Administration

(1) The facility administration shall provide the following: (a) Adequate and properly trained personnel who can demonstrate competency in pediatric patient care delivery in their assigned area of the facility. This shall include, but is not limited to, the following required pediatric skills and competencies that are assessed annually: 1. Recognition, interpretation and recording of age-appropriate physiological variables; 2. Capable of managing pediatric shock and respiratory failure including early recognition and stabilization of problems that may lead to shock and respiratory failure; 3. Medication administration and fluid administration; 4. Resuscitation (including cardiopulmonary resuscitation certification and PALS or similar certification); 5. Respiratory care techniques; 6. Preparation and maintenance of patient monitors; and 7. Principles of patient and family centered care and psychosocial skills to meet the needs of both the patient and his/her family. (b) A policy requiring annual pediatric multidisciplinary mock codes for staff caring for pediatric patients. (c) A Physician Pediatric Emergency Care Coordinator and a Nurse Pediatric Emergency Care Coordinator responsible for assuring readiness of staff and facility to provide emergency services to children at the facility’s designated level of care. 1. The physician PECC and the nurse PECC shall work collaboratively to facilitate all aspects of pediatric readiness within the facility. Aspects of pediatric readiness shall include, but are not limited to, multidisciplinary staff education, medication, equipment, supplies, quality and performance improvement, policies and procedures, integration of pediatric needs in facility disaster and/or emergency plans and collaboration with regional pediatric care agencies and committees. 2. The physician and nurse PECCs may be concurrently assigned other roles in the ED or may oversee more than one program in the ED. The CRPC who has the educational agreement with the facility shall be notified of any changes in the Physician and Nurse PECC personnel. 3. PECC roles may be shared through formal agreements with administrative entities when applied within facility systems. STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 (d) The financial resources to provide the emergency department or the pediatric emergency department with the equipment necessary to provide the level of services of the designated PECF classification. (e) Facilities designed for easy access and appropriate for the care of pediatric patients at the designated PECF classification. (f) Access to emergency care for all urgent and emergent pediatric patients regardless of financial status. (g) Participation in a network of pediatric emergency care within the region where it is located by linking the facility with a regional referral center to: 1. Guarantee transfer and transport agreements to include at least one CRPC, and 2. Refer critically ill patients to an appropriate facility. (h) Basic, Primary, General, and General with a PICU facilities shall have one education agreement with a CRPC. (i) A collaborative environment with EMS and EMSC systems to educate pre-hospital personnel, nurses and physicians. (j) Collaboration with pre-hospital care and transport. (k) Public education regarding access to pediatric emergency care, injury prevention, first aid and cardiopulmonary resuscitation. (l) A QA and QI program in all areas that provide pediatric care that shall include, but is not limited, to the following indicators: 1. Deaths; 2. Incident reports; 3. Child abuse cases; 4. Cardiopulmonary or respiratory arrests; 5. Admissions within forty-eight (48) hours after being discharged from the emergency department; 6. Surgery within forty-eight (48) hours after being discharged from an emergency department; 7. Pediatric transfers; 8. Pediatric inpatient illness and injury outcome data; 9. Participation in a QI program in both a CRPC and a General Facility with a PICU which compares their PICU performance with PICUs of similar census and capabilities; 10. Program specific objectives for hospital pediatric readiness as defined by the current version of the U.S. Department of Health and Human Services’ Health STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Resources and Services Administration’s Maternal and Child Health Bureau’s Emergency Medical Services for Children Program’s National EMSC Performance Measures; and 11. Facilities shall participate in data collection to assure that quality indicators, as established by the Board are monitored; and the data shall be made available to a central data monitoring agency, as approved by the Board. (m) Resuscitation equipment and a metric weight-based medication resource are available in any area caring for a pediatric patient. (2) In a Comprehensive Regional Pediatric Center, facility administration shall also: (a) Provide assistance to local and state agencies for EMS and EMSC in organizing and implementing a network for providing pediatric emergency care within a defined region that: 1. Provides transfer and transport agreements with other classifications of facilities; 2. Provides transport services when needed for receiving critically ill or injured patients within the regional network; 3. Provides necessary consultation to participating network facilities; 4. Organizes and implements a network of educational support that: (i) Trains instructors to teach pediatric pre-hospital, nursing and physician- level emergency care; (ii) Assures that training courses are available to all facilities and health care providers utilizing pediatric emergency care facilities within the region; (iii) Supports EMS agencies and EMS Directors in maintaining a regional network of pre-hospital provider education and training; (iv) Assures dissemination of new information and maintenance of pediatric emergency skills; (v) Updates standards of care protocols for pediatric emergency care; (vi) Assures that emergency departments and pediatric intensive care units within the facility shall participate in regional education for emergency medical service providers, emergency departments and the general public; (vii) Provides public education and promotes patient and family centered care in relation to policies, programs and environments for children treated in emergency departments. 5. Assists in organizing and providing support for regional, state and national data collection efforts for EMSC that: (i) Defines the population served; (ii) Maintains and monitors pediatric specific quality indicators; (iii) Includes injury and illness epidemiology; STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 (iv) Includes trauma/illness registry (this shall include severity, site, mechanism and classification of injury/illness, plus demographic information, outcomes and transport information); (v) Is adaptable to answer questions for clinical research; and (vi) Supports active institutional and collaborative regional and statewide research. (b) Organize a structured QI program with the assistance and support of local/state EMS and EMSC programs that allows ongoing review and: 1. Reviews all issues and indicators described under all classifications of Pediatric Emergency Care Facilities emergency departments; 2. Provides feedback, quality review and information to all participating facilities, EMS and transport systems, and appropriate state agencies; 3. Develops quality indicators for the review of pediatric care which are linked to periodic continuing education and reviewed at all participating institutions; 4. Reviews all pediatric trauma and medical related morbidity and mortality, including those that are primary admitted patients versus secondary transferred patients; and 5. Evaluates the emergency services provided for children with an emphasis on patient and family centered philosophy of care, family participation in care, family support during emergency visits and transfers and family information and decision-making. (c) Provide the following pediatric emergency department/trauma center personnel: 1. A physician on duty in the emergency department who is board eligible or board certified and meets the requirements of maintenance of certification in pediatric emergency medicine; or was a credentialed pediatric emergency medicine provider in Tennessee prior to the promulgation of these rules. 2. Physicians who are board eligible or board certified and meet the requirements of maintenance of certification, or who were credentialed providers in Tennessee prior to the promulgation of these rules in the following subspecialties: pediatric surgery, pediatric orthopedic surgery, neurosurgery and pediatric anesthesiology. (i) These physicians shall be readily available to the emergency department twenty-four (24) hours per day, seven (7) days per week and shall also be promptly available around the clock as determined by the patient’s acuity. (ii) For on-call physician coverage, if the physician is not a pediatric subspecialty trained provider, then they should have sufficient training and experience in pediatric emergency and trauma care and be knowledgeable about current management of pediatric trauma and emergent medical problems in their specialty. 3. The CRPC shall also have other subspecialty trained surgical and medical providers who are board eligible or board certified and meet the requirements of maintenance of certification, or who were credentialed providers in Tennessee STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 prior to the promulgation of these rules in their respective subspecialty as listed in Table 1. 4. Registered nurses with pediatric emergency, pediatric critical care or pediatric surgical experience as well as training in trauma care; 5. Laboratory personnel, a radiology technician and a respiratory therapist with pediatric experience; 6. Available support services to the emergency department as included in Table 1; 7. A CRPC Coordinator position whose responsibilities include, but are not limited to: (i) Being a regional liaison and coordinator for the statewide EMSC project, including participation in CRPC Coordinator meetings quarterly; (ii) Planning and providing educational activities to meet the needs of the emergency network facilities and pre-hospital providers; (iii) Support of maintaining and updating the CRPC Pediatric Facility Notebook, which may be in electronic format; (iv) Review and coordination of quality improvement indicators for emergency network facilities and pre-hospital providers; (v) Attending a conference on pediatric emergency and/or critical care on a yearly basis; (vi) Serving as a resource person for national, state and regional EMS health professionals, health department officials, community colleges/universities, facilities, physicians, and professional societies to coordinate EMSC project activities and share program expertise in their regions; and (vii) Utilizing data collected by the CRPC from pre-hospital and facility records to provide data for performance improvement, education and research.