Section 410 IAC 39-5-3 - Neonatal Level III facility requirementsAuthority: IC 16-21-13-5
Affected: IC 16-21-13
Sec. 3.
(a) A Neonatal Level III facility is a Neonatal Level II facility plus the ability to provide acute and comprehensive neonatal intensive care for infants who are born at less than thirty-two (32) weeks gestation or less than one thousand five hundred (1,500) grams at birth or have medical or surgical conditions regardless of gestational age. In addition to the requirements of a Neonatal Level II facility, a Neonatal Level III facility shall meet the requirements set forth in this section.(b) A Neonatal Level III facility shall demonstrate as follows its capability of providing neonatal care through written standards, protocols, guidelines, and training, including (Neonatal Level II plus the following): (1) Each Neonatal Level III facility shall have the following facility capabilities: (A) Provide sustained neonatal life support.(B) Pediatric ophthalmology services for the monitoring of ROP. The facility shall have an organized program for or consultative agreement for the treatment and follow-up of ROP that incorporates neonatal risks and benefits with the provision of care.(C) Pediatric surgical specialists (including anesthesiologists with pediatric experience) readily available at all times, or at another facility through prearranged consultative agreement, and shall perform all procedures in newborn infants within a time interval that incorporates neonatal risks and benefits with the provision of emergency care.(D) Pediatric medical subspecialty services must be provided onsite or through prearranged consultative agreement, which allows for emergency transport between institutions within a time interval that incorporates neonatal risks and benefits with the provision of emergency care.(E) Capability to perform major surgery onsite or through a prearranged consultative agreement with a risk appropriate institution.(2) Each Neonatal Level III facility shall obtain and maintain current equipment and technology, including, but not limited to, the following: (A) Advanced imaging with interpretation on an urgent basis, including, but not limited to, computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography.(B) Provide a full range of evidence-based respiratory support for periods longer than twenty-four (24) hours.(3) Each Neonatal Level III facility shall have medications required to support care of the Level III neonate.(4) Each Neonatal Level III facility shall establish and maintain the following policies and procedures: (A) Written plan for accepting or transferring neonates as back transports for ongoing convalescent care. Back transport needs to be done in consultation with the referring physician.(B) Prearranged written plan with a neurodevelopmental follow-up clinic or neurodevelopmental practice.(c) Each Neonatal Level III facility shall ensure the following staffing requirements are met, including (Neonatal Level II plus the following): (1) Physician services, as follows: (A) Director of the neonatal intensive care unit (NICU) shall be a full-time, board certified neonatologist.(B) A pediatrician who has completed pediatric residency training, or an advance practice provider with adequate NICU training and experience, with privileges for neonatal care appropriate to the level of the nursery, shall be physically present at all times.(C) A neonatologist shall be readily available at all times.(2) Nursing services, as follows: (A) All nurses working with neonates at high risk shall have evidence of continuing education in neonatal nursing and special training and experience in the management of neonates with complex illnesses and neonatal complications.(B) Adequate numbers of nursing leaders and registered nurses (RNs) with competence in Level III care criteria and ability to stabilize and make preparations to transfer high-risk neonates who exceed Level III care criteria, readily available at all times.(C) A director of perinatal nursing services, master's prepared or actively seeking a master's degree, who has overall responsibility for inpatient activities in the neonatal area. This RN shall have demonstrated expertise in perinatal care as well as in the care of patients at high risk.(D) A RN who is master's prepared or actively seeking a master's degree shall coordinate education.(3) Respiratory therapists who can supervise the assisted ventilation of newborn infants physically present at all times.(4) Pharmacy personnel with pediatric expertise who can work to continually review their systems and processes of medication administration to ensure that patient care policies are maintained.(5) Physical therapist or occupational therapist with additional continuing education units in the area of neonatal care, as a member of the interdisciplinary care team.(6) Speech therapist, with additional continuing education units in the area of neonatal care, as a member of the interdisciplinary care team.(7) At least one (1) registered dietitian or nutritionist who has special training in perinatal nutrition and can plan diets that meet the special needs of neonates at high risk.(8) Social services, pastoral care, and bereavement service provided as appropriate to meet the needs of the population served.Indiana State Department of Health; 410 IAC 39-5-3; filed 8/14/2019, 3:32 p.m.: 20190911-IR-410180416FRA