Section 410 IAC 39-5-1 - Neonatal Level I facility requirementsAuthority: IC 16-21-13-5
Affected: IC 16-21-13
Sec. 1.
(a) A Neonatal Level I facility is a facility that offers a basic level of newborn care to infants at low risk. These units have personnel and equipment available to perform neonatal resuscitation at every delivery and to evaluate and provide routine postnatal care for healthy term newborn infants. In addition, Level I neonatal units have personnel who can care for physiologically stable infants who are born at thirty-five (35) weeks of gestation or more and can stabilize ill newborn infants who are born at less than thirty-five (35) weeks of gestation until they can be transferred to a facility where the appropriate level of neonatal care is provided.(b) A Neonatal Level I facility shall demonstrate its capability of providing neonatal care through written standards, protocols, guidelines, and training, including the following: (1) Each Neonatal Level I facility shall have the following facility capabilities: (A) Appropriately detect, stabilize, and initiate management of unanticipated neonatal problems that occur until the patient can be transferred to a facility at which specialty neonatal care is available.(B) Ability to initiate education and quality improvement programs to maximize patient safety, collaborate with higher-level facilities to do so, or both.(C) Provide resuscitation and stabilization of unexpected neonatal problems according to the most current Neonatal Resuscitation Program (NRP) training.(D) Select and manage neonatal patients at a neonatal risk level appropriate to its capability.(E) Access to laboratory testing and blood bank supplies at all times.(2) Each Neonatal Level I facility shall obtain and maintain current equipment and technology, including, but not limited to, the following: (C) Emergency call system.(D) Intravenous infusion pump with drug library.(H) Compressed air and oxygen source.(I) Oxygen blender with flow meter and tubing.(J) Equipment for examination, immediate care, and identification of the newborn.(K) All equipment necessary to provide resuscitation and stabilization of unexpected neonatal problems according to the NRP training. All equipment necessary to provide resuscitation and stabilization of the unexpected neonatal problems must be located within the delivery area. All other equipment may be located in the facility.
(3) Each Neonatal Level I facility shall have the following medications: (C) Emergency medications, necessary to provide resuscitation and stabilization of unexpected neonatal problems according to NRP training, shall be available in the delivery area and neonatal units.(4) Each Neonatal Level I facility shall establish and maintain the following policies and procedures: (A) Formal transfer plans in partnership with a higher level of care facility that include, but are not limited to, the following: (ii) Determination of conditions necessitating consultation.(iii) Referral and transfer.(iv) A reliable, accurate, and comprehensive communication system between participating hospitals and transport teams.(B) The hospital shall provide care to the newborn in accordance with acceptable standards of practice, as provided for by 410 IAC 15-1.6-9(a). The current Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG) recommendations related to the care of the newborn shall be considered as authoritative sources of such acceptable standards of practice.(c) Each Neonatal Level I facility shall ensure the following staffing requirements are met: (1) Pediatricians, family physicians, or advanced practice providers readily available at all times.(2) Nursing services, as follows: (A) Registered nurse (RN) with demonstrated training and experience in the assessment, evaluation, and care of normal newborns, physically present at all times.(B) Adequate numbers of RNs with competence in Level I care criteria and ability to stabilize and make preparations to transfer high-risk neonates who exceed Level I care criteria, readily available at all times.(C) Nursing care under the leadership of a RN.(D) All nursing staff formally trained, certified, and competent in NRP.(E) Each delivering facility shall have a written plan for ensuring registered nurse-patient ratios as per Guidelines for Perinatal Care, or Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Guidelines for Professional Registered Nurse Staffing for Perinatal Units.(3) NRP trained professionals readily available at all times to the delivery and neonatal units.(4) Pharmaceutical services in accordance with 410 IAC 15-1.5-7.(5) Blood bank technicians readily available at all times.(6) A radiologic technician readily available at all times to perform portable x-rays.(7) The hospital shall provide lactation support for the care of mothers and newborns per AWHONN and International Board Certified Lactation Consultant Staffing Recommendations for Inpatient Setting Association (ILCA) recommendations on number of full-time equivalents per number of annual deliveries, based on the level of care at which the hospital is certified.Indiana State Department of Health; 410 IAC 39-5-1; filed 8/14/2019, 3:32 p.m.: 20190911-IR-410180416FRA