DAR File No. 27186

Health, Health Systems Improvement, Licensing

R432-100-17

Perinatal Services

NOTICE OF PROPOSED RULE

DAR File No.: 27186
Filed: 05/24/2004, 09:52
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This change updates the incorporation by reference of the Guideline for Perinatal Services, Fifth Edition and the Guidelines for Construction and Equipment of Hospital and Medical Facilities, 2001 Edition. This amendment corrects language submitted in the first filing. (DAR NOTE: This filing supersedes that first filing on Section R432-100-17 that was published in the 03/15/2004 issue of the Bulletin on page 51 under DAR No. 26954.)

Summary of the rule or change:

The change requires support personnel to be available according to the designated level and equipment for oxygen and resuscitation to be available for both mother and newborn. The section is also reorganized for consistency and clarity.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 21

Guidelines for Perinatal Care, Fifth Edition; and Guidelines for Construction and Equipment of Hospital and Medical Facilities, 2001 ed.

Anticipated cost or savings to:

the state budget:

There should be a minimum impact to adopt the current guidelines for state owned and operated facility since the Fifth Edition reflects the current practice. The Department will have an approximate $350 cost to mail the revised rule to the affected parties.

local governments:

There should be a minimum impact to adopt the current guidelines for local government owned and operated facility since the Fifth Edition reflects the current practice and the smaller hospitals typically do not operate an intensive care unit for newborns.

other persons:

There should be a minimum impact to adopt the current guidelines for privately owned and operated facility since the Fifth Edition reflects the current practice and the majority of the hospitals are accredited by the Joint Commission that requires the standard of care.

Compliance costs for affected persons:

The hospital cost should be cost neutral since each hospital is allowed to self-designate their level of nursery service staff accordingly.

Comments by the department head on the fiscal impact the rule may have on businesses:

The rule describes the standards for hospitals who provide perinatal services and adopts the new Guidelines for Perinatal Care, Fifth Edition. This is already the standard of care in most regulated facilities. Fiscal impact on regulated facilities should be minimal. Scott D. Williams, M.D.

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Debra Wynkoop at the above address, by phone at 801-538-6152, by FAX at 801-538-6325, or by Internet E-mail at debwynkoop@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/15/2004

This rule may become effective on:

07/16/2004

Authorized by:

Scott D. Williams, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-100. General Hospital Standards.

R432-100-17. Perinatal Services.

(1) Each hospital shall comply with the requirements of this section and shall designate its capability to provide perinatal (antepartum, labor, delivery, postpartum and nursery) care in accordance with Level I basic, Level II specialty, or Level III sub-specialty or tertiary care as described in the Guidelines for Perinatal Care, Fifth Edition and the Guidelines for Design and Construction of Hospital and Heath Care Facilities, 2001 Edition, which is incorporated by reference.

(a) A qualified member of the hospital staff shall provide [A]administrative, medical and nursing direction and oversight for[of] perinatal services [shall be provided by a person appointed and authorized by the hospital administrator]according to each hospital's designated level of care, Level I, II or III.

(b) [Medical direction for perinatal services shall be provided by a qualified member of the medical staff.

(c) Each hospital shall establish and implement security protocols for perinatal patients.

(d) ]A qualified registered nurse shall be immediately available at all hours of the day and as well as sufficient numbers of trained competent staff to meet the designated level.

(c) Support personnel shall be available to the perinatal care service according to each hospital's designated level of care.

(2) Each hospital shall establish and implement security protocols for perinatal patients.

(3) The perinatal department shall include facilities and equipment for antepartum, labor and delivery, nursery, postpartum, and optional birthing rooms.

(a) Perinatal areas shall be located and arranged to avoid non-related traffic to and from other areas.

(b) The hospital shall isolate patients with infections or other communicable conditions. The use of maternity rooms for patients other than maternity patients shall be restricted according to hospital policy.

([3]c) Each hospital shall have [access to ]at least one surgical suite for operative delivery.

([a]d) Equipment and supplies shall be immediately available and maintained for the mother and newborn, including:

(i) furnishings suitable for labor, birth, and recovery;

(ii) oxygen with flow meters and masks or equivalent;

(iii) mechanical suction and bulb suction[ immediately available];

(iv) resuscitation equipment;

(v) emergency medications, intravenous fluids, and related supplies and equipment;

(vi) a device to assess fetal heart rate;

(vii) equipment to monitor and maintain the optimum body temperature of the newborn;

(viii) a clock capable of showing seconds;

(ix) an adjustable examination light; and

(x) a newborn warming unit with temperature controls that comply with Underwriters' Laboratories requirements. The unit must be capable of administering oxygen and suctioning.

([b]e) The hospital shall maintain a delivery room record keeping system for cross referencing information with other departments.

(4) If birthing rooms are provided, they shall be equipped in accordance with 100-17(3[(a](d)).

(5) [Each hospital shall comply with the following provisions:

(a) No attempt shall be made to delay the imminent, normal birth of a child.

(b) A prophylactic solution approved by the Department of Health shall be instilled in the eyes of the infant within three hours of birth in accordance with R386-702-9.

(c) Metabolic screening shall be performed in accordance with State Health Laboratory rules developed pursuant to Section 26-10-6.

(6) Each hospital shall designate its capability to provide nursery care in accordance with the following levels of nursery care as described in the Guidelines for Perinatal Care, Fourth Edition and The Guidelines for Construction and Equipment of Hospital and Medical Facilities, 1992 - 1993 Edition.]The nursery shall include facilities and equipment according to its designated level of care: Level I - Basic Newborn Care; Level II - Specialty Continuing Care; and Level III - Sub-specialty or Tertiary Newborn Intensive Care including an individual bassinet for each infant; with space between bassinets as follows:

(a) Level I Basic: Full Term or Well Baby Nursery 24 inches between bassinets;

(b) Level II Specialty: Continuous Care Nursery 50 square feet per bassinet and four feet between bassinets for Continuing Care nurseries;

(c) Level III Sub-specialty: Newborn Intensive Care Nursery 100 square feet per bassinet and four feet between bassinets.

[(7) The nursery area shall provide each infant with separate equipment and supplies for bathing, dressing, and handling.

(a) There shall be equipment and supplies in or near the nursery that include:

(i) an individual bassinet for each infant;

(ii](d) accurate scales; and

([iii](e) a [reliable ]wall thermometer;[.

(b) Temperatures between 70-80 degrees F. shall be maintained in the nursery.]

([c]6) The following equipment and supplies shall be available:

(a) [There shall be ]an individual thermometer, or one with disposable tips, for each infant[.];

([d]b) [A]a supply of medication shall be immediately available for emergencies[.];

[(e) The following equipment and supplies shall be available:

(i](c) a covered soiled-diaper container with removable lining;

([ii]d) a linen hamper with removable bag for soiled linen other than diapers;

([iii]e) a newborn warming unit with temperature controls that comply with Underwriters' Laboratories requirements;

([iv]f) oxygen, oxygen equipment, and suction equipment; and

([v]g) an oxygen concentration monitoring device.

(7) Temperature shall be maintained between 70-80 degrees Farenheit in the nursery area.

(8)[f)] Infant formula storage space shall be available that conforms to the manufacturer's recommendations.[

(g)] Only single-use bottles shall be used for newborn feeding.

([8]9) A suspect nursery or isolation area shall be available. Equipment and supplies shall be provided for the isolation area.

(a) Isolation facilities shall be used for any infant who:

(i) has a communicable disease;

(ii) is delivered of an ill mother infected with a communicable disease;

(iii) is readmitted after discharge from a hospital; or

(iv) is delivered outside the hospital.

(b) There shall be separate hand washing facilities for the isolation area.

(10) Each hospital shall comply with the following provisions:

(a) No attempt shall be made to delay the imminent, normal birth of a child;

(b) A prophylactic solution in accordance with R386-702-9 shall be instilled in the eyes of the infant within three hours of birth;

(c) Metabolic screening shall be performed in accordance with Section 26-10-6 and R398-1; and

(d) A newborn hearing screening shall be performed in accordance with R398-2.

KEY: health facilities

[2003]2004

Notice of Continuation October 16, 2002

26-21-2.1

26-21-5

26-21-20

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Debra Wynkoop at the above address, by phone at 801-538-6152, by FAX at 801-538-6325, or by Internet E-mail at debwynkoop@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.