WAC 246-976-860   Designation standards for facilities providing level I pediatric trauma rehabilitation service.  (1) Level I pediatric rehabilitation services shall:

     (a) Treat inpatients and outpatients, regardless of disability or level of severity or complexity, who are:

     (i) Under fifteen years old; or

     (ii) For adolescent trauma patients, determine whether educational goals, premorbid learning or developmental status, social or family needs, or other factors indicate treatment in an adult or pediatric setting.

     (b) Have and retain accreditation by the commission on accreditation of rehabilitation facilities (CARF) for hospital-based comprehensive inpatient rehabilitation category one, including the additional designated pediatric program standards required to provide pediatric rehabilitative services;

     (i) Abeyance or deferral status do not qualify an applicant for designation;

     (ii) If the applicant holds one-year accreditation, the application for trauma care service designation shall include a copy of the CARF survey report and recommendations;

     (c) House patients in a designated pediatric rehabilitation area, providing a pediatric milieu;

     (d) Provide a peer group for persons with similar disabilities;

     (e) Be directed by a physiatrist who is in-house or on-call and responsible for rehabilitation concerns twenty-four hours every day;

     (f) Have a diversion or transfer policy with protocols on an individual patient basis, based on the ability to manage that patient at that time;

     (g) In addition to the CARF medical consultative service requirements, have the following medical services in-house or on-call twenty-four hours every day:

     (i) Anesthesiology, with an anesthesiologist or certified registered nurse anesthetist (CRNA);

     (ii) A pediatrician;

     (iii) Radiology;

     (h) Provide rehabilitation nursing personnel twenty-four hours every day, with:

     (i) Management by a registered nurse;

     (ii) At least one certified rehabilitation registered nurse (CRRN) on duty each day shift and evening shift when a trauma patient is present;

     (iii) A minimum of six clinical nursing care hours per patient day for each trauma patient;

     (iv) All nursing personnel trained and/or experienced in pediatric rehabilitation;

     (v) The initial care plan and weekly update reviewed and approved by a CRRN; and

     (vi) An orientation and training program for all levels of rehabilitation nursing personnel;

     (i) Provide the following health personnel and services twenty-four hours every day:

     (i) Access to pharmaceuticals, with pharmacist in house;

     (ii) Personnel trained in intermittent urinary catheterization; and

     (iii) Respiratory therapy;

     (j) Provide the following trauma rehabilitation services with staff who are licensed, registered, or certified, who are trained and/or experienced in pediatric rehabilitation, and who are in-house or available for treatment every day when indicated in the rehabilitation plan:

     (i) Occupational therapy;

     (ii) Physical therapy;

     (iii) Psychology, including:

     (A) Neuropsychological services;

     (B) Clinical psychological services, including testing and counseling; and

     (C) Substance abuse counseling;

     (iv) Social services;

     (v) Speech/language pathology;

     (k) Provide the following services in-house or through affiliation or consultative arrangements with staff who are licensed, registered, certified, or degreed:

     (i) Communication augmentation;

     (ii) Educational component of the program appropriate to the disability and developmental level of the child, to include educational screening, instruction, and discharge planning coordinated with the receiving school district;

     (iii) Orthotics;

     (iv) Play space, with supervision by a pediatric therapeutic recreation specialist or child life specialist, to provide assessment and play activities;

     (v) Prosthetics;

     (vi) Rehabilitation engineering for device development and adaptations;

     (vii) Therapeutic recreation;

     (l) Provide the following diagnostic services in-house or through affiliation or consultative arrangements with staff who are licensed, registered, certified, or degreed:

     (i) Electrophysiologic testing, to include:

     (A) Electroencephalography;

     (B) Electromyography;

     (C) Evoked potentials;

     (ii) Diagnostic imaging, including computerized tomography, magnetic resonance imaging, nuclear medicine, and radiology;

     (iii) Laboratory services; and

     (iv) Urodynamic testing;

     (m) Have an outreach program regarding pediatric trauma rehabilitation care, consisting of telephone and on-site consultations with physicians and other health care professionals in the community and outlying areas;

     (n) Have a formal program of continuing pediatric trauma rehabilitation care education, both in-house and outreach, provided for nurses and allied health care professionals;

     (o) Have an ongoing structured program to conduct clinical studies, applied research or analysis in rehabilitation of pediatric trauma patients, and report results within a peer-review process.

     (2) A level I pediatric rehabilitation service shall:

     (a) Have a quality assurance/improvement program in accordance with WAC 246-976-881;

     (b) Participate in trauma registry activities as required in WAC 246-976-430;

     (c) Participate in the regional trauma quality assurance program as required in WAC 246-976-910.



[Statutory Authority: Chapter 70.168 RCW. 98-19-107, § 246-976-860, filed 9/23/98, effective 10/24/98; 98-04-038, § 246-976-860, filed 1/29/98, effective 3/1/98; 93-20-063, § 246-976-860, filed 10/1/93, effective 11/1/93.]