Requirements for Tertiary Pediatric Services (Level III)

Tertiary pediatric services (Level III) must meet the requirements listed in 105 CMR 130.720 and 130.740. In addition, Level III services must meet the following requirements (in case of conflict between these requirements and those listed in 105 CMR 130.740, Level III services must meet the requirements listed in 105 CMR 130.750): (A) At least one social worker with an M.S.W. and experience working with pediatric patients and their families must be assigned to the pediatric service. (B) Occupational therapy services must be available in-hospital and provided or supervised by an occupational therapist with documented experience as a pediatric occupational therapist. (C) Physical therapy services must be available in-hospital and provided or supervised by a physical therapist with documented experience as a pediatric physical therapist. (D) There must be a board certified or board eligible radiologist or a radiology resident in- hospital at all times. (E) At least one radiologist and one radiology technician in the hospital at all times must have training and experience in pediatric radiology and radiologic technology respectivelybeyond that required for board certification in radiology and certification in radiologic technology. (F) There must be a pediatric patient recreation program supervised by at least one trained activity therapist, whose education and experience is in one or more of the following fields: child development, early childhood education, or early childhood counseling. (G) Each Level III service must have a pediatric intensive care unit (PICU), discrete from the adult ICU, that is designed and staffed to provide for critically ill or potentially critically ill pediatric patients who need highly specialized intervention and advanced life-support technology. The PICU shall meet the following requirements: (1) The PICU shall be directed by a board-certified pediatrician, or a pediatric anesthesiologist board-certified in anesthesiology, who has documented special training and experience in the care and management of critically-ill pediatric patients. (2) The PICU Director shall be assisted by at least one Associate Director who is a board- certified pediatrician or anesthesiologist with special training and experience in the care and management of critically ill pediatric patients. (3) A physician who is responsible for the PICU patients shall be in-hospital 24 hours a day. (4) A person capable of intubating and resuscitating pediatric patients shall be available within or immediately adjacent to the PICU 24 hours a day. (5) Consultant board-certified physicians with training and experience in the following: pediatric surgery, cardio-thoracic surgery, neurosurgery, and neurology shall be available to the PICU 24 hours a day. Consultants from other subspecialties shall be available as necessary. (6) The hospital shall designate a registered nurse who has responsibility and accountability for the 24 hour nursing management of the PICU service. She or he shall have at least five years of nursing experience, of which at least two years is pediatric nursing experience, be bachelor’s prepared and meet the qualifications for the management position as defined by hospital policy. (7) Registered nurses in the PICU shall have had documented experience in either clinical pediatric nursing or adult medical/surgical nursing and shall have received specialized orientation in the care and management of critically-ill pediatric patients prior to assuming PICU staff nurse positions. (8) The registered nurse/patient ratio in the PICU shall be between 1:1 and 1:2, depending upon the number of nursing care hours required by each patient in accordance with M.G.L. c. 111, § 231 and 958 CMR 8.00: Patient Assignment Limits for Registered Nurses in Intensive Care Units in Acute Hospitals. (9) Support personnel Respiratory therapyservices necessaryto operate, maintain, regulate, or repair monitoring and ventilatory equipment shall be available to the PICU 24 hours a day.