Download Latest updates with OSDH Proposed Rule Changes to Title 310

OSDHTitle310ProposedRuleChanges
Update
OAHESpringMeeting
April19,2017
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OSDHProcessImprovementTeam- Update
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OSDHProcessImprovementTeam
§ TaskForcestartedFebruary2015
§ Participants:includedrepresentativesfrom
healthcareproviders,architects,consultants,
attorneys
§ QualityImprovementProcess:designedtoensure
thatOSDHimplementsclear,reasonableandtimely
managementpracticesforconstructionandplan
reviewsforhospitalsandotherhealthfacilitiesin
compliancewithapplicablestateandfederallaws
andrulesandup-to-dateguidelines.
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OSDHProcessImprovementTeam
§ ProcessImprovementTeamHighlights
o Modifiedprocesstoallowconcurrentsubmittalofthe
functionalprogramwithStage1plans;
o ModifiedprocesstoallowOSDHreview-and-commenton
thefunctionalprogramandStage1plans,asanalternative
todisapproval;
o EstablishedpageontheOSDHwebsitededicatedtoplan
reviewprocessimprovements,withexecutivesummaries
oftheTeam'smeetings,linkstothefunctionalprogram
templates,answerstofrequently-asked-questions,
customersurvey
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OSDHProcessImprovementTeam
§ ProcessImprovementTeamInitiatives
o AdoptFGIGuidelinesforDesignandConstructionof
HospitalsandOutpatientFacilities,2014edition
• ExistingcodesoriginatefromAIAGuidelines,1992-1993edition
o AdoptNFPA101LifeSafetyCode,2012edition
• AdoptedJuly5,2016byCentersforMedicare&MedicaidServices
o ProcessforExceptions&TemporaryWaivers
o ProcessforSelfCertification
o EnactPlanReviewProcessImprovements
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OSDHRuleMaking- Update
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OSDHRuleMaking
§ OSDH2017RulemakingProcess- Update
RulesandImpactStatements:Complete
FormalCommentPeriod:Complete
PublicHearing:Complete
HospitalAdvisoryCouncil:Approved
StateBoardofHealth:Approved
ReviewprocesswithLegislature&GovernorthroughMay
2017– CurrentlyinProcess
o PublicationofRules:July2017
o EffectiveDate:app.10daysafterpublication
o
o
o
o
o
o
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OSDHRuleMaking
§ OACTitle63:OklahomaHospitalLicensingAct
o SB719:Proposaltoincreasehospitallicensefeesfrom$10per
bedto$25(63OS1-106.1)
o SB719:Proposaltoincreaseplanreviewfeesupto0.15%of
designandconstructioncost(63OS1-707)
• $66.7millionproject=$100,000fee(currently$2,000max)
• Recommendationistoproposeafeecap(nottoexceedamount)
§ CurrentStatus– nohearing(notmovingforward):
o SB719:Hospitals
o SB740:NursingHomes
o SB774:ResidentialCareHomes
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OSDHRuleMaking
§ OACTitle310,Chapter667ProposedAmendments
o 667-41-1(a)(1):FGI:GuidelinesforDesignand
ConstructionofHospitalsandOutpatientFacilities,2014
o 667-41-1(a)(2):NFPA101LifeSafetyCode,2012
o 667-41-1(b):CodeConflicts
o 667-41-1(c)&(d):ExceptionsorTemporaryWaivers
o 667-41-1(e):FunctionalProgramApproval
o 667-47-1(a):SubmissionofPlansandSpecifications
o 667-47-1(d)(1):AdministrativeCompletenessReview
o 667-47-1(e):OSDHPlanReviewFees- Hospitals&ASCs
o 667-47-10:SelfCertificationofPlans
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OSDHRuleMaking
§ OACTitle310,Chapter667CurrentStatus
o Theagencyrulesareincludedinanomnibusbill
o Thelegislaturemaycreateaseparatebilltodisapprove
specificrules(unlikelyatthispoint)
o Iftheomnibusbillispassedbythehouseandsenate,then
theyareeffectiveapproximately10daysafterthe
Governor'ssignature(mid-to-lateJune)
o Iftheomnibusbillisnot passedbythehouseandsenate,
thentheGovernor’sofficecandisapprovecertainrulesor
doablanketapprovalofallrules(mid-September)
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OSDHRuleMaking
§ OACTitle63ProposedAmendments(feeincreases)
§ OACTitle310ProposedAmendments(rulechanges)
o
o
o
o
o
Chapter667:HospitalStandards
Chapter615:AmbulatorySurgeryCenters
Chapter663:ContinuumofCareandAssistedLiving
Chapter675:NursingandSpecializedFacilities
Chapter680:ResidentialCareHomes
§ OSDHHome>BoardofHealth>
ProposedAmendmentstotheStateBoardofHealthRules
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OACTitle310,Chapter667:HospitalStandards
Subchapter41:GeneralConstructionProvisions
ProposedAmendments
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310:667-41-1(a)(1)
FGI:GuidelinesforDesignandConstructionof
HospitalsandOutpatientFacilities,2014edition
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FGIGuidelines2014
§ Incorporatedbyreference- nochanges
o Over40stateshaveadoptedsomeversionoftheGuidelines
§ OSDHwillconsult/collaboratetodevelopadministrative
practices,templates,training
§ FGIGuidelinesNotableDifferencesto310:667-49:
o
o
o
o
Formalinterpretations&erratasheets
Definitions(i.e.Invasiveprocedure,surgeryzones)
Pre-planning&Commissioningrequirements
HVACrequirements(ANSI/ASHRAE/ASHEStandard170,2013
version)
§ 2018versionplannedforpublicationNov2017
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FGIGuidelines2014
§ PartOne:GeneralRequirements
o
o
o
o
1.1Introduction
1.2Planning,Design,Construction,andCommissioning
1.3Site
1.4Equipment
§ PartTwo:Hospitals
§ PartThree:OutpatientFacilities
§ PartFour:ANSI/ASHRAE/ASHE170- Ventilation
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FGIGuidelines2014:Chapter1.2
§ 1.2-1.1Application
o Tomeettheobjectivesofthischapter,healthcare
organizationsshoulddevelopaninterdisciplinarydesign
processtoguidefacilitydesign.
§ 1.2-1.2MultidisciplinaryProjectTeam:Stakeholders
affectedbyandintegraltothedesign
o Requiredmembers:administrators,clinician,infection
control,architects,engineers,facilitymanagers,safety
officers,securitymanagers,usersofequipmentand
relevantsupportstaff
o Recommendedmembers:patientadvocates,A/E
consultants,constructionspecialist
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FGIGuidelines2014:Chapter1.2
§ 1.2-2FunctionalProgram:Aplanningdocumentusedto
determinetheapplicationoftheFGIGuidelinesand
servesasthebasisfortheprojectdesignand
constructiondocuments
o DefinitionandapplicationreplacesOAC310:667-41(e)&(f)
o 1.2-2.1.1.1:Afunctionalprogramshallbedevelopedfornew
construction,majorrenovations,andprojectsthatchangethe
functionaluseofanyfacilityspace.
o 1.2-2.1.1.3:Activitiessuchasequipmentreplacement,fire
safetyupgrades,orminorrenovationsthatwillnotchangethe
facility'sfunctionorcharactershallnotrequireafunctional
program
o 1.2-2.1.1.2:Thegoverningbodyshallberesponsiblefor
developing,documenting,andupdatingthefunctionalprogram
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FGIGuidelines2014:Chapter1.2
§ FunctionalProgram– PracticalApplication
o Primarypurposeistocommunicatethefunctionalplanning
assumptionsanddecisionsoftheownertotheproject
designers
o Identifiesoverallgoals,facilityfunctions,andbasicdesignneeds
theprojectintendstosupport
o OSDHProposedAmendment310:667-41-1(e):TheHospital's
governingbodyhasauthoritytoapproveFunctionalNarratives
o Onceapproved,shouldserveasthebasisfordesignand
constructiondocuments
o Shouldbeupdatedduringthedesignandconstructionphases
andshouldberetainedtofacilitatefutureprojects
o Notpartoftheconstructiondocumentsandisnotalegally
bindingdocument
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FGIGuidelines2014:Chapter1.2
§ 1.2-2.2FunctionalProgramContent
o Executivesummaryofthekeyelementsofthefunctional
program
o Purposeoftheprojectandservicestobeprovided
o Projecttypeandsize
• FacilitytypeasdefinedbytheGuidelines
• Squarefootageandnumberofstories
o Constructiontype/occupancyandbuildingsystems
• Fornewconstruction,descriptionsoftheplannedconstructiontype
andoccupancy
• Forrenovation,descriptionsoftheexistingandplannedconstruction
typesandoftheexistingengineeringsystemsthatservicethefacility
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FGIGuidelines2014:Chapter1.2
§ 1.2-2.2FunctionalProgramContent- continued
o Projectcomponentsandscope
• Departmentsaffectedbytheproject
• Servicesrequiredforthecompletedprojecttofunctionasintended
o Indirectsupportfunctions
• Increasedordecreaseddemands,workloads,staffingrequirements,
etc.,thatwillbeimposedonsupportfunctionsrelatedtothe
constructionproject
o Operationalrequirements,suchas:
• Projectedoperationaluseanddemandloadingforaffected
departments/projectcomponents
• Operationalcirculationpatterns(patients,staff,visitors)
• Departmentaloperationalrelationshipsandrequiredadjacencies
o Architecturalspacerequirements
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FGIGuidelines2014:Chapter1.2
§ 1.2-3SafetyRiskAssessment(SRA)
o A1.2-3:TheSRAisamultidisciplinary,documentedassessment
processintendedtoproactivelyidentifyhazardsandriskand
mitigateunderlyingconditionsofthebuiltenvironmentthatcan
contributetoadversesafetyevents.
o TableA1.2-a:SRATeamMemberExpertiseChecklist
o Potentialadversesafetyevents:
•
•
•
•
•
•
Infections
Falls
Medicationerrors
Immobility-relatedoutcomes
Securitybreaches
Musculoskeletalorotherinjuries
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FGIGuidelines2014:Chapter1.2
§ Underlyingconditionsthatcancauseadversesafetyevents:
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Noise
Vibration
Visualdistractionanddisorganizationofspace
Lighttype,quality,andquantityforeachroom
Characteristicsofsurfacesfordifferentspaces
Indooraircharacteristicsfordifferentspaces
Sourcesofinfection
Ergonomics
Stafffatigue
Spacerequiredtoaccommodatefunctions
Standardizedlocationsforequipment
Barrierstomobilizationofpatients
Communicationssystems
Visibilityofpatients
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FGIGuidelines2014:Chapter1.2
§ 1.2-3SafetyRiskAssessment(SRA)
o 1.2-3.1.6SRAReport: Includesidentifiedhazardsandrisk
anddesignstrategiesthatmitigatethoserisk
o 1.2-3.1.7SRACompliance:SRAisexpectedtobe
documented,updatedandcommunicatedthrough
commissioning
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FGIGuidelines2014:Chapter1.2
§ 1.2-3SRAComponents(Table1.2-1)
o
o
o
o
o
o
o
InfectionControlRiskAssessment(ICRA)
PatientHandlingandMovementAssessment(PHAMA)
PatientFallPrevention
MedicationSafety
BehavioralandMentalHealth
PatientImmobility
SecurityRisk
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FGIGuidelines2014:Chapter1.2
§ 1.2-3.2InfectionControlRiskAssessment(ICRA)
o A1.2-3.2ICRA:Identifyanddesigntoconsiderbothlongrangeinfectionpreventionandduringconstruction
• Identifythenumber,locationandtypeofairborneinfection
isolation(AII)andprotectiveenvironment(PE)rooms
• Specialheating,ventilation,andair-conditioningneeds
• Waterandplumbingsystems
• Characteristicsforselectionofmaterialsforsurfacesand
furnishings
o 1.2-3.2.3.1InfectionControlRiskMitigation
Recommendations(ICRMRs):Writtenplanonmethods
usedtopreventinfectionduringconstructionand
commissioning
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FGIGuidelines2014:Chapter1.2
§ 1.2-3.3PatientHandlingandMovementAssessment
(PHAMA)
o A1.2-3.3Assessmentofbothpatientandequipment
movement
§ 1.2-3.5MedicationSafety
o A1.2-3.5.1Needtoidentifythenumberandlocationof
medicationsafetyzonesforpreparing,dispensing,storing
andadministeringmedications
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FGIGuidelines2014:Chapter1.2
§ 1.2-4EnvironmentofCareRequirements
o DeliveryofCareModelConcepts
o Patients,Visitors,Physicians,andStaffAccommodation
andFlow
o BuildingInfrastructureandSystemsDesignCriteria
o PhysicalEnvironmentElements
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FGIGuidelines2014:Chapter1.2
§ 1.2-5PlanningandDesignConsiderationsand
Requirements
o
o
o
o
o
AcousticDesign
SustainableDesign
Wayfinding
Bariatric-SpecificDesignConsiderations
ProvisionsforDisasters
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FGIGuidelines2014:Chapter1.2
§ 1.2-7Commissioning
o TotalbuildingcommissioningratherthanjustHVAC
o 1.2-7.3CommissioningAgent:Commissioningshallbeled
byanindependentcommissioningagent…
o 1.2-8Recorddrawings,manuals,anddesigndata
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FGIGuidelines2014:Chapter1.2
§ 1.2-7Commissioning
o 1.2-7.1CommissioningRequired
•
•
•
•
•
HVAC
Automatictemperaturecontrol
Domestichotwater
Firealarmandfireprotectionsystems
Essentialelectricalpowersystems
o A1.2-7.2.1CommissioningRecommended
•
•
•
•
•
•
Buildingenvelope
Lightingcontrolsandlevels
Communicationssystems
Normalpowersystems
Plumbingsystems
Acousticmeasures
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Questions
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