Section 410 IAC 27-10-1 - Patient careAuthority: IC 16-21-1-7; IC 16-21-2-2.5
Affected: IC 16-21-1
Sec. 1.
(a) All patient care services must: (1) meet the needs of the patient, within the scope of the service offered, in accordance with acceptable standards of practice of midwifery;(2) be under the direction of a qualified person or persons; and(3) require that: (A) the patient care services rendered are:(i) reviewed and analyzed at regular meetings of patient care personnel; and(ii) used as a basis for evaluating the quality of services provided; and(B) personnel with appropriate training are available at all times to handle possible emergencies involving patients of the center.(b) Written patient care policies and procedures must be available to personnel and must include, but not be limited to, the following: (1) A provision that labor shall not be induced, stimulated, or augmented with chemical agents during the first or second stage of labor.(2) A provision that the center clearly delineate the medical and social risk factors that exclude women from the low-risk intrapartum group, which must include, but are not limited to, the following: (A) Past obstetrical history: (i) all hypertensive disorders of pregnancy;(ii) previous delivery other than spontaneous or low forceps;(B) Associated conditions: (i) vaginal plastic surgery;(iii) cardiovascular disease except mild asymptomatic Class 1 without hemodynamic abnormality;(v) renal disease (albuminuria, hematuria, casts);(vi) acute or chronic liver disease;(ix) hematologic disease;(xi) neurological disorder; and(C) Prenatal course of current pregnancy:(i) anemia (less than ten (10) grams hemoglobin concentration and not responding to therapy);(ii) uterine bleeding except for threatened abortion in first trimester;(iii) any presentation except vertex position at thirty-seven (37) weeks or beyond;(v) known multiple gestation;(vi) premature labor at less than thirty-seven (37) weeks;(vii) prolonged rupture of membranes for:(AA) eighteen (18) hours without regular contractions; or(BB) twenty-four (24) hours with contractions unless delivery is imminent;(viii) prolonged pregnancy of forty-two (42) weeks or more; or(ix) significant isoimmunization against Rh or other antigen, which may affect the fetus. (3) A provision that the center clearly delineates the medical and social risk factors that exclude women from the low-risk intrapartum group but that may be waived by the staffing physician on an individual basis, including, but not limited to, the following: (A) Maternal characteristics: (i) height less than sixty (60) inches;(ii) weight less than one hundred (100) pounds and greater than two hundred (200) pounds;(iii) clients under sixteen (16) years of age and over forty (40) years of age; or(iv) parity four (4) or more.(B) Past obstetrical history: (i) habitual abortion of: (AA) more than two (2) consecutive spontaneous or induced abortions;(BB) postpartum hemorrhage; and(CC) third stage problem or problems, for example, severe lacerations, inverted uterus, or retained placenta;(iii) previous second stage labor greater than two (2) hours;(iv) premature baby of thirty-seven (37) weeks or less than two thousand five hundred (2,500) grams;(v) respiratory distress;(vi) congenital abnormality;(vii) known genetic disorders;(viii) any neonatal death;(x) significant birth injury; or(xi) infant greater than four thousand five hundred (4,500) grams.(C) Prenatal course of current pregnancy: (i) intrauterine fetal growth retardation or fetus small for gestational age as documented by ultrasound; or(D) Associated conditions: (i) gastrointestinal disorders, for example, regional ileitis or ulcerative colitis;(ii) pulmonary disease not requiring treatment, for example, asthma or chronic bronchitis;(vii) smoking greater than one (1) pack per day;(viii) urinary tract surgery;(x) gestational diabetes; or(xi) venereal and related diseases.(E) Failure of the women to register with the center before the end of the first trimester.(4) A provision that a reliable method of patient identification must be used.(5) A provision for the care of the infant, which shall include, but is not limited to, the following: (A) Resuscitation of the newborn.(B) Prophylactic treatment of the eyes.(C) Documented physical examination of the newborn before discharge.(D) The collection of blood for newborn screenings.(E) Referral for any abnormalities or problems.(F) Procedures for the detection of Rh and ABO isoimmunization.(G) Administration and reporting of universal newborn hearing screening; and(H) Documentation in a newborn screening log that includes: (i) results of newborn blood screening; and (ii) hearing information.(6) A provision for instruction or instructions to be given to the patient or the patient's legal representative regarding follow-up care and transportation needed by the patient on discharge to include at least the following:(A) Signs and symptoms of possible complications.(B) Activities allowed and activities to be avoided.(C) Hygienic and other postdischarge procedures to be followed.(D) The center's emergency phone numbers available on a twenty-four (24) hour basis.(E) Follow-up appointment, if indicated;(7) A provision to maintain a written system of documentation of patients who report postdischarge complications and the center's interventions. The interventions must be documented in the medical record.(8) A provision that facilities, reusable equipment, and supplies must be thoroughly cleaned or sterilized, or both, following use according to center policies and procedures.Indiana State Department of Health; 410 IAC 27-10-1; filed Feb 3, 2006, 2:00 p.m.: 29 IR 1914; readopted filed Jul 12, 2012, 12:09 p.m.: 20120808-IR-410120265RFAReadopted filed 9/26/2018, 2:48 p.m.: 20181024-IR-410180328RFA