(a) The birth
center shall develop and implement a program for evaluating and improving the
quality of
(1) direct care services to
childbearing families; and
(2) the
environment in which services are provided.
(b) The birth center shall
(1) include in its evaluation and improvement
program an organizational plan to identify and resolve problems; and
(2) hold regular meetings of the clinical
staff to review the management of care of individual clients and newborns and
to make recommendations for improving the plan of care.
(c) In the evaluation and improvement program
for direct care services for clients and newborns, the birth center shall
review and document at least annually
(1)
protocols, policies, and procedures relating to client and newborn care, and
revise any protocol, policy, or procedure as necessary;
(2) the appropriateness of the risk
assessment standards developed under
7
AAC 12.403(f) for determining
eligibility for admission to and continuation in the birth center program of
care;
(3) the appropriateness of
diagnostic and screening procedures, including laboratory studies, sonography,
and non-stress tests, as those procedures affect quality of care and cost to
the client;
(4) the appropriateness
of medications prescribed, dispensed, or administered by the birth
center;
(5) performance evaluation,
including peer review, for each employee, including contract staff, with
results maintained in the personnel record;
(6) transfers of clients and newborns to
hospital care; to determine the appropriateness and quality of each transfer,
the birth center shall establish procedures for the evaluation of emergency and
non-emergency transfers, including
(A) the
amount of time to complete transfers;
(B) the efficiency of transportation
services;
(C) the reception of the
client and newborn at the hospital; and
(D) client satisfaction with the transfer, if
that information is provided by the client, either verbally or in
writing;
(7) problems or
complications of pregnancy, labor, and postpartum care, and the appropriateness
of the practitioner's clinical judgment in obtaining consultation and
addressing each problem; and
(8) an
evaluation of staff ability to manage emergency situations, including client
and newborn emergencies, power failures and similar emergencies, and
unannounced periodic fire drills.
(d) The birth center shall ensure that each
review under this section includes at least 20 percent of all births, 100
percent of all transfers to a hospital of clients or newborns, and all
significant outcomes required to be reported under
7
AAC 12.405(j) (9)(B), during the
period covered by the review. The birth center shall document each review and
any action taken as a result of the identification of issues that might affect
the quality of care and services.
(e) The birth center shall include in the
evaluation and improvement program at least the following measures, for
purposes of ensuring a safe, home-like environment:
(1) routine testing of the efficiency and
effectiveness of equipment, including sphygmomanometers, Doppler fetal heart
monitors, sterilizers, resuscitation equipment, transport equipment, oxygen
equipment, communication equipment, heat sources for newborns, smoke alarms,
and fire extinguishers;
(2) routine
review of housekeeping procedures and infection control;
(3) an evaluation of maintenance policies and
procedures for heat, ventilation, emergency lighting, waste disposal, water
supply, and laundry and kitchen equipment.
(f) The birth center shall ensure that the
evaluation and improvement program monitors and promotes quality of care to
clients and newborns through an effective system for collection and analysis of
data, including
(1) utilization of
(A) orientation sessions;
(B) childbirth-related educational
programs;
(C) postpartum home
visits;
(D) follow-up postpartum
office visits by the client; and
(E) follow-up office visits for the
newborn;
(2) types of
local anesthetics and analgesia used; and
(3) outcomes of care provided, including
(A) clients registered for care;
(B) time in the birth center before
birth;
(C) time in the birth center
after birth;
(D) clients admitted
to the birth center for intrapartum care;
(E) births in the birth center;
(F) births en route to the birth
center;
(G) clients transferred
antepartum, intrapartum, or postpartum, including the reason for the
transfer;
(H) newborns transferred,
including the reason for the transfer;
(I) type of delivery, including nonsterile
vaginal delivery;
(K) fourth degree
lacerations;
(L) newborns with
birth weight less than 2,500 grams;
(M) newborns with birth weight greater than
4,500 grams;
(N) Apgar scores six
and below, when taken at five minutes after birth;
(P) spontaneous abortions;
(Q) maternal mortality; and
(R) client satisfaction with services
provided, if that information is provided by the client, either verbally or in
writing.
(g)
The birth center shall seek consultation and expertise from individuals who are
not associated with the birth center to review problems that are identified
through the evaluation and improvement program and that the birth center is
unable to resolve internally.
(h)
The birth center shall take appropriate action to resolve problems, including
(1) administrative or supervisory
action;
(2) in-service education
and training;
(3) modification of
policies and procedures;
(4)
revision of the risk assessment standards developed under
7
AAC 12.403(f); and
(5) revision of any standard forms used for
client and newborn records or other purposes.
(i) The birth center may provide an
alternative intervention appropriate for use in birth centers, including water
birth, use of homeopathic or herbal medicines, or another alternative
intervention intended for use in the perinatal period. In this subsection,
"alternative intervention" means a low-technology intervention that is not
generally used in a medical or hospital setting. Before using an alternative
intervention, the birth center must ensure that
(1) documented science-based evidence exists
that the alternative intervention can be used safely in a birth center setting
for pregnant or laboring women; and
(2) the alternative intervention is supported
by the American College of Nurse Midwives, the American Association of Birth
Centers, the Midwives Association of North America, or another
nationally-recognized professional organization.
