3701-84-51 Level II obstetric care services: specific requirements (antepartum, intrapartum and postpartum care).

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

(1) Antepartum care to include obstetrical care for all uncomplicated patients, selected complicated patients, selected high-risk patients, and the management of emergencies;

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

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

(B) In addition to the requirements under paragraph (B) of rule 3701-84-46 of the Administrative Code, each level II obstetric service shall:

(1) Provide multi-disciplinary planning of patient management and therapy through the postpartum period;

(2) Provide for telephone consultation for maternal-fetal medicine on a twenty-four hour basis; and

(3) Establish criteria for the acceptance of maternal transports from other services based on demonstrated capability of the obstetric care service to provide the appropriate services consistent with the current American academy of pediatrics and American college of obstetricians and gynecologists guidelines for perinatal care.

(C) Each level II obstetric care service shall meet the requirements of paragraph (C) of rule 3701-84-46 of the Administrative Code for intrapartum care.

(D) Each level II obstetric care service shall have the necessary support services including the following services and staff in the building in which the obstetric care service is located on a twenty-four hour basis:

(1) Clinical laboratory services capable of providing the 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; and

(4) Pharmacy services.

(E) Each level II obstetric care service shall be capable of providing:

(1) Anesthesia services. Staff with credentials to administer obstetric anesthesia shall be readily available on a twenty-four hour basis; and

(2) Blood, blood products, and substitutes available on a twenty-four hour basis.

(F) In addition to the requirements under paragraphs (F) and (H) of rule 3701-84-46 of the Administrative Code, each level II obstetric care service shall have qualified staff, as appropriate for the services provided including:

(1) An attending obstetrical physician available on a twenty-four hour basis;

(2) A director of anesthesia services who is a board certified anesthesiologist;

(3) Medical, surgical, radiology and pathology specialists available for consultation;

(4) A multidisciplinary team of staff shall be available in the delivery and newborn area. Two members of the team shall have successfully completed the American heart association/American academy of pediatrics (AHA/AAP) neonatal resuscitation program, or an equivalent program accepted by the director, and be capable of complete neonatal resuscitation;

(5) A physician or certified neonatal nurse practitioner available to attend newborns at high-risk deliveries;

(6) A board certified obstetrician and a board certified pediatrician as co-directors of the obstetric and newborn care service. The co-directors shall establish procedures for patients and shall integrate and coordinate a system for consultation, in-service education, and communication with referring obstetric and newborn care services;

(7) A full-time nurse manager/director who is a registered nurse responsible for the organization and supervision of nursing services in the obstetrical care service.

(8) An RN on staff to provide clinical nursing expertise commensurate with the patient acuity and services provided. Expertise may be demonstrated through education, certification or a minimum of five years obstetric experience;

(9) A licensed dietitian with knowledge of maternal and newborn nutrition and knowledge of parenteral/enteral nutrition management of at-risk newborns or the provider of the service shall have the ability to consult with an individual with those qualifications; and

(10) A licensed social worker to provide psychosocial assessments and family support services;

(11) A certified lactation consultant available; and

(12) Specific RN staffing to include:

(a) An RN competent in obstetric and newborn care on duty twenty-four hours per day for maternal and newborn care;

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

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

(d) At least two RNs available for labor and delivery at all times.

Effective: 05/15/2008

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

Promulgated Under: 119.03

Statutory Authority: 3702.11, 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