Requirements for General Pediatric Services (Level II)

General pediatric services (Level II) must meet the following requirements in addition to those listed in 105 CMR 130.720: (A) Environment. The hospital must have either: (1) a discrete unit designated for pediatric patients; or (2) a discrete sub-unit within an adult care unit containing beds permanently designated as pediatric beds, provided this sub-unit meets the following requirements: (a) Such pediatric beds are located in a specific room, or contiguous specific rooms, and such beds and other support equipment are appropriate for pediatric patients younger than 15 years old. (b) The nursing station or sub-station serving pediatric patients is adjacent to the room(s) containing beds designated for pediatric patients. Observation of these rooms is possible from the nursing station or sub-station. (c) The pediatric service has written policies specifying the ages and types of diagnoses of patients who may be admitted to the sub-unit for elective and emergency purposes, and the types of procedures that may be performed on them. (d) The pediatric sub-unit is situated in such a way that the flow of adult patients through it is discouraged. (3) The service must have an area or areas that are used primarily for recreation or play, and equipped with items appropriate for the pediatric patients of the age using the areas. (B) Administration and Staffing. (1) The hospital must have a designated Chief of Pediatrics who is a board certified pediatrician. The Chief of Pediatrics or one or more physicians designated by the Chief shall be on call at all times for the care of pediatric patients. (2) There must be a physician trained in pediatric resuscitation available in-hospital 24 hours a day. (3) Any pediatric residents and interns assigned to a Level II service shall be supervised by a pediatrician with full privileges at the hospital. (4) A registered nurse designated by the hospital shall be accountable for the 24 hour nursing management of the Level II service. At a minimum, this nurse shall have at least five years of documented nursing experience of which at least two years is pediatric nursing experience and be bachelor’s prepared. (5) At least one registered nurse with pediatric nursing experience shall be assigned to work in each pediatric unit or sub-unit at all times. (C) Services. (1) Social services for pediatric patients must be available in-hospital or through consultant arrangements, and their existence must be made known to the families of pediatric patients. (2) Physical and occupational therapy services shall be available in-hospital or through consultant arrangements. (3) A technician to perform laboratory tests shall be available on a 24-hour basis, in-hospital or on call within l5 minutes. (4) A radiology technician shall be available on a 24-hour basis, in-hospital or ready to obtain images within 30 minutes. (5) When necessary, a registered dietitian shall be available to Level II service staff and the families of pediatric patients for consultation concerning pediatric nutrition. (6) Pharmacy services including 24-hour availability of medications and intravenous solutions must be available in-hospital. Pharmacy consultations with pharmacists experienced in pediatrics must be available on call 24 hours a day.