Section 7 AAC 12.418 - Evaluation and improvement of quality of care(a) The birth center shall develop and implement a program for evaluating and improving the quality of(1) direct care services to childbearing families; and(2) the environment in which services are provided.(b) The birth center shall (1) include in its evaluation and improvement program an organizational plan to identify and resolve problems; and(2) hold regular meetings of the clinical staff to review the management of care of individual clients and newborns and to make recommendations for improving the plan of care.(c) In the evaluation and improvement program for direct care services for clients and newborns, the birth center shall review and document at least annually(1) protocols, policies, and procedures relating to client and newborn care, and revise any protocol, policy, or procedure as necessary;(2) the appropriateness of the risk assessment standards developed under 7 AAC 12.403(f) for determining eligibility for admission to and continuation in the birth center program of care;(3) the appropriateness of diagnostic and screening procedures, including laboratory studies, sonography, and non-stress tests, as those procedures affect quality of care and cost to the client;(4) the appropriateness of medications prescribed, dispensed, or administered by the birth center;(5) performance evaluation, including peer review, for each employee, including contract staff, with results maintained in the personnel record;(6) transfers of clients and newborns to hospital care; to determine the appropriateness and quality of each transfer, the birth center shall establish procedures for the evaluation of emergency and non-emergency transfers, including (A) the amount of time to complete transfers;(B) the efficiency of transportation services;(C) the reception of the client and newborn at the hospital; and(D) client satisfaction with the transfer, if that information is provided by the client, either verbally or in writing;(7) problems or complications of pregnancy, labor, and postpartum care, and the appropriateness of the practitioner's clinical judgment in obtaining consultation and addressing each problem; and(8) an evaluation of staff ability to manage emergency situations, including client and newborn emergencies, power failures and similar emergencies, and unannounced periodic fire drills.(d) The birth center shall ensure that each review under this section includes at least 20 percent of all births, 100 percent of all transfers to a hospital of clients or newborns, and all significant outcomes required to be reported under 7 AAC 12.405(j) (9)(B), during the period covered by the review. The birth center shall document each review and any action taken as a result of the identification of issues that might affect the quality of care and services.(e) The birth center shall include in the evaluation and improvement program at least the following measures, for purposes of ensuring a safe, home-like environment: (1) routine testing of the efficiency and effectiveness of equipment, including sphygmomanometers, Doppler fetal heart monitors, sterilizers, resuscitation equipment, transport equipment, oxygen equipment, communication equipment, heat sources for newborns, smoke alarms, and fire extinguishers;(2) routine review of housekeeping procedures and infection control;(3) an evaluation of maintenance policies and procedures for heat, ventilation, emergency lighting, waste disposal, water supply, and laundry and kitchen equipment.(f) The birth center shall ensure that the evaluation and improvement program monitors and promotes quality of care to clients and newborns through an effective system for collection and analysis of data, including (1) utilization of (A) orientation sessions;(B) childbirth-related educational programs;(C) postpartum home visits;(D) follow-up postpartum office visits by the client; and(E) follow-up office visits for the newborn;(2) types of local anesthetics and analgesia used; and(3) outcomes of care provided, including (A) clients registered for care;(B) time in the birth center before birth;(C) time in the birth center after birth;(D) clients admitted to the birth center for intrapartum care;(E) births in the birth center;(F) births en route to the birth center;(G) clients transferred antepartum, intrapartum, or postpartum, including the reason for the transfer;(H) newborns transferred, including the reason for the transfer;(I) type of delivery, including nonsterile vaginal delivery;(K) fourth degree lacerations;(L) newborns with birth weight less than 2,500 grams;(M) newborns with birth weight greater than 4,500 grams;(N) Apgar scores six and below, when taken at five minutes after birth;(P) spontaneous abortions;(Q) maternal mortality; and(R) client satisfaction with services provided, if that information is provided by the client, either verbally or in writing.(g) The birth center shall seek consultation and expertise from individuals who are not associated with the birth center to review problems that are identified through the evaluation and improvement program and that the birth center is unable to resolve internally.(h) The birth center shall take appropriate action to resolve problems, including (1) administrative or supervisory action;(2) in-service education and training;(3) modification of policies and procedures;(4) revision of the risk assessment standards developed under 7 AAC 12.403(f); and(5) revision of any standard forms used for client and newborn records or other purposes.(i) The birth center may provide an alternative intervention appropriate for use in birth centers, including water birth, use of homeopathic or herbal medicines, or another alternative intervention intended for use in the perinatal period. In this subsection, "alternative intervention" means a low-technology intervention that is not generally used in a medical or hospital setting. Before using an alternative intervention, the birth center must ensure that (1) documented science-based evidence exists that the alternative intervention can be used safely in a birth center setting for pregnant or laboring women; and(2) the alternative intervention is supported by the American College of Nurse Midwives, the American Association of Birth Centers, the Midwives Association of North America, or another nationally-recognized professional organization.Eff. 9/30/2007, Register 183Authority:AS 47.32.010
AS 47.32.030