Washington Administrative Code
Title 246 - Health, Department of
FACILITY STANDARDS AND LICENSING
Chapter 246-329 - Childbirth centers
Section 246-329-120 - Birth center policies and procedures
Universal Citation: WA Admin Code 246-329-120
Current through Register Vol. 24-18, September 15, 2024
The purpose of this section is to ensure the birth center is able to provide safe and appropriate care to the clients of the birth center.
(1) An applicant or licensee must establish and implement policy and procedures which include, but are not limited to:
(a) Definition of a low-risk
maternal client who is eligible for birth services offered by the birth
center.
(b) Definition of a client
who is ineligible for birth services at the birth center.
(c) Identification and transfer of clients
who, during the course of pregnancy, are determined to be ineligible.
(d) Identification and transfer of clients
who, during the course of labor or recovery, are determined to be ineligible
for continued care in the birth center.
(e) Written plans for consultation, referral
and transfer of care for maternal client and newborn. Written plans for
emergency transfer and transport of a newborn to a newborn nursery or neonatal
intensive care nursery, and emergency transfer and transport of a maternal
client to an appropriate obstetrical department, patient care area, or hospital
where appropriate care is available.
(f) Transfer and discharge of neonates to
minimize risk of newborn abduction.
(g) Protocol for medications and laboratory
testing during labor and recovery if the birth center plans to deliver HIV
positive clients.
(h) Rapid HIV
testing using the opt out approach for women who have undocumented HIV test
results when presenting to the birth center in labor.
(i) Protocol for electronic fetal heart
monitoring or intermittent auscultation to monitor fetal status during
labor.
(j) Protocol for the
provision of MMR vaccine to nonimmune postpartum women.
(k) Protocol for the provision of anti D
immune globulin to postpartum women who are unsensitized D-Negative and who
deliver a D positive or Du positive infant.
(2) The applicant or licensee shall assure that transfer of care shall be available twenty-four hours per day to an appropriate obstetrical department, patient care area, or hospital where appropriate care is available.
(3) Clients shall receive and sign written informed consent which shall be obtained prior to the onset of labor and shall include, but is not limited to:
(a) Evidence of an explanation by personnel
of the birth services offered, limitation of services, and potential
risks;
(b) Explanation of the
definition of low-risk maternal client;
(c) Explanation of a client who is ineligible
for childbirth center services;
(d)
Explanation of the birth center policies and procedures for consultation,
referral, transfer of care and emergency transfer and transport;
(e) Explanation of prophylactic treatment of
the eyes of the newborn. The prophylactic treatment is administered to the
newborn according to WAC
246-100-202(1)(e);
(f) Explanation of screening of newborns
under chapter 70.83 RCW and chapter 246-650 WAC; and
(g) Explanation of why rapid HIV testing is
available if documentation of an HIV test during prenatal care is not
available;
(h) Explanation of the
need for prophylactic administration of RhIG (immune globulin) within
seventy-two hours of delivery for an Rh negative mother whose newborn(s) are Rh
positive.
(4) The birth center shall provide or assure:
(a) Education
of clients, family and support persons in childbirth and newborn
care.
(b) Plans for immediate and
long-term follow-up of clients after discharge from the birth center.
(c) Registration of birth and reporting of
complications and anomalies, including sentinel birth defect reporting under
chapter 70.58 RCW.
(d) Prophylactic
treatment of the eyes of the newborn in accordance with WAC
246-100-206(5)(b).
(e) Collection of a newborn screening blood
specimen, or signed refusal, and submission to the department's newborn
screening program under the requirements of WAC
246-650-020.
(f) Rapid HIV testing when documentation of
an HIV test during prenatal care is not available, unless the client refuses to
give consent and the refusal is documented.
(g) For HIV positive women, the
antiretroviral medications during delivery and perform or arrange appropriate
lab tests.
(h) Intrapartum
intravenous antibiotics for Group B Strep positive women per the CDC
protocol.
(i) For Hepatitis B
positive women, HBIG and Hepatitis B immunization for the newborn.
(j) Infection control to housekeeping;
cleaning, sterilization, sanitization, and storage of supplies and equipment,
and health of personnel and clients.
(k) Actions to take when personnel,
volunteers, contractors, or patients or clients exhibit or report symptoms of a
communicable disease in an infectious stage in accordance with chapter 246-100
WAC, Communicable and certain other diseases and chapter 246-101 WAC,
Notifiable conditions.
(l)
Authorization and administration of medications, legend drugs and devices per
appropriate health profession rules.
(m) Actions to address patient or client
communication needs.
(n) Reporting
of patient/client abuse and neglect according to chapter 74.34 RCW.
(o) Emergency care of client.
(p) Actions to be taken upon death of a
client.
(q) Plans for service
delivery when natural or man-made emergencies occur that prevent normal
clinical operation.
(r) Waived
laboratory tests, if applicable, including the procurement of a medical test
site waiver under chapter 246-338 WAC.
Statutory Authority: RCW 18.46.060. 10-05-033, § 246-329-120, filed 2/9/10, effective 3/12/10. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. 07-07-075, § 246-329-120, filed 3/16/07, effective 4/16/07.
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