Current through Register Vol. 35, No. 6, March 26, 2024
All licensed facilities shall follow and maintain written
clinical practice guidelines which address, at a minimum, eligibility for care,
ongoing eligibility, medical consultation, and transfer criteria in accordance
with the scope of practice authorized under each practitioner's individual
license(s) to be reviewed and updated by the internal quality committee at
least annually.
A.
Risk
assessment: A licensed practitioner shall make risk assessments of all
clients that at a minimum include:
(1) an
initial assessment which documents the general health and eligibility of a
potential client and which includes a detailed medical, social and family
history, a physical examination, and routine prenatal labs; the assessment may
also include ultrasounds to determine whether the client meets the criteria for
the facility's scope of care;
(2)
completing, maintaining, and documenting an initial risk assessment and an
on-going risk assessment in the client record which include compliance with
admission criteria prior to client acceptance and throughout the pregnancy with
the clinical director making the final determination of each client's
risk;
(3) if a client before 32
weeks gestation has failed to register for freestanding birth center care and
has not received prenatal care, the client shall not be accepted for care at
the facility unless the client obtains a medical consultation outside of the
facility, meets all other eligibility criteria, and a written, signed exception
is made by the clinical director on a case-by-case basis;
(4) clear documentation of referrals,
consultations and transfers to other providers for ineligible clients or
medical transfers;
(5) assessing
each client's risk status on admission in labor and throughout labor for
continuation of services;
(6)
whether the facility will have adequate space and sufficient staff to support
the client newborn during labor, birth and postpartum;
(7) written criteria for antepartum,
intrapartum, postpartum and newborn acceptance and transfer to a hospital which
delineates the transfer process from the facility to an accepting hospital;
and
(8) limitations on the number
of active labor clients at the facility to the number of birth rooms available
at the facility.
B.
Ineligibility for admission: If any of the following conditions
exist, birth at the facility shall be considered inappropriate or improper:
(1) breech or non-vertex presentation at
labor and delivery;
(2) gestation
less than 37 weeks or greater than 42 weeks;
(3) multiple gestation;
(4) medication controlled gestational
diabetes mellitus; or
(5) vaginal
birth after cesarean (VBAC) candidates with more than one previous cesarean
section, previous incision that is not low transverse, placenta location,
anterior and low-lying over the old scar.
