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007.05.10-48. Physical Facilities, Psychiatric Nursing Unit.

AR ADC 007.05.10-48Arkansas Administrative Code

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 10. Rules for Critical Access Hospitals in Arkansas (Refs & Annos)
Ark. Admin. Code 007.05.10-48
007.05.10-48. Physical Facilities, Psychiatric Nursing Unit.
When part of a general hospital, these units shall be designed for the care of inpatients. Non-ambulatory inpatients may be treated in a medical unit until their medical condition allows for transfer to the psychiatric nursing unit. Provisions shall be made in the design for adapting the area for various types of psychiatric therapies.
The environment of the unit should be characterized by a feeling of openness with emphasis on natural light and exterior views. Various functions should be accessible from common areas while not compromising desirable levels of patient privacy. Interior finishes, lighting and furnishings should suggest a residential rather than an institutional setting. These should, however, conform with applicable fire safety codes. Security and safety devices should not be presented in a manner to attract or challenge tampering by patients.
Where glass fragments pose a hazard to certain patients, safety glazing and/or other appropriate security features shall be used.
Details of such facilities should be as described in the approved functional program. Each nursing unit shall provide the following:
A. Patient Rooms. The patient room requirements noted in Section 44, Physical Accommodations (Adult Medical, Surgical, Communicable or Pulmonary Disease), shall be applied to patient rooms in psychiatric nursing units except as follows:
1. A nurses' call system is not required; but if it is included, provisions shall be made for easy removal or for covering call button outlets;
2. Bedpan-flushing devices shall be omitted from patient room toilets;
3. Handwashing stations are not required in patient rooms;
4. Visual privacy in multibed rooms (e.g., cubicle curtains) is not required;
5. The ceiling and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of a tamper-resistant type;
6. Each patient room shall be provided with a private toilet that meets the following requirements:
a. The door shall not be lockable from within;
b. The door shall be capable of swinging outward; and
c. The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fixtures, sprinkler heads and other appurtenances shall be of the tamper-resistant type.
7. Patient rooms, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, shall be at least 100 square feet for single-bed rooms and 80 square feet per bed for multiple-beds rooms. The dimensions and room arrangement criteria of Section 44 does not apply.
B. Service Areas. The standards noted in Section 44, Physical Accommodations (Adult Medical, Surgical, Communicable or Pulmonary Disease), shall apply to services areas for psychiatric nursing units with the following modifications:
1. A secured storage area shall be provided for patients' belongings that are determined to be potentially harmful (e.g., razors, nail files, cigarette lighters); this area shall be controlled by staff.;
2. Medication station shall include provisions for security against unauthorized access;
3. Food service within the unit may be one, or a combination, of the following:
a. A nourishment station;
b. A kitchenette designed for patient use with staff control of heating and cooking devices; and
4. Storage space for stretchers and wheelchairs may be outside the psychiatric unit, provided that provisions are made for convenient access as needed for disabled patients;
5. In psychiatric nursing units, a bathtub or shower shall be provided for each six beds not otherwise served by bathing facilities within the patient rooms. Bathing facilities shall be designed and located for patient convenience and privacy;
6. A separate charting area shall be provided with provisions for acoustical privacy. A viewing window to permit observation of patient areas by the charting nurse or physician may be used if the arrangement is such that patient files cannot be read from outside the charting space;
7. At least two separate social spaces, one appropriate for noisy activities and one for quiet activities shall be provided. The combined area shall be a minimum of 40 square feet per patient with a minimum of 120 square feet for each of the two spaces. This space may be shared by dining activities;
8. Space for group therapy shall be provided. This may be combined with the quiet space noted above in item 7 when the unit accommodates not more than 12 patients, and when at least 225 square feet of enclosed private space is available for group therapy activities;
9. Patient laundry facilities with an automatic washer and dryer shall be provided. The following elements shall also be provided, but may be either within the psychiatric unit or immediately accessible to it unless otherwise dictated by the functional program;
10. Rooms (s) for examination and treatment shall have a minimum floor area of 120 square feet. Examination and treatment room(s) for medical-surgical patients may be shared by the psychiatric unit patients. (These may be on a different floor if conveniently accessible.)
11. Separate consultation room(s) with minimum floor space of 100 square feet each, provided at a room-to-bed ratio of one consultation room for each 12 psychiatric beds. The room(s) shall be designed for acoustical and visual privacy and constructed to achieve a noise reduction of at least 45 decibels. This room is not required if all rooms are private;
12. Psychiatric units each containing 15 square feet of separate space per patient for patient therapy/multipurpose use, with a minimum total area of at least 200 square feet, whichever is greater. Space shall include provision for handwashing, work counter(s), storage, and displays. This space may serve more than one nursing unit. When psychiatric nursing unit(s) contain less than 12 beds, the therapy and other functions may be performed within the noisy activities area, if at least an additional 10 square feet per patient served is included; and
13. A conference and treatment planning room for use by the psychiatric unit.
C. Seclusion Treatment Room. There shall be at least one seclusion room for up to 24 beds or a major fraction thereof. If a facility has more than one psychiatric nursing unit, the number of seclusion rooms shall be a function of the total number of psychiatric beds in the facility. Seclusion rooms may be grouped together.
1. The seclusion room is intended for short-term occupancy by a violent or suicidal patient. The room(s) shall be located for direct nursing staff supervision. Each room shall be for only one patient. It shall have an area of at least 60 square feet and shall be constructed to prevent patient hiding, escape, injury or suicide. Where restraint beds are required by the functional program, 80 square feet shall be required.
2. Room doors shall be designed with hardware that will permit the doors to swing out. Outside corners shall be omitted where possible. The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type. The walls shall be completely free of objects. Special fixtures and hardware for electrical circuits shall be used. Minimum ceiling height shall be nine feet. Doors shall be three feet eight inches wide and shall permit staff observation of the patient while also maintaining provisions for patient privacy. Seclusion treatment rooms shall be accessed by an anteroom or vestibule which also provides direct access to a toilet room. The toilet room and anteroom shall provide for safe management of the patient.
3. Where the interior of the seclusion room is padded with combustible materials, these materials shall be of a type acceptable to NFPA standards. The room area, including floor, walls, ceilings, and all openings shall be protected with not less than one-hour-rated construction.

Credits

Amended Jan. 1, 2016.
<Statutory authority: Promulgated under the Authority of Ark. Code Ann. ยง 20-7-123, 20-9-201 et seq.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.10-48, AR ADC 007.05.10-48
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