A. Obstetrical
Level I Unit (Basic Care)
1. General
Provisions
a. Care and supervision for low
risk pregnancies greater or equal to 35 weeks gestation and postpartum patients
who are generally healthy and do not have medical, surgical, or obstetrical
conditions that present a significant risk of maternal morbidity or mortality,
shall be provided.
b. Participation
in the state perinatal quality collaborative, which is under the authority of
the Louisiana Commission on Perinatal Care and Prevention of Infant Mortality,
is required and defined as reporting national perinatal measures determined by
the Louisiana Commission on Perinatal Care and Prevention of Infant
Mortality.
c. There shall be a
triage system present in policies and procedures for identification,
stabilization and referral of high risk maternal and fetal conditions beyond
the scope of care of a level I unit, including situations where an infant will
require a higher level of care than what may be provided by the neonatal level
of care of the facility.
d.
Postpartum care facilities shall be available onsite.
e. There shall be capability to provide for
resuscitation and stabilization of inborn neonates.
f. The hospital shall have a policy for
infant security and an organized program to prevent infant
abductions.
g. The hospital shall
have a program in place to address the needs of the family, including
parent-siblingneonate visitation.
h. The hospital shall have a written transfer
agreement with another hospital that has an approved appropriate higher level
of care.
i. The hospital shall have
the capability to screen, provide brief intervention and refer to treatment
through consultation with appropriate personnel for behavioral health
disorders, including depression, and substance use disorder.
j. Social services, pastoral care and
bereavement services shall be provided as appropriate to meet the needs of the
patient population served.
2. Personnel Requirements
a. Obstetrical services shall be under the
medical direction of a qualified physician who is a member of the medical staff
with obstetric privileges. The physician shall be board certified or board
eligible in obstetrics/gynecology or family practice medicine. The physician
has the responsibility of coordinating perinatal services with the pediatric
chief of service.
b. The nursing
staff shall be adequately trained and staffed to provide patient care at the
appropriate level of service. Registered nurse to patient ratios may vary in
accordance with patient needs.
c.
The unit shall provide credentialed medical staff to ensure the capability to
perform emergency cesarean delivery within a time interval that best
incorporates maternal and fetal risks and benefits.
d. The maternal care providers, including
midwives, family physicians or obstetricians, shall be readily available at all
times.
e. Anesthesia, radiology,
ultrasound, electronic fetal monitoring (along with personnel skilled in the
use of these) and laboratory services shall be readily available at all
times.
f. At least one credentialed
physician or certified registered nurse midwife shall attend all deliveries,
and at least one individual who is American Academy of Pediatrics (AAP)
certified in neonatal resuscitation and capable of neonatal resuscitation shall
attend all deliveries.
g. The nurse
manager shall be a registered nurse (RN) with specific training and experience
in obstetric care. The RN manager shall participate in the development of
written policies, procedures for the obstetrical care areas, and coordinate
staff education and budget preparation with the chief of service. The RN
manager shall name qualified substitutes to fulfill duties during
absences.
h. A facility shall have
at least one individual with additional education in breastfeeding who is
available for support, counseling and assessment of breastfeeding
mothers.
i. A facility shall have
ability to initiate education and quality improvement programs to maximize
patient safety, and/or collaborate with higher-level facilities to do
so.
3. Physical Plant
a. Laboring and postpartum patients shall not
be placed in rooms with non-obstetrical patients.
b. Each room shall have at least one toilet
and lavatory basin for the use of obstetrical patients.
c. The arrangement of the rooms and areas
used for obstetrical patients shall be such as to minimize traffic of patients,
visitors, and personnel from other departments and prevent traffic through the
delivery room(s).
d. There shall be
an isolation room provided with hand washing facilities for immediate
segregation and isolation of a mother and/or baby with a known or suspected
communicable disease.
e. For any
new construction or major alteration of the obstetrical unit/suite, the
hospital shall ensure that the OB unit has a cesarean delivery room (surgical
operative room) to perform cesarean deliveries at all times.
4. Program Functions and Services
a. Laboratory and Blood Bank Services
i. There shall be protocols and capabilities
for massive transfusion with process to obtain more blood and component therapy
as needed, emergency release of blood products and management of multiple
component therapy available on-site.
b. Medical Imaging Services
i. Ultrasound equipment shall be physically
present at all times in the hospital and available during labor and
delivery.
ii. Basic ultrasound
imaging for maternal or fetal assessment including interpretation, shall be
readily available at all times.
c. Obstetrical Services
i. Ensure the availability and interpretation
of non-stress testing and electronic fetal monitoring.
ii. A trial of labor for patients with prior
cesarean delivery may be attempted only if the necessary personnel to perform a
cesarean delivery and perform maternal resuscitation are physically present.
This personnel includes, all credentialed medical staff needed to perform an
emergency cesarean delivery.
iii.
The facility shall have written guidelines or protocols for various conditions
that place the pregnant or postpartum patient at risk for morbidity and/or
mortality, including promoting prevention, early identification, early
diagnosis, therapy, stabilization, and transfer. The guidelines or protocols
shall address at a minimum:
(a). massive
hemorrhage and transfusion of the pregnant or postpartum patient in
coordination with the blood bank, including management of unanticipated
hemorrhage and/or coagulopathy;
(b). hypertensive disorders in
pregnancy;
(c). sepsis and/or
systemic infection in the pregnant or postpartum patient; and
(d). venous thromboembolism in the pregnant
and postpartum patient, including assessment of risk factors, prevention, and
early diagnosis and treatment.