Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-68 - Guidelines for Discharge of Postpartum Mother and Newborns
Section 0780-01-68-.05 - SPECIFIC GUIDELINES
Universal Citation: TN Comp Rules and Regs 0780-01-68-.05
Current through September 24, 2024
(1) Discharge Planning.
(a) Discharge planning should occur
in a planned and systematic fashion for all postpartum mothers and new-borns in
order to enhance care, prevent complications and minimize the need for
rehospitalization. Prior to discharge a discussion should be held between the
physician or another health care provider and the mother (and father if
possible) about any expected perinatal problems and ways to cope with those
problems. The parties should discuss plans for future and immediate care as
well as instructions to follow in the event of an emergency or
complication.
(b) Follow-up care
must be planned for both mother and infant at the time of discharge. For
patients leaving the hospital prior to 24-48 hours, contact within 48-72 hours
of discharge is recommended and may include appropriate follow-up within 48-72
hours as deemed necessary by the attending provider, depending upon individual
patient need. This follow-up visit will be acknowledged as a provider
encounter.
(c) Maternal
considerations. Prior to discharge, the mother should be informed of normal
postpartum events including but not limited to:
1. Lochial patterns;
2. Range of activity and exercise;
3. Breast care;
4. Bladder care;
5. Dietary needs;
6. Perineal care;
7. Emotional responses;
8. Conditions to report to physician or other
health care provider including:
(i) Elevation
of temperature,
(ii)
Chills,
(iii) Leg pains,
and
(iv) Increased vaginal
bleeding.
9. Method of
contraception;
10. Coitus
resumption; and
11. Specific
instructions for follow-up (routine and emergent).
(d) Neonatal Considerations. Prior to
discharge, the following points should be reviewed with the mother or,
preferably, with both parents:
1. Condition of
the infant;
2. Immediate needs of
the infant; (eg., feeding methods and environmental supports);
3. Instructions to follow in the event of a
newborn complication or emergency;
4. Feeding techniques;
5. Skin care, including cord care and genital
care;
6. Temperature assessment and
measurement with the thermometer;
7. Assessment of neonatal
well-being;
8. Recognition of
illness, including jaundice;
9.
Proper infant safety including use of car seat and sleeping position;
10. Reasonable expectations for the future;
and
11. Importance of maintaining
immunization begun with initial dose of hepatitis B vaccine.
(2) Criteria for Maternal Discharge Less Than 24-48 Hours Following Delivery.
(a) Prior to discharge of the mother, the
following should occur:
1. The mother should
have been observed after delivery for a sufficient time to ensure that her
condition is stable, that she has sufficiently recovered and that she may be
safely transferred to outpatient care.
2. Laboratory evaluations should be obtained
and include ABO blood group and Rh typing with appropriate use of Rh immune
globulin and hematocrit or hemoglobin.
3. The mother should have received adequate
preparation for and be able to assume self-care and immediate neonatal
care.
(b) Factors which
may exclude maternal discharge prior to 24-48 hours include:
1. Abnormal bleeding.
2. Fever equal to or greater than 100.4
degrees.
3. Inadequate or no
prenatal care.
4. Cesarean
section.
5. Untreated or unstable
maternal medical condition.
6.
Uncontrolled hypertension.
7.
Inability to void.
8. Inability to
tolerate solid foods.
9. Adolescent
mother without adequate support or the establishment of appropriate follow-up.
A nurse home visit within 24-48 hours of discharge would constitute appropriate
follow-up.
10. All efforts should
be made to keep mother and infant together to ensure simultaneous
discharge.
11. Psychosocial
problems (maternal or family) which have been identified prenatally or in
hospital. If appropriate follow-up has not been established, a nurse home visit
within 24-48 hours of discharge would constitute appropriate
follow-up.
(3) Criteria for Neonatal Discharge Less than 24-48 Hours Following Delivery.
(a) The
nursery stay is planned to allow the identification of early problems and to
reinforce instruction in preparation for care of the infant at home.
Complications often are not predictable by prenatal and intrapartum events.
Because many neonatal problems do not become apparent until several days after
birth there is an element of medical risk in early neonatal discharge. Most
problems are manifest during the first 12 hours, and discharge at or prior to
24 hours is appropriate for many newborns.
1.
Prior to discharge of the newborn at 24-48 hours, the following should have
occurred:
(i) The course of antepartum,
intrapartum, and postpartum care for both mother and fetus should be without
problems which may lead to newborn complications.
(ii) The infant is a single birth at 37 to 42
weeks' gestation and the birth weight is appropriate for gestational age
according to appropriate intrauterine growth curves.
(iii) The infant's vital signs are documented
as being normal and stable for the 12 hours preceding discharge, including a
respiratory rate below 60/minute, a heart rate of 100 to 160 beats per minute,
and an axillary temperature of 36.1 degrees C in an open crib with appropriate
clothing.
(iv) The infant has
urinated and passed at least one stool.
(v) No evidence of excessive bleeding after
circumcision greater than 2 hours.
(vi) The infant has completed at least two
successful feedings, with documentation that the baby is able to coordinate
sucking, swallowing, and breathing while feeding.
(vii) No evidence of significant jaundice in
the first 24 hours of life.
(viii)
The parent's or caretaker's knowledge, ability, and confidence to provide
adequate care for the infant are documented.
(ix) Laboratory data are available and
reviewed including:
(I) Maternal syphilis and
hepatitis B surface antigen status.
(II) Cord or infant blood type and direct
Coomb's test result as clinically indicated.
(x) Screening tests are performed in
accordance with state regulations. If the test is performed before 24 hours of
milk feeding, a system for repeating the test must be assured during the
follow-up visit.
(xi) Initial
hepatitis B vaccine is administered or a scheduled appointment for its
administration has been made.
(xii)
A physician-directed source of continuing medical care for both the mother and
the infant is identified. For newborns discharged less than 24-48 hours after
delivery, a definitive plan for contact within 48-72 hours after discharge has
been made. A nurse home visit within 24-48 hours would be considered
appropriate follow-up.
2. Maternal factors which may exclude
discharge of the newborn prior to 24-48 hours include:
(i) Inadequate or no prenatal care;
(ii) Medical conditions that pose a
significant risk to the infant;
(iii) Group B streptococcus
colonization;
(iv) Untreated
syphilis;
(v) Suspected active
genital herpes;
(vi) HIV;
(vii) Adolescent mother without adequate
support or the establishment of appropriate follow-up. A nurse home visit
within 24-48 hours of discharge would constitute appropriate
follow-up;
(viii) Mental
retardation or psychiatric illness; and
(ix) Requirements for continued maternal
hospitalization.
3.
Newborn factors which may exclude discharge of the newborn prior to 24-48 hours
include:
(i) Pre-term gestation (less than 37
weeks);
(ii) Small for gestational
age;
(iii) Large for gestational
age;
(iv) Abnormal physical exam,
vital signs, color, activity, feeding or stooling;
(v) Significant congenital malformations;
and
(vi) An abnormal laboratory
finding such as:
(I) Hypoglycemia,
(II) Hyperbilirubinemia,
(III) Polycythemia,
(IV) Anemia, and
(V) Rapid plasma reagin positive.
Authority: T.C.A. §§ 4-5-101 et seq.,56-2-301, 56-32-218 and 56-7-2350.
Disclaimer: These regulations may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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