6 Colo. Code Regs. § 1011-1 Chapter 04, pt. 23

Current through Register Vol. 47, No. 17, September 10, 2024

Part 23 - PERINATAL SERVICES

23.1 The hospital shall provide emergent labor and delivery services in accordance with federal law. The hospital may provide non-emergent perinatal care services. If provided, the following standards shall apply.

23.2 Physician Services

(A) The director of obstetrical services shall be a physician who is board eligible or certified in obstetrics. However, an acute care hospital with one hundred (100) beds or fewer located in a rural area may have a physician director who is qualified by education, training, competencies, and experience to direct the scope of care provided.

(B) The director of neonate services shall be a physician who is board eligible or certified in pediatrics. However, an acute care hospital with one hundred (100) beds or fewer located in a rural area may have a physician director who is qualified by education, training, competencies, and experience to direct the scope of care provided.

(C) There shall be a physician with obstetrical privileges in the hospital or able to arrive within thirty (30) minutes of being summoned.

23.3 Nursing Services

(A) Labor, delivery, neonate, and postpartum nursing care shall be supervised by a registered nurse qualified by education, training, competencies, and experience.

(B) A registered nurse qualified by education, training, competencies, and experience in delivery room nursing shall be present as a circulating nurse during each delivery.

(C) Additional registered and licensed practical nurses or auxiliary personnel shall be available as necessary.

(D) Maternity patients shall be closely observed by a registered nurse during and after delivery until vital signs are established, shock and hemorrhage are not evidenced, and the patient is awake.

(E) A registered nurse shall supervise the nursing care of neonates. A registered nurse shall be in attendance in the nursery at all times that neonates are present.

23.4 All deliveries shall be attended by an obstetrician, a physician with obstetrical privileges, or a certified nurse midwife, except in emergencies.

23.5 The hospital shall have obstetrical and neonatal specialists, as appropriate to the hospital's scope of services.

23.6 The hospital shall develop and implement admission and transfer criteria for perinatal services that reflect the hospital's scope of services.

23.7 Labor and Delivery

(A) The hospital shall develop and implement policies and procedures, based on nationally-recognized guidelines and standards of care that address, at a minimum, the following:

(1) Receipt of prenatal records for admissions, other than emergency admissions.

(2) Management of labor, including but not limited to the monitoring of the well-being of the mother and the fetus.

(3) Cesarean Sections, including the following:

(a) The capability of performing a Cesarean section within thirty (30) minutes of the decision to perform such a delivery method.

(b) Vaginal birth after a Cesarean section.

(4) Use of analgesic and anesthetic agents for pain management and the responsibilities of persons who administer it. This policy shall be developed in consultation with the anesthesia service.

(5) Postpartum assessments and care of the obstetrical patient and the neonate.

(6) Identification and management of high risk obstetrical patients including protocols for consultations and for the transfer of patients whose needs exceed the hospital's scope of services to a facility capable of providing the appropriate level of care. The transfer is a joint responsibility of the sending and receiving facilities.

(7) Protocols for visitors during labor and delivery.

(8) Miscarriages and stillbirths.

(9) Any policies and procedures required by federal or state law.

(10) Infection prevention and control. These policies shall be reviewed by the infection prevention and control committee and shall include the following:

(a) Obstetric patients shall be separated from other patients, with the exception of non-infectious gynecological patients.

(b) A protocol to be followed for obstetric patients and neonates with suspected or confirmed communicable disease.

(c) Isolation of communicable disease cases, based on nationally-recognized perinatal standards of practice. If a neonate is isolated with their mother, both shall be isolated in a private room.

(B) There shall be an appropriately credentialed staff member present at every delivery who has been trained according to nationally recognized standards in neonatal resuscitation.

23.8 Neonate Care

(A) Identification shall be placed securely on each neonate before removal from the delivery room.

(B) Neonate screening shall be conducted in accordance with 5 CCR 1005-4, Newborn Screening and Second Newborn Screening and 6 CCR 1009-6, Newborn Hearing Screening.

(C) Security measures shall be instituted to safeguard newborns neonates against access by unauthorized persons.

(D) The hospital shall develop and implement policies and procedures based on nationally-recognized guidelines and standards of practice, that address, at a minimum, the following:

(1) Stabilization of neonates after birth, including stabilization of high-risk neonates.

(2) Monitoring of neonates, including the following requirements:

(a) Examination of neonates at least once per day until discharge.

(b) A physical examination performed by an appropriately credentialed licensed independent practitioner prior to discharge of the neonate.

(3) Care of high-risk neonates, including protocols for consultations and for the transfer of neonates whose needs exceed the hospital's scope of services to a facility recognized for its capability to provide the appropriate higher level of care. The transfer is a joint responsibility of the sending and receiving facilities.

(4) Parent and sibling visitation of neonates.

(5) Admission and care of neonates born outside of the hospital.

23.9 Discharge Planning

(A) As part of the discharge planning process, the hospital shall assess the educational needs of the parent(s) and provide, or arrange for, education in self-care and neonate care, as appropriate.

6 CCR 1011-1 Chapter 04, pt. 23