Classification of emergency psychiatric services

(a) Level III. A Level III facility shall provide emergency medical 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 psychiatric 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, OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 218 September 13, 2019 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) Outpatient psychiatric resources. The hospital shall maintain a current list of outpatient psychiatric resources available within the community or region and make appropriate referrals for patients who do not require emergency inpatient psychiatric treatment. (4) 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) Psychotropic medications appropriate for treating psychiatric emergencies including benzodiazepines such as lorazepam and neuroleptics such as haloperidol; and (B) Thiamine and glucose for intravenous administration. (5) 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 psychiatrist, or group of psychiatrists to provide immediate consultative services for psychiatric patients twenty-four (24) hours a day. Such services shall include providing instructions for the initiation of appropriate therapy and/or patient transfer. (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 psychiatric services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 219 September 13, 2019 of the emergent psychiatric 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 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) Outpatient psychiatric resources. The hospital shall maintain a current list of outpatient psychiatric resources available within the community or region and make appropriate referrals for patients who do not require emergency inpatient psychiatric treatment. (C) Diagnostic imaging. The hospital shall have diagnostic x-ray services available twenty-four (24) hours a day. A radiologic 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 hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (D) 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; (iv) Therapeutic drug monitoring; (v) Drug and alcohol screening; and (vi) 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 (vii) 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. (viii) 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) Psychiatrist. A physician board certified, board eligible, OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 220 September 13, 2019 or residency trained in psychiatry shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four (24) hours a day. (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) Equipment to perform electroencephalographic (EEG) testing; (B) Psychotropic medications appropriate to deal with psychiatric emergencies including benzodiazepines such as lorazepam and neuroleptics such as haloperidol; and (C) Thiamine and glucose for intravenous administration. (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 psychiatrist, or group of psychiatrists to provide immediate consultative services for psychiatric 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 Level I facility shall provide emergency medical services with organized emergency and psychiatry departments. A physician and nursing staff with special capability in psychiatric care shall be on site twenty-four (24) hours a day. The facility shall have the capability to provide immediate emergency inpatient psychiatric treatment twenty-four (24) hours a day. A hospital shall be classified at Level I for emergency psychiatric 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 psychiatric patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in psychiatric care shall be on site twenty-four (24) hours a day. Emergency room personnel shall be provided with training on the facility's policies and procedures related to psychiatric patients including those for the use of physical and chemical restraints and seclusion, obtaining informed consent for psychotropic medications, suicide precautions, patient right to refuse treatment and the duty to protect, Emergency Order of Detention and commitment procedures, and determining a patient's legal status. 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) Psychiatry. The facility shall have an organized psychiatric service with appropriately credentialed physicians immediately available twenty-four (24) hours a day. Physician members of the psychiatric service shall be board certified, board eligible, or residency trained in psychiatry. On call physicians shall respond as required by the hospital's policy. (C) Outpatient psychiatric resources. The hospital shall OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 221 September 13, 2019 maintain a current list of outpatient psychiatric resources available within the community or region and make appropriate referrals and follow-ups for patients who do not require emergency inpatient psychiatric treatment. (D) Inpatient psychiatric services. All inpatient psychiatric services shall be provided under the direction of a physician director of inpatient psychiatric services and shall comply with Subchapter 33 of this Chapter. (E) Diagnostic Imaging. The hospital shall have diagnostic x-ray and computed tomography services available twenty-four (24) hours a day. A radiologic technologist and computerized tomography technologist 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) Computed tomography; (ii) Magnetic resonance imaging; and (iii) Neuroradiology. (iv) 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. (F) 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) Therapeutic drug monitoring; (v) Drug and alcohol screening; and (vi) 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 (vii) 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. (G) 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) Psychiatric services director. The medical staff shall designate a physician credentialed to provide psychiatric care as OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 222 September 13, 2019 psychiatric services director. (C) Psychiatric nursing services director. A registered nurse with experience in psychiatric nursing shall be responsible for psychiatric nursing service administration. (D) Physician qualifications. Physician members of the psychiatry service shall be board certified, board eligible, or residency trained in psychiatry. (3) Supplies and equipment: Emergency department. In addition to the requirements at OAC 310:667-59-19(d)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: (A) Equipment to perform electroencephalographic (EEG) testing; (B) Psychotropic medications appropriate to deal with psychiatric emergencies including benzodiazepines such as lorazepam and neuroleptics such as haloperidol; and (C) Thiamine and glucose for intravenous administration. (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.