Section 410 IAC 39-4-3 - Obstetric Level III facility requirementsAuthority: IC 16-21-13-5
Affected: IC 16-21-13
Sec. 3.
(a) An Obstetric Level III facility is an Obstetric Level II facility plus care of more complex maternal medical conditions, obstetric complications, and fetal conditions. In addition to the requirements of an Obstetric Level II facility, an Obstetric Level III facility shall meet the requirements set forth in this section.(b) An Obstetric Level III facility shall demonstrate as follows its capability of providing uncomplicated and complicated obstetrical care through written standards, protocols, guidelines, and training, including (Obstetric Level II plus the following): (1) Each Obstetric Level III facility shall have all of the following facility capabilities: (A) Demonstrated experience and capability to provide comprehensive management of severe maternal complications.(B) An onsite intensive care unit (ICU) should accept pregnant women and have critical care specialists, immediately available at all times.(C) ICU collaborates actively with the maternal-fetal medicine (MFM) care team in the management of all pregnant women and women in the postpartum period who are in critical condition or have complex medical conditions.(2) Each Obstetric Level III facility shall obtain and maintain current equipment and technology, including, but not limited to, the following: (A) Advanced imaging available at all times, including basic interventional radiology, maternal echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine imaging with interpretation.(B) Ultrasonography with capability to perform Doppler studies.(C) Appropriate equipment available to stabilize and monitor women in labor and delivery until they can be safely transferred to the ICU.(3) The medication requirements for Obstetric Level III are the same as Obstetric Level I, set forth in section 1 of this rule.(4) The policies and procedures for Obstetric Level III are the same as Obstetric Level I, set forth in section 1 of this rule.(c) Each Obstetric Level III facility shall ensure the following staffing requirements are met (Obstetric Level II plus the following): (1) Physician services, as follows: (A) An obstetrician-gynecologist (OB-GYN) physically present at all times.(B) MFM specialist available at all times onsite, by telephone, or by telemedicine with inpatient privileges.(C) Director of MFM service who is a board certified MFM specialist.(D) Director of anesthesia service is a board certified anesthesiologist.(E) Full complement of subspecialists readily available at all times for consultation, including critical care, general surgery, infectious disease, hematology, cardiology, nephrology, neurology, and neonatology.(2) Nursing services, as follows: (A) All nurses working with antepartum patients at high risk shall have evidence of continuing education in maternal-fetal nursing and special training and experience in the management of women with complex maternal illnesses and obstetric complications.(B) 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 obstetric area. This registered nurse (RN) shall have demonstrated expertise in perinatal care as well as in the care of patients at high risk.(C) A RN who is master's prepared or is actively seeking a master's degree shall coordinate education.(D) Adequate numbers of nursing leaders and RNs with competence in Level III care criteria and ability to stabilize and make preparations to transfer high-risk women who exceed Level III care criteria, readily available at all times.(3) Anesthesia services physically present at all times.(4) Registered pharmacist with experience in perinatal-neonatal pharmacology readily available at all times.(5) 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 women at high risk.(6) Social services, pastoral care, and bereavement services provided as appropriate to meet the needs of the population served.Indiana State Department of Health; 410 IAC 39-4-3; filed 8/14/2019, 3:32 p.m.: 20190911-IR-410180416FRA