with Level III pediatric services. When this is inadvisable, such a patient may be admitted to an adult intensive care unit (ICU) if the ICU meets the following criteria for the duration of the pediatric patient’s stay: (1) A physician who is capable of pediatric resuscitation is available in-hospital 24 hours a day. (2) There is a consultation with a pediatrician for every pediatric patient younger than 15 years old admitted to the ICU. (3) A registered nurse with clinical pediatric experience is available to the ICU for nursing consultation and/or care whenever a pediatric patient requires it. (4) Emergency pediatric drug dosages are available in the ICU. (5) Pediatric-sized emergency resuscitation equipment is available in the ICU. (6) Emergency laboratory services utilizing microtechniques shall be available in-hospital 24 hours a day. (7) A radiology technician shall be available in-hospital 24 hours a day. (K) A pediatric service shall provide education on chronic and other related conditions to families of pediatric patients with such conditions, and services to such families. (L) A pediatric service admitting a newborn infant, as defined under 105 CMR 130.601, from either another hospital, birth center, or home, shall verify that the newborn hearing screening has been conducted by the hospital or birth center from which the newborn infant has been transferred or where the newborn infant was born and, in the event it has not been conducted, shall ensure that the screening is performed prior to discharge of the newborn infant, in a manner consistent with standards established by the Department under 105 CMR 130. 616(D)(2)(l).