Idaho Admin. Code r. 16.03.14.400

Current through September 2, 2024

Section 16.03.14.400 - MATERNITY AND NEWBORN SERVICE

If a hospital offers maternity and newborn service, care shall be provided during pregnancy, labor, delivery, postpartum and neonatal periods with appropriate staff, space and equipment.

01.Area Requirements. If the hospital offers maternity and newborn service, it shall be located in such a manner as to minimize traffic to and from other patient care areas.

02.Delivery/Birthing Room Facilities. The delivery/birthing room shall be located in such a manner as to prevent traffic to and from other areas, and meet the following:

a. At least one (1) delivery room shall be provided; and

b. Scrub-up facilities shall be provided for the delivery room. Each sink shall have a soap dispenser, elbow, knee, or foot action water control, and gooseneck spout. Disposable brushes or brushes capable of withstanding sterilization shall be provided; and

c. A separate space shall be provided for the cleanup of non-sterile and contaminated material; and

d. Walls, ceilings and floors shall be of a waterproof, washable surface; and

e. Space shall be available for the storage of sterile and non-sterile supplies; and

f. A janitor's closet shall be provided within or adjacent to the delivery suite and be used only for the delivery suite; and

g. There shall be provided a source of oxygen with a mechanism for controlling the concentration of oxygen and with a suitable device for administering oxygen to both infants and adults; and

h. There shall be provided a safe and suitable type of suction device for both infants and adults; and

i. A properly heated bassinet shall be provided; and

j. Functional obstetrical equipment and supplies shall be provided to assure safe and aseptic treatment of mothers and infants; and

k. There shall be immediately available all cardiopulmonary resuscitation equipment for both adults and infants; and

l. The delivery and birthing rooms shall not be used for purposes other than obstetrical care, except in a disaster or life threatening emergency.

03.Alternate Birthing Services. If the facility so desires, it may establish birthing services as an alternate to traditional delivery services that meet currently accepted professional practices and the following is provided:

a. Patients requesting use of alternate birthing services shall meet pre-established criteria as developed and approved by the medical staff and be identified as low risk maternity patients prior to admission.

b. Birthing facilities shall be as follows:

i. The alternate birthing service shall be so located as to have ready accessibility to emergency services, including surgical and/or traditional delivery facilities; and

ii. The birthing area shall be of sufficient size to adequately provide for staff, equipment, supplies, support personnel and emergency procedures during labor, delivery and the immediate postpartum period; and

iii. There shall be immediately available oxygen, suction, linen, instruments, supplies, medications and equipment to meet the needs of both mother and infant.

04.Rooming-In. Rooming-in care of newborn infants is permissible provided the following requirements are met:

a. The room shall have a lavatory equipped with hot and cold running water, soap, soap dispenser, approved disposable towel, and waste receptacle; and

b. Mother and infant shall have individual equipment and supplies; and

c. Individual self-closing containers shall be provided for the infant's soiled linen.

05.Nursery Facilities. The newborn nursery in each hospital shall meet the following requirements:

a. An existing nursery shall provide a minimum of twelve (12) square feet per bassinet. A nursery established by new construction or a new hospital (see Subsection 002.26) shall provide a minimum of twenty-four (24) square feet per bassinet or as required under Section 600, whichever is more restrictive; and

b. Bassinets shall be spaced at least twenty-four (24) inches apart; and

c. Each bassinet shall be mounted on a single stand and be removable to facilitate cleaning; and

d. Each bassinet shall be fully equipped to give individualized routine care to babies. A common bathing table or dressing table shall not be used; and

e. Handwashing facilities shall be provided and equipped with soap, soap dispenser, disposable towel, and waste receptacle; and

f. Each nursery shall have at least one (1) mechanical unit approved by Underwriters' Laboratories, Inc., capable of providing a temperature, humidity, and oxygen controlled environment; and

g. Space and facilities for the care of premature infants shall be provided; and

h. Scales and examining tables shall be provided and be protected to prevent cross infection; and

i. Sufficient separation between well infants and infants that are suspected of harboring some infectious disease to avoid transmission of the disease causing organisms.

06.Patient Accommodations. Maternity patient accommodations shall meet the following requirements:

a. Postpartum nursing facilities shall meet the requirements of nursing units outlined in these rules; and

b. Isolation capability shall be available at all times for an obstetrical or newborn patient showing any evidence of infection that requires isolation; and

c. At least one (1) labor/birthing room shall be provided in the facility for examinations and preparation of patients for delivery unless alternative services are utilized as described in Subsection 400.03.

07.Practices and Procedures. Practices and Procedures for the nursery and delivery room shall be as follows:

a. All health care personnel in the delivery/birthing room or alternative birthing area during a delivery shall observe appropriate sterile or aseptic techniques as the case requires, including established dress requirements; and

b. All persons entering the newborn nursery shall dress in such a manner to protect the newborn from cross contamination; and

c. A safe means of identifying both the infant and mother shall be employed before the infant is removed from the delivery room or alternate birthing area. This shall be of a type that cannot be removed during routine care of the infant; and

d. Infants found to have an infectious condition (skin lesions, inflammation of the eye, diarrhea, or other evidence of infection or born of a mother with an identified infectious condition) shall be transferred promptly to an isolation area outside the general nursery. Those infants whose eyes have not received prophylactic treatment, due to the religious opposition of parents or for any other reason, shall be cared for during their stay in the hospital in accordance with Subsection 400.05.i.

08.Obstetrical Records. All obstetrical records shall include, in addition to the requirements for medical records, the following:

a. Report of antenatal blood serology, and RH factor determination; and

b. Past obstetrical history of patient's previous pregnancies, prior to onset of labor whenever possible; and

c. Obstetrical assessment report describing conditions of mother and fetus on admission; and

d. If fetal monitoring is used, all fetal monitoring records; and

e. Complete description of progress of labor including reasons for induction and operative procedures, if any, signed by the attending physician; and

f. Records of anesthesia, analgesia, and medications given in the course of labor and delivery; and

g. Signed report of obstetrical consultant when such service has been obtained; and

h. Names of assistants present during delivery; and

i. Progress notes including descriptions of involution of uterus, type of lochia, condition of breasts and nipples; and

j. Report of condition of infant following delivery.

09.Newborn Records. Records of newborn infants shall include, in addition to the requirements for medical records set forth in Section 2-1360, the following information:

a. Date and hour of birth, birth weight and length, period of gestation, sex; and

b. Parents' names and address; and

c. Type of identification placed on infant in delivery room; and

d. Description of complications of pregnancy or delivery including premature rupture of membranes, condition at birth including color, quality of cry, method and duration of resuscitation; and

e. Record of instillation into each eye at delivery of prophylactic remedy; and

f. Report of initial physical examination, including any abnormalities, signed by the attending physician; and

g. Record of metabolic screening blood tests; and

h. Progress notes including: temperature, weight and feeding charts; number, consistency, and color of stools; condition of eyes and umbilical cord; condition and color of skin; motor behavior; and condition upon discharge.

10.Policies and Procedures. Written policies and procedures involving maternity and newborn service shall be reviewed and revised at least once yearly. They shall be approved by the medical staff, nursing department, and hospital administration. Policies shall govern personnel, patients, and visitors to be admitted to the obstetrical area. Policies and procedures shall include at least the following:

a. A policy for infection control supported by specific procedures, including all appropriate aseptic techniques, housekeeping procedures and isolation procedures. These policies and procedures shall be approved by the infection control committee; and

b. Policies and supporting procedures for transporting or admitting infants born outside the hospital and/or born outside the obstetrical unit. These procedures shall be approved by the infection control committee; and

c. Written policies and supporting procedures shall govern nursing care of the patient during labor, delivery, and postpartum; and

d. Written policies and supporting procedures shall govern nursing care of the newborn infant; and

e. Written policies and supporting procedures to govern "rooming-in" services; and

f. A procedure for identification of the infant upon delivery and discharge; and

g. An admission policy indicating types of high risk mothers or infants admitted; and

h. A policy and procedure for consultation with and/or transfer to a newborn intensive care unit for high risk infants; and

i. A policy and supporting procedure for the care and maintenance of all movable and fixed equipment, including electrical and mechanical equipment; and

j. Additional policies and procedures for the alternate birthing service that shall include at least the following:

i. Definition of the low-risk maternity patient; and

ii. Written screening process for evaluating maternity patients; and

iii. Written criteria that, if met, would necessitate the transfer of a laboring mother to traditional labor and delivery setting.

11.Staffing. The maternity and newborn service shall be staffed as follows:

a. The service shall be under the supervision of a licensed registered nurse on a twenty-four (24) hour basis; and

b. A licensed registered nurse shall be in attendance during labor and delivery.

12.Capability. The hospital shall have the capability for operative delivery including cesarean section.

13.Waiver of Capability. A hospital offering maternity and newborn services without C-section capability upon the effective date of these rules may apply in writing to the licensing agency for waiver of the requirement of Subsection 400.12. Waiver will not be granted without a showing by the hospital that:

a. There is an existing hospital policy that requires its medical staff in advance of admission to inform their patients of the percentage of C-section deliveries in the United States, the likelihood that a C-section will be required in the instant case, the risks of delivery in a hospital without C-section capability and the location of the nearest hospital with C-section capability; and

b. The hospital has adopted for use a form of informed consent to be signed by the patient in advance of admission. Such form shall make on its face a detailed showing that the items in Subsection 400.13.a. have been presented to the patient; and

c. There is an existing hospital policy for emergency transport with a physician in attendance to a C-section capable hospital in the event of an unforeseen emergency; and

d. The hospital has in place a medical record system to document the informed consent of each patient admitted to the maternity and newborn service.

Idaho Admin. Code r. 16.03.14.400

Effective March 17, 2022