Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 133 - HOSPITAL LICENSING
Subchapter J - HOSPITAL LEVEL OF CARE DESIGNATIONS FOR NEONATAL CARE
Section 133.186 - Neonatal Designation Level I
Universal Citation: 25 TX Admin Code ยง 133.186
Current through Reg. 49, No. 38; September 20, 2024
(a) Level I (Well Care). The Level I neonatal designated facility must:
(1) provide care for mothers and their
infants of generally more than or equal to 35 weeks gestational age who have
routine, transient perinatal problems;
(2) have skilled medical staff and personnel
with documented training, competencies, and annual continuing education
specific for the patient population served; and
(3) provide the same level of care that the
neonate would receive at a higher-level designated neonatal facility and
complete an in-depth critical review and assessment of the care provided to
these infants through the neonatal QAPI Plan and process if an infant less than
35 weeks gestational age is retained.
(b) Neonatal Medical Director (NMD). The NMD must be a physician who:
(1) is a currently
practicing pediatrician, family medicine physician, or physician specializing
in obstetrics and gynecology with experience in the care of neonates/infants
and with privileges in neonatal care;
(2) maintains a current status of successful
completion of the Neonatal Resuscitation Program (NRP) or a department-approved
equivalent course;
(3) demonstrates
effective administrative skills and oversight of the neonatal QAPI Plan;
and
(4) completes annual continuing
medical education specific to the care of neonates.
(c) Program Functions and Services.
(1) The neonatal program must collaborate
with the maternal program, consulting physicians, and nursing leadership to
ensure pregnant mothers who are at high risk of delivering a neonate that
requires a higher-level of care are transferred to a higher-level facility
before delivery unless the transfer would be unsafe.
(2) The facility provides appropriate,
supportive, and emergency care delivered by trained personnel for unanticipated
maternal-fetal or neonatal problems that occur during labor and delivery
through the disposition of the patient.
(3) The on-call physician, advanced practice
nurse, or physician assistant must have documented special competence in the
care of neonates, privileges and credentials to participate in neonatal/infant
care reviewed by the NMD, and:
(A) must
maintain a current status of successful completion of the NRP or a
department-approved equivalent course;
(B) must complete annual continuing education
specific to the care of neonates;
(C) must arrive at the patient bedside within
30 minutes of an urgent request;
(D) if not immediately available to respond
or is covering more than one facility, must ensure appropriate back-up coverage
is available, back-up call providers are documented in the neonatal on-call
schedule and must be readily available to respond to the facility staff;
and
(E) the back-up call physician,
advanced practice nurse, or physician assistant must arrive at the patient
bedside within 30 minutes of an urgent request.
(4) The facility must have written guidelines
defining the availability of appropriate anesthesia, laboratory, radiology,
respiratory, ultrasonography, and blood bank services on a 24-hour basis as
described in §
133.41 of this title (relating to
Hospital Functions and Services).
(A) If
preliminary reading of imaging studies pending formal interpretation is
performed, the preliminary findings must be documented in the medical
record.
(B) The facility must
ensure regular monitoring and comparison of the preliminary and final readings
through the radiology QAPI Plan. Summary reports of activities must be
presented at the Neonatal Program Oversight.
(5) Pharmacy services must be in compliance
with the requirements in §
133.41 of this title and must have
a pharmacist available at all times.
(A) If
medication compounding is done by a pharmacy technician for neonates/infants, a
pharmacist must provide immediate supervision of the compounding
process.
(B) When medication
compounding is done for neonates/infants, the pharmacist must implement
guidelines to ensure the accuracy of the compounded final product and ensure:
(i) the process is monitored through the
pharmacy QAPI Plan; and
(ii)
summary reports of activities are presented to the Neonatal Program
Oversight.
(6) The facility must have personnel with
appropriate training for managing neonates/infants, written policies,
procedures, and guidelines specific to the facility for the stabilization and
resuscitation of neonates based on current standards of professional practice.
The facility must ensure the availability of personnel who can stabilize
distressed neonates, including those less than 35 weeks gestation until they
are transferred to a higher-level facility. Variances from these standards are
monitored through the neonatal QAPI Plan and process.
(A) Each birth must be attended by at least
one person who maintains a current status of successful completion of the NRP
or a department-equivalent course, whose primary focus is management of the
neonate and initiating resuscitation.
(B) At least one person must be immediately
available on-site with the skills to perform a complete neonatal resuscitation
including endotracheal intubation, establishment of vascular access, and
administration of medications.
(C)
Additional personnel with current status of successful completion of the NRP,
or a department-equivalent course, must be on-site and immediately available
upon request for the following:
(i) multiple
birth deliveries, to care for each neonate;
(ii) deliveries with unanticipated
maternal-fetal problems that occur during labor and delivery; and
(iii) deliveries determined or suspected to
be high-risk for the pregnant patient or neonate.
(D) Variances from these standards are
monitored through the neonatal QAPI Plan and process and reported at the
Neonatal Program Oversight.
(E)
Neonatal resuscitative equipment, supplies, and medications must be immediately
available for trained personnel to perform resuscitation and stabilization on
any neonate/infant.
(7)
A registered nurse with experience in neonatal or perinatal care must provide
supervision and coordination of staff education.
(8) The neonatal program ensures the
availability of support personnel with knowledge and skills in breastfeeding
and lactation to assist and counsel mothers.
(9) Social services, supportive spiritual
care, and counseling must be provided as appropriate to meet the needs of the
patient population served.
Disclaimer: These regulations may not be the most recent version. Texas 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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