Section 410 IAC 39-4-4 - Obstetric Level IV facility requirementsAuthority: IC 16-21-13-5
Affected: IC 16-21-13
Sec. 4.
(a) An Obstetric Level IV facility is an Obstetric Level III facility plus onsite medical and surgical care of the most complex maternal conditions and critically ill pregnant women and fetuses throughout antepartum, intrapartum, and postpartum care. In addition to the requirements of an Obstetric Level III facility, an Obstetric Level IV facility shall meet the requirements set forth in this section.(b) An Obstetric Level IV facility shall demonstrate as follows its capability of providing uncomplicated and complicated obstetrical care through written standards, protocols, guidelines, and training, including (Obstetric Level III plus the following): (1) Each Obstetric Level IV facility shall have all of the following facility capabilities: (A) Onsite medical and surgical care of complex maternal conditions (including congenital maternal cardiac lesions, vascular injuries, neurosurgical emergencies, and transplants) with the availability of critical care unit or intensive care unit (ICU) beds.(B) Provide seamless communication between maternal-fetal medicine (MFM) specialists and other subspecialists in the planning and facilitation of care for women with the most high-risk complications of pregnancy.(C) Institutional support for the routine involvement of a MFM care team with the critical care units and specialists.(D) MFM care team with expertise to assume responsibility for pregnant women and women in the postpartum period who are in critical condition or have complex medical conditions. This includes co-management of ICU-admitted obstetric patients.(2) The equipment requirements for Obstetric Level IV are the same as Obstetric Level III, set forth in section 3 of this rule.(3) The medication requirements for Obstetric Level IV are the same as Obstetric Level I, set forth in section 1 of this rule.(4) The policies and procedures requirements for Obstetric Level IV are the same as Obstetric Level I, set forth in section 1 of this rule.(c) Each Obstetric Level IV facility shall ensure the following staffing requirements are met (Obstetric Level III plus the following): (1) Physician services, as follows: (A) Director of obstetric service is board certified in MFM or obstetrics and gynecology, with expertise in critical care obstetrics.(B) Adult medical and surgical specialty and subspecialty consultants readily available at all times to collaborate with MFM care team and advanced neurosurgery, transplant, or cardiac surgery.(C) MFM specialist readily available at all times for onsite consultation and management, with full privileges.(2) Nursing services, as follows: (A) Adequate numbers of registered nurses (RNs) who have experience in the care of women with complex medical illnesses and obstetric complications; this includes competence in Level IV care criteria, readily available at all times.(B) An advanced practice RN available to staff for consultation, education, and support on nursing care issues.(3) Physician and nursing leadership with expertise in maternal intensive and critical care.Indiana State Department of Health; 410 IAC 39-4-4; filed 8/14/2019, 3:32 p.m.: 20190911-IR-410180416FRA