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PDFWAC 246-330-115


This section outlines the organizational guidance and oversight responsibilities of ambulatory surgical facility resources and staff to support safe patient care.
An ambulatory surgical facility must have a governing authority that is responsible for determining, implementing, monitoring and revising policies and procedures covering the operation of the facility that includes:
(1) Selecting and periodically evaluating a chief executive officer or administrator;
(2) Appointing and periodically reviewing a medical staff;
(3) Approving the medical staff bylaws;
(4) Reporting practitioners according to RCW 70.230.120;
(5) Informing patients of any unanticipated outcomes according to RCW 70.230.150;
(6) Establishing and approving a coordinated quality performance improvement plan according to RCW 70.230.080;
(7) Establishing and approving a facility safety and emergency training program according to RCW 70.230.060;
(8) Reporting adverse events and conducting root cause analyses according to chapter 246-302 WAC;
(9) Providing a patient and family grievance process including a time frame for resolving each grievance according to RCW 70.230.080 (1)(d);
(10) Defining who can give and receive patient care orders that are consistent with professional licensing laws; and
(11) Defining who can authenticate written or electronic orders for all drugs, intravenous solutions, blood, and medical treatments that are consistent with professional licensing laws.
[Statutory Authority: Chapter 70.56 RCW. WSR 12-16-057, § 246-330-115, filed 7/30/12, effective 10/1/12. Statutory Authority: Chapter 70.230 RCW. WSR 09-09-032, § 246-330-115, filed 4/7/09, effective 5/8/09.]
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