CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

NAC 449.556 Staff responsible for operating water treatment system. (NRS 449.0302) 1. Each member of the staff of a facility who is responsible for operating the water treatment system of the facility must demonstrate to the satisfaction of the Bureau that he or she understands t…

NAC 449.5565 Staff that repairs or maintains equipment used to provide care to patients. (NRS 449.0302) A facility shall not allow a member of the staff of the facility to repair or maintain any equipment of the facility that is used to provide care to a patient of the facility u…

NAC 449.558 Preparation and maintenance. (NRS 449.0302) 1. Each facility shall establish a system for preparing and maintaining a clinical record for each patient of the facility. The system must be developed to ensure that the care provided to each patient of the facility is: (a…

NAC 449.5585 Additional requirements. (NRS 449.0302) 1. In addition to the provisions of NAC 449.558, the clinical record of each patient of a facility must include: (a) An accurate assessment of the progress of the patient, including all changes in the medical status of the pati…

NAC 449.559 Medical history and physical examination. (NRS 449.0302) Each facility shall prepare a medical history of each patient of the facility and conduct a physical examination of the patient. The medical history and physical examination must be completed within 30 days befo…

NAC 449.5595 Transient patients. (NRS 449.0302) 1. The clinical record of each transient patient of a facility must include: (a) Each order for the treatment of the patient at the treating facility; (b) Each laboratory report ordered by the treating facility concerning the patien…

NAC 449.561 Discharge or transfer of patients; removal of records. (NRS 449.0302) 1. If a patient of a facility is discharged from the facility, the facility shall, within 30 days after the patient is discharged, prepare a discharge summary concerning the patient. The discharge s…

NAC 449.5615 Cessation of operation of facility. (NRS 449.0302) If a facility ceases to operate, the facility shall: 1. Ensure the preservation of the clinical records of the facility; and 2. Not more than 30 days after the facility ceases to operate, notify the Bureau in writing…

NAC 449.570 General qualifications; identification to be worn during training; provision of care; requirements to act as preceptor. (NRS 449.0302) 1. A person may not act as a dialysis technician at a facility unless he or she is qualified in accordance with the provisions of NAC…

NAC 449.5705 Qualification of technician determined to be qualified before July 1, 2001. (NRS 449.0302) 1. If a person completes an orientation program of a facility pursuant to the provisions of NAC 449.5525 and has been determined by the facility to be qualified to provide dial…

NAC 449.571 Program of training: Curriculum; duties of instructor; written examinations. (NRS 449.0302) 1. Each program for training a dialysis technician provided by a facility must consist of a written curriculum that specifies the objectives for each portion of the course. 2. …

NAC 449.5715 Program of training: Qualifications of instructors. (NRS 449.0302) Each instructor who provides instruction pursuant to a program of training specified in NAC 449.571 must be: 1. A physician who is qualified as a medical director in accordance with the provisions of …

NAC 449.573 Program of training: Certain persons authorized to provide instruction and serve as preceptor. (NRS 449.0302) If a licensed nurse or dialysis technician has at least 1 year of experience in performing hemodialysis and has filed with the facility a current written list…

NAC 449.5735 Program of training: Required hours. (NRS 449.0302) 1. Except as otherwise provided in subsection 2, each program of training specified in NAC 449.571 must consist of at least 80 hours of education in the classroom and 200 hours of directly supervised clinical traini…

NAC 449.574 Committee to review program of training. (NRS 449.0302) Each facility shall appoint a committee to review the training provided pursuant to a program of training specified in NAC 449.571. The membership of the committee must consist of at least the medical director, s…

NAC 449.5745 Written list concerning knowledge and skills. (NRS 449.0302) The supervising nurse or a registered nurse of a facility who qualifies as an instructor for the facility shall complete a written list to determine the knowledge and skills of each dialysis technician in p…

NAC 449.576 Peritoneal dialysis: Additional activities required. (NRS 449.0302) In addition to the written list required pursuant to the provisions of NAC 449.5745, if a dialysis technician who is enrolled in a course of training pursuant to the provisions of NAC 449.571 intends …

NAC 449.5765 Cannulation or administration of normal saline or heparin: Additional activities required. (NRS 449.0302) In addition to the written list required pursuant to the provisions of NAC 449.5745, if a dialysis technician who is enrolled in a course of training pursuant to…

NAC 449.577 Cannulation or administration of normal saline, heparin or lidocaine: Verification and documentation of competency required. (NRS 449.0302) If a dialysis technician intends to cannulate a dialysis access during the treatment of a patient of the facility or administer …

NAC 449.5775 Documentation of successful completion of program of training; employment by another facility. (NRS 449.0302) 1. A facility shall issue to each dialysis technician who successfully completes a program of training and receives an evaluation of his or her competency pr…

NAC 449.579 Patient care: Technicians must demonstrate certain knowledge and competency. (NRS 449.0302) A dialysis technician who provides care directly to a patient of a facility must demonstrate knowledge of and competency to carry out the responsibilities specified in NAC 449.…

NAC 449.5795 Prohibited acts. (NRS 449.0302) A dialysis technician of a facility shall not: 1. Initiate the provision of education for any patient of the facility; 2. Alter any treatment that is ordered for a patient of the facility, including shortening the period for providing …

NAC 449.612 Definitions. (NRS 449.0302) As used in NAC 449.612 to 449.61256, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.612011 to 449.612017, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Bd. of Hea…

NAC 449.612011 “Approval” defined. (NRS 449.0302) “Approval” means the approval granted by the Division to a hospital authorizing the hospital to perform open-heart surgery. (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

NAC 449.612012 “Approved hospital” defined. (NRS 449.0302) “Approved hospital” means a hospital that has obtained approval from the Division to perform open-heart surgery. (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

NAC 449.612014 “Cardiac surgery” defined. (NRS 449.0302) “Cardiac surgery” means an operation performed on the heart or on the blood vessels connected to the heart in which access to the area of interest is provided by means of an incision in the wall of the thorax or for which t…

NAC 449.612017 “Open-heart surgery” defined. (NRS 449.0302) “Open-heart surgery” means any cardiac surgery requiring the use of a heart-lung bypass machine. (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

NAC 449.61202 Prerequisites to initial provision of service. (NRS 449.0302) A hospital that desires to provide a new service for the performance of open-heart surgery must make application to the Division requesting approval of the service. A hospital shall not provide such a ser…

NAC 449.61204 Form and contents of application for approval to provide service. (NRS 449.0302) 1. The application for approval must include a statement describing: (a) The qualifications of the personnel of the hospital to perform open-heart surgery; (b) The facilities and equipm…

NAC 449.61206 Notification of applicant upon review of application; site inspection required. (NRS 449.0302) 1. Within 10 days after it receives an application for approval from a hospital, the Division shall notify the hospital, in writing, whether the application is complete. I…

NAC 449.61208 Composition and duties of site inspection team. (NRS 449.0302) The site inspection team: 1. Must be composed of: (a) A cardiothoracic surgeon; (b) A cardiologist; (c) A cardiac intensive care nurse; (d) An administrator of a hospital at which open-heart surgery is c…

NAC 449.6121 Hospital to pay costs of inspection. (NRS 449.0302) The costs incurred in connection with any inspection required by the provisions of NAC 449.612 to 449.61256, inclusive, must be paid by the hospital affected. (Added to NAC by Bd. of Health, eff. 8-31-89)

NAC 449.61212 Approval or denial of application; period of validity of approval; cessation of performance of surgeries. (NRS 449.0302) 1. Within 15 working days after it receives the findings of the site inspection team, the Division shall approve or notify the hospital of its in…

NAC 449.61214 Amount of surgery required following approval. (NRS 449.0302) After approval of a service for open-heart surgery is granted, such surgeries must be performed in an approved hospital at the following rates: 1. Not less than 80 operations during the first 12 months af…

NAC 449.61216 Provision of patient with preoperative instruction. (NRS 449.0302) On specific orders from the patient’s physician, a cardiac surgical nurse shall provide each nonemergent cardiac surgical patient with preoperative instruction concerning the proposed surgical proced…

NAC 449.61218 Surgical team: Composition; privileges and qualifications of members; participation of qualified nurses. (NRS 449.0302) 1. A surgical team assigned to each open-heart surgery at an approved hospital must be composed of a cardiovascular surgeon who will be the primar…

NAC 449.6122 Qualifications of anesthesiologist. (NRS 449.0302) Anesthesia during open-heart surgery at an approved hospital must be administered by an anesthesiologist who: 1. Is certified by or who is eligible for certification by the American Board of Anesthesiologists; and 2.…

NAC 449.61222 Qualifications of nurse in charge of service. (NRS 449.0302) The registered nurse in charge of the service for open-heart surgery at an approved hospital must: 1. Have not less than 2 years of operating room nursing experience and not less than 1 year of current exp…

NAC 449.61224 Perfusion team: Use required; qualifications; approval of members by surgeon of record. (NRS 449.0302) 1. An approved hospital shall use a perfusion team, which must include a senior perfusionist who is responsible for the supervision of all perfusion services provi…

NAC 449.61226 Operating rooms: General requirements. (NRS 449.0302) 1. An approved hospital shall maintain two fully equipped operating rooms, one dedicated to and another available for services for open-heart surgery. Each operating room must have a minimum clearance of 400 squa…

NAC 449.61228 Operating rooms: Equipment and staff. (NRS 449.0302) 1. Each operating room designated or available for open-heart surgery must be equipped with: (a) A heart-lung bypass machine. (b) Proper suction and plumbing outlets for heat exchangers for the heart-lung bypass m…

NAC 449.6123 Intensive care facility: General requirements. (NRS 449.0302) 1. An approved hospital shall maintain an intensive care facility within the hospital. The facility must: (a) Have accommodations which can isolate patients; (b) Have a sufficient system for controlling te…

NAC 449.61232 Intensive care facility: Staff. (NRS 449.0302) 1. The administration of intensive care units in an approved hospital for patients recovering from or awaiting open-heart surgery must be under the direction of a qualified physician approved by the cardiac surgeon. 2. …

NAC 449.61234 Intensive care facility: Equipment and supplies. (NRS 449.0302) 1. The following equipment must be immediately available to the intensive care facility: (a) A laryngoscope. (b) Endotracheal tubes. (c) Respirators. (d) Hypothermia equipment. (e) Tracheostomy sets. (f…

NAC 449.61236 Orientation and continuing education of personnel. (NRS 449.0302) An approved hospital shall provide, under the direction of the cardiac surgeon, an orientation program and a program of continuing education for surgical nurses, technicians and any personnel who part…

NAC 449.61238 Maintenance of blood bank. (NRS 449.0302) An approved hospital shall maintain a blood bank which operates 24 hours a day under the direction of qualified specialists. These persons must be able to supply blood and blood derivatives to surgical teams assigned to open…

NAC 449.6124 Maintenance of cardiac catheterization laboratory. (NRS 449.0302) 1. An approved hospital shall maintain a cardiac catheterization laboratory which operates 24 hours a day under the direction of a qualified specialist. 2. The laboratory must be located in the hospita…