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WAC 246-976-800

Agency filings affecting this section

Trauma rehabilitation service standards.

WAC 246-976-800 Trauma Rehabilitation Service Standards
Levels
A designated trauma rehabilitation service must:
I
II
III
I Pediatric
(1) Be a licensed hospital as defined in chapter 246-320 WAC.
X
 
 
X
(2) Treat adult and adolescent trauma patients in inpatient and outpatient settings regardless of disability or level of severity or complexity.
X
 
 
 
(3) Treat pediatric and adolescent trauma patients in inpatient and outpatient settings regardless of disability or level of severity or complexity.
 
 
 
X
(4) Treat adult and adolescent trauma patients in inpatient and outpatient settings with disabilities or level of severity or complexity within the facility's capability and as specified in the facility's admission criteria.
 
X
 
 
(5) For adolescent patients (approximately twelve to eighteen years of age), the service must consider whether physical development, educational goals, preinjury learning or developmental status, social or family needs, and other factors indicate treatment in an adult or pediatric rehabilitation service.
X
X
 
X
(6) Have and retain full accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) for inpatient medical rehabilitation programs.
X
X
 
 
(7) Have and retain full accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) for pediatric inpatient medical rehabilitation programs.
 
 
 
X
(8) House patients on a designated rehabilitation nursing unit.
X
X
 
 
(9) House patients in a designated pediatric rehabilitation area, providing an environment appropriate to the age and developmental status of the patient.
 
 
 
X
(10) Provide a peer group for persons with similar disabilities.
X
X
 
X
(11) Have a medical director who:
X
X
 
X
(a) Is a physiatrist;
 
 
 
 
(b) Is responsible for the organization and direction of the trauma rehabilitation service; and
 
 
 
 
(c) Participates in the trauma rehabilitation service's quality improvement program.
 
 
 
 
(12) Have a physiatrist in-house or on-call twenty-four hours every day and responsible for the day-to-day clinical management and the treatment plan of trauma patients.
X
X
 
X
(13) Provide rehabilitation nursing personnel twenty-four hours every day, with:
X
X
 
X
(a) Management and supervision by a registered nurse;
X
X
 
X
(b) The initial care plan and weekly update reviewed and approved by a certified rehabilitation registered nurse (CRRN);
X
X
 
X
(c) An orientation and training program for all levels of rehabilitation nursing personnel;
X
X
 
X
(d) A minimum of six clinical nursing care hours, per patient day, for each trauma patient;
X
X
 
X
(e) At least one CRRN on duty, each day and evening shift, when a trauma patient is present;
X
 
 
X
(f) At least one CRRN on duty, one shift each day, when a trauma patient is present.
 
X
 
 
(14) Provide the following trauma rehabilitation services with providers who are licensed, registered, certified, or degreed and are available to provide treatment as defined in the patient's rehabilitation plan:
X
X
 
X
(a) Occupational therapy;
X
X
 
X
(b) Physical therapy;
X
X
 
X
(c) Speech/language pathology;
X
X
 
X
(d) Social services;
X
X
 
X
(e) Nutritional counseling;
X
X
 
X
(f) Clinical psychological services, including testing and counseling;
X
X
 
X
(g) Neuropsychological services.
X
X
 
X
(15) Provide the following health personnel and consultative services in-house or on-call twenty-four hours every day:
X
X
 
X
(a) A pharmacist with immediate access to pharmaceuticals and patient medical records and pharmacy data bases;
X
X
 
X
(b) Respiratory care practitioners;
X
X
 
X
(c) Pastoral or spiritual care;
X
X
 
X
(d) A radiologist;
X
X
 
X
(e) A pediatrician.
 
 
 
X
(16) Provide the following services in-house or through affiliation or consultative arrangements with providers who are licensed, registered, certified, or degreed:
X
X
 
X
(a) Anesthesiology (anesthesiologist or CRNA);
X
X
 
X
(b) Audiology;
X
X
 
X
(c) Communication augmentation;
X
X
 
X
(d) Dentistry;
X
X
 
X
(e) Diagnostic imaging, including:
X
X
 
X
(i) Computerized tomography;
 
 
 
 
(ii) Magnetic resonance imaging;
 
 
 
 
(iii) Nuclear medicine; and
 
 
 
 
(iv) Radiology;
 
 
 
 
(f) Driver evaluation and training;
X
X
 
 
(g) Educational program appropriate to the disability and developmental level of the pediatric or adolescent patient, to include educational screening, instruction, and discharge planning coordinated with the receiving school district;
X
X
 
X
(h) Electrophysiologic testing, including:
X
X
 
X
(i) Electroencephalography;
 
 
 
 
(ii) Electromyography; and
 
 
 
 
(iii) Evoked potentials;
 
 
 
 
(i) Laboratory services;
X
X
 
X
(j) Orthotics;
X
X
 
X
(k) Prosthetics;
X
X
 
X
(l) Pediatric therapeutic recreation specialist or child life specialist;
 
 
 
X
(m) Rehabilitation engineering for device development and adaptations;
X
X
 
X
(n) Substance abuse counseling;
X
X
 
X
(o) Therapeutic recreation;
X
X
 
X
(p) Vocational rehabilitation;
X
X
 
 
(q) Urodynamic testing.
X
X
 
X
(17) Have providers with documented special competence in pediatric rehabilitation care. This requirement applies to all pediatric trauma rehabilitation providers.
 
 
 
X
(18) Serve as a regional referral center for patients in their geographical area needing only level II or III rehabilitation care.
X
 
 
 
(19) Have an outreach program regarding trauma rehabilitation care, consisting of telephone and on-site consultations with physicians and other health care professionals in the community and outlying areas.
X
X
 
X
(20) Have a formal program of continuing trauma rehabilitation care education, both in-house and outreach, provided for nurses and allied health care professionals.
X
X
 
X
(21) Have an ongoing structured program to conduct clinical studies, applied research, or analysis in rehabilitation of trauma patients, and report results within a peer review process.
X
 
 
X
(22) Have a quality improvement program that reflects and demonstrates a process for continuous quality improvement in the delivery of trauma rehabilitation care, with:
X
X
 
X
(a) An organizational structure and plan that facilitates the process of quality improvement and identifies the authority to change policies, procedures, and protocols that address the care of the trauma patient;
 
 
 
 
(b) Representation and participation by the interdisciplinary trauma rehabilitation team;
 
 
 
 
(c) A process for communicating and coordinating with referring trauma care providers as needed;
 
 
 
 
(d) Development of outcome standards;
 
 
 
 
(e) A process for monitoring compliance with or adherence to the outcome standards;
 
 
 
 
(f) A process of internal peer review to evaluate specific cases or problems;
 
 
 
 
(g) A process for implementing corrective action to address problems or deficiencies;
 
 
 
 
(h) A process to analyze and evaluate the effect of corrective action; and
 
 
 
 
(i) A process to ensure that confidentiality of patient and provider information is maintained according to the standards of RCW 70.41.200 and 70.168.090.
 
 
 
 
(23) Participate in the regional trauma quality improvement program as defined in WAC 246-976-910.
X
X
X
X
(24) Participate in the Washington state trauma registry as defined in WAC 246-976-430.
X
X
X
X
(25) Provide a community based program of coordinated and integrated outpatient trauma rehabilitation services, evaluation, and treatment to persons with trauma-related functional limitations who do not need or no longer require comprehensive inpatient rehabilitation. Services may be provided in, but not limited to, the following settings:
 
 
X
 
(a) Freestanding outpatient rehabilitation centers;
 
 
 
 
(b) Organized outpatient rehabilitation programs in acute hospital settings;
 
 
 
 
(c) Day hospital programs;
 
 
 
 
(d) Other community settings.
 
 
 
 
(26) Treat patients according to admission criteria based on diagnosis and severity.
 
 
X
 
(27) Be directed by a physician with training and experience necessary to provide rehabilitative physician services, acquired through one of the following:
 
 
X
 
(a) Formal residency in physical medicine and rehabilitation; or
 
 
 
 
(b) A fellowship in rehabilitation for a minimum of one year; or
 
 
 
 
(c) A minimum of two years' experience in providing rehabilitation services for patients typically seen in CARF-accredited inpatient rehabilitation programs.
 
 
 
 
(28) Provide the following trauma rehabilitation services with providers who are licensed, registered, or certified according to the frequency as defined in the rehabilitation plan:
 
 
X
 
(a) Occupational therapy;
 
 
 
 
(b) Physical therapy;
 
 
 
 
(c) Social services;
 
 
 
 
(d) Speech/language pathology.
 
 
 
 
(29) Provide or assist the patient to obtain the following as defined in the rehabilitation plan:
 
 
X
 
(a) Audiology;
 
 
 
 
(b) Dentistry;
 
 
 
 
(c) Driver evaluation and training;
 
 
 
 
(d) Education;
 
 
 
 
(e) Nursing;
 
 
 
 
(f) Nutrition counseling;
 
 
 
 
(g) Orthotics;
 
 
 
 
(h) Pastoral or spiritual care;
 
 
 
 
(i) Prosthetics;
 
 
 
 
(j) Psychology;
 
 
 
 
(k) Rehabilitation engineering for device development and adaptations;
 
 
 
 
(l) Respiratory therapy;
 
 
 
 
(m) Substance abuse counseling;
 
 
 
 
(n) Therapeutic recreation;
 
 
 
 
(o) Vocational rehabilitation.
 
 
 
 
(30) Have a quality improvement program that reflects and demonstrates a process for continuous quality improvement in the delivery of trauma care, with:
 
 
X
 
(a) A process to identify and monitor trauma rehabilitation care and outcome standards and indicators;
 
 
 
 
(b) An interdisciplinary team, to include the trauma rehabilitation service physician director;
 
 
 
 
(c) A process to ensure confidentiality of patient and provider information in accordance with RCW 70.41.200 and 70.168.090.
 
 
 
 
[Statutory Authority: RCW 70.168.050, 70.168.060, and 70.168.070. WSR 09-23-085, § 246-976-800, filed 11/16/09, effective 12/17/09.]