3701-84-46 Level I obstetric care services: specific requirements (antepartum, intrapartum and postpartum care).

(A) Designation as a level I obstetric care service requires that the provider of the obstetric care service provide:

(1) Antepartum care to include obstetrical care for uncomplicated pregnancies and the management of emergencies;

(2) Intrapartum care to include obstetrical care for the management of uncomplicated labor and delivery patients, selected complicated labor and delivery patients, unanticipated complications of labor and delivery, and emergencies; and

(3) Postpartum care to include obstetrical care consistent with the antepartum and intrapartum care provided and the management of unanticipated postpartum complications and emergencies.

(B) Each level I obstetric care service shall, using licensed health care professionals acting within their scopes of practice:

(1) Develop and follow a written service plan for the care of patients;

(2) Provide for the appropriate range of services for the patient population it serves;

(3) Provide or have a written referral policy for obtaining public health, dietetic, genetic, and toxicology services;

(4) Establish written criteria for determining those conditions that can be routinely managed by the service. The criteria shall be based on staff education, staff competence, the amount of staff experience with the listed conditions, and support services available to the service;

(5) Provide a formal education program for staff such as the American heart association/American academy of pediatrics (AHA/AAP) neonatal resuscitation program or an equivalent program accepted by the director;

(6) Conduct a risk assessment of patients to ensure identification of appropriate consultation requirements or referral for high-risk patients;

(7) Provide follow-up services to patients or refer patients for appropriate follow-up;

(8) Provide education for mothers regarding personal care and nutrition, newborn care and nutrition, and newborn feeding; and

(9) Provide for consultation or referral of maternal transports as needed. A system shall be in place to prepare and efficiently transport the patient consistent with the current American academy of pediatrics and American college of obstetricians and gynecologists guidelines for perinatal care.

(1) An emergency caesarean section delivery within thirty minutes of the time that the decision is made to perform the procedure on a twenty-four hour per day basis;

(2) Fetal monitoring; and

(3) Resuscitation and stabilization of newborns and emergency care for the mother and newborn in each delivery room.

(D) Each level I obstetric care service shall have the staff and support services to meet the needs of patients. Staff necessary to provide services shall be available on call on a twenty-four hour basis.

(E) Each level I obstetric care service shall have available in the building in which services are provided, on a twenty-four hour basis, the following services:

(1) Clinical laboratory services capable of providing necessary testing;

(2) Diagnostic x-ray services capable of providing portable x-ray services;

(3) Portable ultrasound visualization equipment and services for diagnosis and evaluation;

(4) Pharmacy services;

(5) Anesthesia services; and

(6) Blood, blood products and substitutes.

(F) Each level I obstetrical care service shall have qualified staff, as appropriate for the services provided including:

(1) Physician coverage for the management and delivery of patients not under the private care of another physician;

(2) A physician or a certified nurse- midwife in attendance at all deliveries and responsible for ascertaining that the newborn adaptations to extrauterine life are proceeding normally and for ensuring immediate post delivery care of the newborn;

(3) RNs with the appropriate education and demonstrated competence, commensurate with the acuity and volume of patients served, to provide direct supervision of patients.

(G) Each level I obstetric care service shall have specific RN staffing to include:

(1) An RN competent in obstetric and newborn care on duty twenty-four hours per day for maternal and newborn care except as provided in paragraph (G)(4) of this rule;

(2) An RN with obstetric and newborn experience for each patient in the second stage of labor;

(3) An RN to circulate for the cesarean birth deliveries; and

(4) When no patients are present on the service, the availability within thirty minutes of an RN meeting the appropriate education and demonstrated competence shall be deemed to meet the twenty-four hour RN staffing requirement of paragraph (G)(1) of this rule.

(H) Each level I obstetric care service shall have at least one staff member in attendance for newborns when they are not with the mother or her designee.

(I) Each level I obstetric care service shall have an individual who has successfully completed the AHA/AAP neonatal resuscitation program, or an equivalent program accepted by the director, and who is capable of initiating and completing full resuscitation, present at each delivery.

(J) Each level I obstetric care service shall maintain the ability to obtain the services of a physician to assist the primary physician or certified nurse-midwife in case of unavoidable delivery of a high-risk patient, emergency cesarean section, or unexpected fetal or neonatal stress.

(K) Each level I obstetric care service shall have co-directors of the obstetric and newborn care service responsible for the overall operation of the obstetric and newborn care service;

(1) One co-director shall be a board certified obstetrician or board certified family physician with experience in obstetrics; and

(2) One co-director shall be a board certified pediatrician or a board certified family physician with experience in pediatrics,

(L) Each level I obstetric care service shall provide a nurse manager who is a registered nurse responsible for the organization and supervision of nursing services in the obstetrical and newborn care service.

(M) Each level I obstetric care service shall provide for a licensed dietitian with knowledge of maternal and newborn nutrition, or the service shall have the ability to obtain maternal and newborn nutrition consultation.

(N) Each level I obstetric care service shall provide for a licensed social worker with knowledge of maternal and newborn psychosocial and family support services.

(O) Each level I obstetric care service shall have available a certified lactation consultant.

Effective: 05/15/2008

R.C. 119.032 review dates: 02/29/2008 and 03/01/2013

Promulgated Under: 119.03

Statutory Authority: 3701.11, 3702.13

Rule Amplifies: 3702.11, 3702.12, 3702.13, 3702.14, 3702.141, 3702.15, 3702.16, 3702.18, 3702.19, 3702.20

Prior Effective Dates: 3/1/1997, 3/24/03