Classification of emergency ophthalmology services

(a) Level III. A Level III facility shall provide services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site twenty-four (24) hours a day. A hospital shall be classified at Level III for emergency ophthalmology services if it meets the following requirements: (1) Clinical services and resources. No diagnostic, surgical, or medical specialty services are required. (2) Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician shall be on site twenty- four (24) hours a day. In the absence of a physician, licensed independent practitioner, registered nurse, or paramedic level emergency medical technician, at least one of the practitioners on duty shall have received training in advanced life support techniques and be deemed competent to initiate treatment of the emergency patient. (A) If the facility is licensed as a General-Medical Surgical Hospital it shall also meet the personnel and staffing requirements at OAC 310:667-29-1 and any other applicable parts of this Chapter. (B) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Psychiatric, it shall also meet the personnel and staffing requirements at OAC 310:667-33-2 and any other applicable parts of this Chapter. (C) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Rehabilitation, it shall also meet the personnel and staffing requirements at OAC 310:667-35-3 and any other applicable parts of this Chapter. (D) If the facility provides emergency medical services and is licensed as a Critical Access Hospital, it shall also meet the personnel and staffing requirements at OAC 310:667-39-14 and any other applicable parts of this Chapter. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 201 September 13, 2019 (A) Ophthalmic irrigating device or procedure and sterile irrigating solution suitable for ophthalmic irrigation; (B) Nitrazine pH paper; (C) Distance and near vision charts or projector, or other equipment for the proper assessment of visual acuity; (D) Ophthalmoscope; (E) Agents for pupillary dilation such as: (i) Topical sympathomimetic; and (ii) Topical parasympatholytics. (F) Drugs for the treatment of acute angle-closure glaucoma including: (i) Topical miotic agents; (ii) Topical adrenergic antagonists; (iii) Oral and intravenous carbonic anhydrase inhibitors; and (iv) Hyperosmotic agents. (G) Topical anesthetic agents; (H) Penlight and loupes or magnifying lenses; (I) Equipment for tonometry; (J) Sterile, individually wrapped, fluorescein impregnated paper strips; (K) Light source with a blue filter or Wood lamp; (L) Lid retractors; (M) Ophthalmic spud device or equivalent; (N) Topical antibiotics; (O) Eye shields; and (P) Supplies and equipment necessary for patching the eye. (4) Agreements and policies on transfers. (A) The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (B) The facility shall have a written agreement with a hospital, or board certified, board eligible, or residency trained ophthalmologist, or group of ophthalmologists to provide immediate consultative services for ophthalmology patients twenty-four (24) hours a day. Such services shall include providing instructions for the initiation of appropriate therapy and/or patient transfer. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice. (b) Level II. A Level II facility shall provide emergency medical services with an organized emergency department. A physician and nursing staff shall be on site twenty-four (24) hours a day. A hospital shall be classified at Level II for emergency ophthalmology services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent ophthalmology patient and credentialed by the hospital to provide emergency medical services and nursing personnel shall be on site twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 202 September 13, 2019 310:667-29-2. (ii) For a hospital licensed as a critical access hospital, emergency services shall also comply with OAC 310:667-39-14. (B) Diagnostic imaging. The hospital shall have diagnostic x-ray services available twenty-four (24) hours a day. A radiology technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (ii) For a hospital licensed as a critical access hospitals, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (C) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing; (ii) Coagulation studies; (iii) Blood gas/pH analysis; and (iv) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (v) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (vi) For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (2) Personnel. (A) Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (B) Ophthalmologist. A physician board certified, board eligible, or residency trained in ophthalmology shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four (24) hours a day. (C) Optometrist. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: (A) Ophthalmic irrigating device or procedure and sterile irrigating solution suitable for ophthalmic irrigation; (B) Nitrazine pH paper; (C) Distance and near vision charts or projector, or other OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 203 September 13, 2019 equipment for the proper assessment of visual acuity; (D) Ophthalmoscope; (E) Agents for pupillary dilation such as: (i) Topical sympathomimetic; and (ii) Topical parasympatholytics. (F) Drugs for the treatment of acute angle-closure glaucoma including: (i) Topical miotic agents; (ii) Topical adrenergic antagonists; (iii) Oral and intravenous carbonic anhydrase inhibitors; and (iv) Hyperosmotic agents. (G) Topical anesthetic agents; (H) Penlight and loupes or magnifying lenses; (I) Equipment for tonometry; (J) Slit-lamp biomicroscope; (K) Sterile, individually wrapped, fluorescein impregnated paper strips; (L) Lid retractors; (M) Ophthalmic spud device or equivalent; (N) Topical antibiotics; (O) Eye shields; and (P) Supplies and equipment necessary for patching the eye. (4) Agreements and policies on transfers. (A) The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (B) The facility shall have a written agreement with a hospital, or board certified, board eligible, or residency trained ophthalmologist, or group of ophthalmologists to provide immediate consultative services for ophthalmology patients twenty-four (24) hours a day. Such services shall include providing instructions for the initiation of appropriate therapy and/or patient transfer. (c) Level I. A facility providing emergency medical services with organized emergency and ophthalmology departments. A physician and nursing staff with special capability in ophthalmic care shall be on site twenty-four (24) hours a day. The facility shall have the capability to provide immediate diagnostic imaging and sight saving surgical intervention twenty-four (24) hours a day. A hospital shall be classified at Level I for emergency ophthalmology services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent ophthalmology patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in ophthalmic care shall be on site twenty-four (24) hours a day. For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667- 29-1 through OAC 310:667-29-2. (B) Ophthalmology and ophthalmic surgery. The facility shall have an organized ophthalmology and ophthalmic surgery service with appropriately credentialed physicians experienced in OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 204 September 13, 2019 ophthalmic medical and surgical procedures immediately available twenty-four (24) hours a day. Physician members of the ophthalmology service shall be board certified, board eligible, or residency trained in ophthalmology. On call physicians shall respond as required by the hospital's policy. (C) Neurology. A board certified, board eligible, or residency trained neurologist shall be on site or on call twenty-four (24) hours a day and promptly available in the emergency department. (D) Anesthesia. A board certified, board eligible, or residency trained anesthesiologist shall be on site or on call twenty-four (24) hours a day and promptly available. All anesthesia shall be administered as required in OAC 310:667-25-2. (E) Operating suite. An operating suite with adequate staff and equipment shall be immediately available twenty-four (24) hours a day. The hospital shall define and document in writing the minimum staffing requirements for the operating suite. An on call schedule for emergency replacement staff shall be maintained. At least one operating suite shall have conventional and laser surgery and photocoagulation capability. (F) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. (G) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. (H) Diagnostic Imaging. The hospital shall have diagnostic x- ray, computed tomography, and ultrasonography services available twenty-four (24) hours a day. A radiologic technologist, computerized tomography technologist, and staff designated as qualified to perform ultrasonography shall be on duty or on call and immediately available twenty-four (24) hours a day. A single technologist designated as qualified in both diagnostic x-ray and computerized tomography procedures by the radiologist may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. The diagnostic imaging service shall provide at least the following services: (i) Angiography; (ii) Ultrasonography; (iii) Computed tomography; (iv) Magnetic resonance imaging; and (v) Neuroradiology. (vi) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (I) Clinical laboratory service. The hospital shall have OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 205 September 13, 2019 clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing; (iii) Coagulation studies; (iv) Blood gas/pH analysis; and (v) Comprehensive microbiology services or at least appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (vi) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (J)Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel. (A) Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (B) Ophthalmology services director. The medical staff shall designate a physician credentialed to provide medical and/or surgical ophthalmic care as ophthalmology services director. (C) Physician qualifications. Physician members of the ophthalmology service shall be board certified, board eligible, or residency trained in ophthalmology. (D) Optometrist. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-19(b)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: (A) Gonioscopy equipment; and (B) Equipment for indirect ophthalmoscopy. (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.