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2.3-4.2.1 Staff Work Area(s)
*2.3-4.2.1.1
Resident care/living areas (units), participant activity areas, and outpatient rehabilitation areas shall have staff work areas in centralized or decentralized direct care locations.
A2.3-4.2.1.1 Staff work areas
  1. Decentralized nursing models proximal to patient/resident rooms may improve staff efficiency, visibility, fall prevention, transfer rates, and medical errors without being disruptive to residents.
  2. Whether centralized or decentralized, staff work areas should be designed to minimize the institutional character, command-station appearance, and noise associated with traditional nurse stations and to foster close, open relationships between residents, participants, outpatients, and staff.
  3. Confidential or noisy staff conversations should be accommodated in an enclosed staff lounge and/or conference area.
  4. At least part of each staff work area should be low enough and open enough to permit easy conversations between staff and residents seated utilizing resident-operated mobility devices.
2.3-4.2.1.2
See the facility chapters in Parts 3 through 5 for additional requirements.
2.3-4.2.2 Medication Distribution and Storage Locations (Centralized and Decentralized)
*2.3-4.2.2.1 General
  1. Provisions shall be made to support 24-hour distribution of medications.
  2. A medication room, a self-contained medication distribution unit, medication storage in resident rooms, or other approaches acceptable to the authority having jurisdiction (AHJ) shall be permitted to be used for preparing, dispensing, and administering medications.
A2.3-4.2.2.1 <Chapter 1066>, "Physical Environments that Promote Safe Medication Use," of the U.S. Pharmacopeia-National Formulary (USP-NF) may be used as a resource in developing the medication distribution and storage system.
2.3-4.2.2.2 Medication Room
Where provided, a medication room shall be located on each resident care/living area (unit) for storage of emergency and contingency medications and supplies or as part of a medication distribution system.
(1)  A medication room shall have a minimum area of 50 square feet (4.65 square meters) or meet the requirements in the functional program.
*(2)  Each medication room shall include the following:
(a)  A work counter sized to accommodate functions for the facility type and care population
(b)  Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
(c)  Refrigerator for storage
(d)  Double-locked storage for controlled drugs
*(e)  Sharps containers, where sharps are used. Where provided, these shall be placed in accordance with the OSHA Bloodborne Pathogen standard at 29 CFR 1910.1030(d) (4)(iii)(A)(2)(i).
(f)  Task-specific lighting levels as recommended in USP-NF <Chapter 1066>
*(g)  Medication room sound levels
(i)  See Table 2.5-4 (Minimum Design Room Sound Absorption Coefficients), Table 2.5-2 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems), and Table 2.5-5 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms) for acoustic requirements.
(ii)  See Section 2.5-5 (Communication Systems) for additional requirements on nurse call and paging.
A2.3-4.2.2.2 (2) Medication room organization.
Work space organization elements should be described in the functional program. These include:
  1. Number of staff working in the medication room
  2. Key tasks to be performed in the medication room
  3. Amount of space needed to support these tasks
  4. Space for medication-associated equipment
  5. Space for safety technology to be used
A2.3-4.2.2.2 (2)(e) Placement of sharps containers. NIOSH provides an ergonomically ideal formula for determining the height of sharps containers by establishing the eye-level height and maximum thumb tip reach of the staff population and then including a drop angle of 15 degrees. For a standing work station, the sharps container height should be 52 to 56 inches above the standing surface of the user. For a seated work station, the sharps container height should be 38 to 42 inches above the floor on which the chair rests. These height installation recommendations will accommodate 95 percent of all adult female staff. This information can be found in found in DHHS (NIOSH) Publication No. 97-111, "Selecting, Evaluating, and Using Sharps Disposal Containers." NIOSH recommends locating the sharps container as close as feasible to the immediate area where sharps are used.
A2.3-4.2.2.2 (2)(g) Distractions and interruptions interfere with staff concentration and attentiveness to medication use system activities.
2.3-4.2.2.3 Self-Contained Medication Distribution Units, Automated Medication-Dispensing Stations, or Mobile Medication-Dispensing Carts
Where these or other systems approved by the AHJ are used, the following shall apply:
  1. Location of such units shall be permitted at the staff work area, in the clean utility room, in an alcove, or in a resident room as approved by the AHJ.
  2. Medication units located in resident rooms shall be secured.
  3. Areas used for medication preparation and distribution by mobile cart shall include task-specific lighting.
*2.3-4.2.2.4 Decentralized Medication Cabinets
Where medication storage is located in the resident room, the following shall apply:
  1. Medication storage located in resident rooms shall be secured.
  2. Decentralized medication cabinets in resident rooms shall include task-specific lighting.
A2.3-4.2.2.4 Decentralized medication storage areas should also include a writing surface or area for electronic device (laptop, tablet, etc.) for staff recording of resident data.
2.3-4.2.3 Central Bathing Rooms or Areas
See the facility chapters in Parts 3 through 5 for requirements.
2.3-4.2.4 Equipment and Supply Storage
*2.3-4.2.4.1 Storage for Equipment and Supplies for Care and Services
Storage space(s) for equipment and supplies used by staff for resident, participant, and outpatient care and services shall be immediately accessible to the areas where they are used.
  1. Sufficient storage space(s) shall be provided to keep required corridor width free of equipment and supplies.
  2. Cabinets, closets, rooms, and alcoves shall be permitted to provide storage.
A2.3-4.2.4.1 Equipment and supply storage
  1. Equipment may include portable lifts, movable commodes, shower chairs, and carts.
  2. Supplies may include linens, disposable products, slings, accessories for lifts such as battery chargers, dressings, office supplies, etc.
*2.3-4.2.4.2 Storage for Mobility Devices and Support Equipment
Storage shall be provided for resident-operated mobility devices and personal support equipment that is:
  1. Sized to meet the needs of the functional program.
  2. Located out of the way of traffic and circulation.
*2.3-4.2.4.3 General Storage
General storage space(s) shall be provided in the same building for furniture and equipment such as air mattresses, medical supplies, and housekeeping supplies and equipment.
A2.3-4.2.4.3 General storage. More storage space is always needed, whether for seasonal storage of lawn furniture or for holiday decorations. Tall broom closets should also be considered in residential spaces such as individual units and kitchenettes.
2.3-4.2.4.4
See the facility chapters in Parts 3 through 5 for additional requirements.
2.3-4.2.5 Clean Utility Room
Where a clean utility room is provided, it shall meet the following requirements:
2.3-4.2.5.1
Where the clean utility room is used for preparing resident care items, it shall contain:
  1. Work counter
  2. Hand-washing station
  3. Storage facilities for clean supplies
2.3-4.2.5.2
Where the room is used only for storage and holding as part of a system for distribution of clean materials, omission of the work counter and hand-washing station shall be permitted.
2.3-4.2.5.3
Where the room is used for clean linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
2.3-4.2.5.4
Where the room is also used as a medication room, see Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for additional requirements.
2.3-4.2.6 Soiled Utility Room
Where a soiled utility room is provided, it shall meet the following requirements:
2.3-4.2.6.1
Combining the soiled utility room with the soiled linen and laundry and/or environmental services room shall be permitted for areas with small groups of residents.
2.3-4.2.6.2
The soiled utility room shall contain the following:
  1. Clinical sink or equivalent flushing-rim fixture with a rinsing hose or bedpan washer
  2. Hand-washing station
  3. Space for soiled linen receptacles
  4. Space for waste receptacles
2.3-4.2.6.3
Where the room is used for soiled linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
2.3-4.2.6.4
Where the room serves as an environmental services room, see facility chapters in Parts 3 through 5 for additional requirements.
2.3-4.2.7 Personal Laundry Facilities
Where decentralized personal laundry services are provided for washing and drying personal resident or participant laundry, the following requirements shall be met:
2.3-4.2.7.1
Separate laundry facilities shall be provided for small groups of residents or participants.
2.3-4.2.7.2
A work counter for sorting and folding shall be provided.
2.3-4.2.7.3
Hand-washing stations shall be provided in, adjacent to, or directly accessible from the laundry room.
2.3-4.2.7.4 Shared Facilities
(1)  Combination of personal laundry facilities and soiled utility and soiled linen holding facilities shall be permitted where the airflow is from the washing/drying area to the soiled utility/holding area.
(2)  Combination of personal laundry facilities and clean utility and clean linen storage shall be permitted.
*(3)  Provision of accessible laundry equipment in a resident activity room and/or therapy room shall be permitted.
A2.3-4.2.7.4 (3) Loading, transferring, sorting, and folding laundry are familiar activities that may be therapeutic for many residents.
*2.3-4.2.8 Resident and Participant Telephone Access
Provisions shall be made in or near each resident unit to allow residents to make and receive telephone calls in private.
A2.3-4.2.8 Telephone access. Use of technology is becoming increasingly prevalent in residential care facilities. Cable television, high-speed Internet, and ready access to bedside telephones are just a few examples of the expected norm in resident rooms. Many residents will expect access to the Internet to communicate with family and friends. Provision of telephone/data connections or wi-fi access for each resident room should be considered.
*2.3-4.2.9 Accommodations for Telemedicine Services
Where telemedicine services are provided, provisions shall be made to support the practice of exchanging medical information between sites via electronic communications.
A2.3-4.2.9 Accommodations for telemedicine services. The following should be considered where a space is used for telemedicine services:
  1. The space should be designed to accommodate the service being provided.
  2. It should be possible to maintain visual and speech privacy for the duration of the visit in the room or area where services are offered.
  3. The acoustic environment should facilitate communications within the room and through the telecommunication system.
  4. Lighting levels should be designed to allow for video capture and help control glare from natural or artificial light sources.
  5. Access to technology should be provided.

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