3701-84-55 Level III obstetric care services: specific requirements (antepartum, intrapartum and postpartum care).

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

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

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

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

(4) Referral to other level III services as appropriate.

(B) Each level III obstetrics care service shall, using licensed health care professionals acting within the scopes of their 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 served including nutrition, genetic, and toxicology services;

(3) Develop and follow a written referral policy for obtaining public health services;

(4) Conduct risk assessments for identification of, and appropriate consultation for, the high-risk patient;

(5) Provide consultation on a twenty-four hour basis;

(6) Provide or coordinate continuing education for referring services;

(7) Provide opportunities for clinical experience for purposes of graduate nursing education and/or continuing education;

(8) Provide opportunities for graduate medical education such as pediatric or obstetrics-gynecology residencies, and neonatal or maternal-fetal medicine fellowships;

(9) Participate, on an ongoing basis, in basic or clinical obstetrics research;

(10) Coordinate delivery of a formal education program including the American heart association/American academy of pediatrics (AHA/AAP) neonatal resuscitation program or an equivalent program accepted by the director for providers of obstetric care services;

(11) Provide multi-disciplinary planning relating to management and therapy through the postpartum period;

(12) Coordinate and facilitate maternal transports from referring services consistent with the current American academy of pediatrics and American college of obstetricians and gynecologists guidelines for perinatal care;

(13) Accept obstetric referrals on a twenty-four hour basis;

(14) Conduct ongoing continuing education, including fetal heart-rate assessment;

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

(16) Provide follow-up services to patients or refer patients for appropriate follow-up.

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

(D) In addition to meeting the requirements of paragraph (D) of rule 3701-84-51 of the Administrative Code, each level III obstetrical care service shall be capable of providing:

(1) All specialized diagnostic services or referral to another obstetric service;

(2) Maternal-fetal medicine on site within thirty minutes on a twenty-four hour basis;

(3) Anesthesia services. Staff with credentials to administer obstetric anesthesia, assigned exclusively to the obstetric service, shall be available in the building in which the service is located on a twenty-four hour basis; and

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

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

(1) A board certified maternal-fetal medicine subspecialist and a board certified neonatologist as co-directors for the obstetric care service. The co-directors shall coordinate and integrate the following:

(a) A system for consultation;

(b) In-service education programs;

(c) Coordination and communication with support services and other obstetric care services; and

(d) Defining and establishing, in collaboration with other members of the obstetric team, appropriate protocols and procedures for obstetric patients;

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

(3) An RN with a master’s degree in nursing and an area of specialization in perinatal health to provide clinical nursing expertise commensurate with the patient acuity and services provided;

(4) A full complement of specialists in appropriate fields including surgery, pulmonology, infectious disease, internal medicine, and endocrinology, all of whom shall be available. Medical-surgical subspecialists in all areas shall be available for consultation;

(5) A biomedical engineer;

(6) An American college of medical genetics (ACMG) certified or eligible genetics counselor to identify families at risk for genetic abnormalities, obtain family genetic history, provide genetic counseling in complicated cases and, if necessary, refer complicated cases to a medical geneticist on staff or the obstetrics care service shall have the ability to obtain the services of an individual meeting the requirements of this paragraph;

(7) An attending obstetrical physician that is available in the building in which the obstetric care service is located on a twenty-four hour basis;

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

(9) Medical, surgical, radiological, and pathology specialists shall be available on a twenty-four hour basis;

(10) A multi disciplinary team of staff shall be available in the obstetric and newborn area. Two members of the team shall have successfully completed the AHA/AAP neonatal resuscitation program, or an equivalent program accepted by the director, and be capable of complete neonatal resuscitation;

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

(12) A licensed dietitian with knowledge of maternal and newborn nutrition and knowledge of parenteral/enteral nutrition management of at-risk newborns;

(13) A licensed social worker to provide psychosocial assessments, family support services, and medical social work;

(14) A certified lactation consultant available for support and education of the breast feeding patient; and

(15) 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