Section 250.1820  Maternity and Neonatal Service (Perinatal Service)

 

a)         Chief of Obstetric and Pediatric Services

 

1)         Each hospital should have an organized obstetric staff with a chief of obstetric service who is either certified or qualified in obstetrics or a physician  who is interested in and regularly practicing obstetrics as chief of the maternity service, and document a source for obstetric consultation available on a 24-hour basis. The chief's level of qualification and expertise is to be appropriate to level of care rendered in the facility.

 

2)         The chief's responsibilities shall include:

 

A)        the general supervision of the care of the perinatal patients assigned to the unit;

 

B)        the establishment of criteria for admissions;

 

C)        the adherence to licensing requirements;

 

D)        the adoption by the medical staff of standards of practice and privileges;

 

E)         the identification of clinical conditions and procedures requiring consultation;

 

F)         the arrangement of conferences held at regular intervals (quarterly is suggested as a minimum interval) to review operations, complications, and mortality;

 

G)        assurance that the clinical records, consultations and reports are properly completed and analyzed;

 

H)        the provision for exchange of information between medical, administrative and nursing staffs.

 

3)         Each hospital should have an organized pediatric staff with a chief of service who is either certified or qualified in pediatrics or a physician who is interested in and regularly practicing neonatology as chief of the neonatology service and a source for neonatology consultation available on a 24-hour basis.  This physician's responsibilities shall include subsections (a)(2)(A) through (H) of this Section, as relates to the care of newborn infants.

 

b)         Provision of Care

 

1)         All hospitals described or considered as general hospitals by the Illinois Department of Public Health shall provide for the admission, medical care, transfer or discharge of obstetric and neonatal patients.

 

2)         No hospital shall fail to provide such care without the expressed written consent of the Director of the Illinois Department of Public Health.

 

3)         Each licensed hospital providing maternity and perinatal services shall comply with the perinatal care standards promulgated by the Department (Regionalized Perinatal Care, 77 Ill. Adm. Code 640).

 

c)         Location

 

1)         Maternity and neonatal services shall be located and arranged to provide maximum protection for mothers and neonatal patients from infection and cross-infection from patients in other services of the hospital.

 

2)         Hospital maternity and neonatal facilities shall be located in the hospital so as to prevent through traffic to any other part of the hospital.

 

d)         Adequacy of Services

 

1)         The hospital shall have well-organized maternity and neonatal services adequately supervised by qualified personnel with the necessary space, facilities, equipment and personnel to perform or make available maternity and neonatal services commensurate with the needs of the population in the hospital service area.

 

2)         Total live births generated by the hospital service area will determine the size of the postpartum nursing unit (number of rooms and beds), which in turn will be related to space allotments for delivery rooms, nurseries and other facilities.  The size of the unit will affect medical and nursing care plans for the maternity and neonatal service.

 

e)         Maternity and Neonatal Service Plan

 

1)         Hospitals providing maternity and neonatal services must develop a plan for the management of the obstetric and neonatal patients that meets the requirements of this Subpart.  The plan must be developed by the nursing department and medical staff and must be approved by the governing authority of the hospital.

 

2)         The hospital's written Maternity and Neonatal Service Plan shall be known to medical staff and nursing personnel and more specifically to maternity and nursery personnel.  A copy of the Plan shall be available in each maternity and nursery unit and in every relevant hospital service area; the Plan must be reviewed at least every two years and revised as indicated by the review.

 

f)          Levels of Care

 

1)         Maternity and neonatal patients should be identified according to the level of specialized care required.

 

A)        Level I or Primary Perinatal Care means the minimal level of care provided to the healthy or low risk patient.

 

B)        Level II or intermediate perinatal care means the level of care provided to a mother, fetus or newborn infant that is less than tertiary or the greatest degree of intensive care but that is a greater degree of intensity than normal or general care.

 

C)        Level III or intensive perinatal care means the level of care providing close medical and surgical coordination, multidisciplinary consultation and supervision provided to those patients with medical and surgical problems that require highly specialized treatment and highly trained personnel.

 

2)         Service Management Plan

 

A)        A service management plan must be provided for the primary, intermediate and intensive levels of care for all patients.  The plan must provide for consultation services and establish the availability of such services to stimulate early diagnosis of maternal, fetal and neonatal problems. Services unable to provide all three levels of care of patients must maintain plans for the safe transfer of certain categories of patients to hospitals with more specialized facilities, services and personnel.

 

B)        When the condition permits, a patient may be transferred from the tertiary care facility to an intermediate care facility that is nearest the family residence or another facility that can provide the appropriate level of care.  A neonatal patient should be transferred to a nursery nearest the family's home that is able to provide an appropriate level of care.

 

g)         Infection Control

 

1)         The facility shall establish policies and procedures that include the use of universal precautions and address isolation techniques and facilities.  The policies and procedures must be well known to all personnel performing services in the maternity and newborn service areas.  A copy of the procedures must be placed in each maternity and nursery unit and in relevant hospital service areas.

 

A)        There must be a continuing program of instruction for all personnel on the mode of spread of infection.

 

B)        The policies and procedures relative to the criteria for isolation and aseptic techniques must be enforced.

 

2)         Infection Control Requirements:

 

A)        Professional and ancillary maternity and nursery personnel who have contact with patients shall be free of transmissible disease.

 

B)        Health assessment of personnel

 

i)          Health assessment of nursery personnel shall be performed at a frequency determined by the Infection Control Committee and shall include screening for tuberculosis in accordance with Section 690.720 of the Control of Communicable Diseases Code (77 Ill. Adm. Code 690).

 

ii)         Evidence of prior rubella infection or rubella vaccination shall be required of nursery personnel.

 

C)        Except that hair must be properly covered or controlled, caps, beard bags, and masks are not needed for routine nursery activities. Caps, beard bags and masks are required in the delivery room, and for surgical procedures including umbilical vessel catheterization.

 

D)        Handwashing to the elbows with an antiseptic agent by a procedure developed and posted by the Infection Control Committee is required before entering the nursery, and between patients.

 

E)         All rings, watches and bracelets shall be removed before handwashing and entering the nursery.

 

F)         The facility's Infection Control Committee shall establish a dress code for full and part-time employees and visitors in compliance with the "Guidelines for Perinatal Care."

 

G)        In the normal care nursery, infants with suspected infections are moved to a transition nursery for observation.

 

H)        Individual isolation technique is applied to the infected or potentially infected maternity or newborn infant.  A closed isolette does not constitute isolation, nor is it a part of isolation technique.

 

I)          Movement of an infected newborn to a separate isolation room is not necessary if there is adequate nursing and medical staff for unhurried movement between patients and adequate time for thorough handwashing between patients and gowning, sufficient space (four to six feet) for easy movement between patients and to remove temptation to move from one patient to another without handwashing, a continuing program of instruction for all nursery personnel on the mode of spread of infections, and if there are two sinks for each nursery room.  If these conditions are not met, an isolation room with separate scrub facilities is necessary for the infected patient.  See Section 250.2440(h) for additional requirements.

 

J)         Infants born outside the hospital or under conditions not aseptic, or of mothers with membranes ruptured 24 hours or more, or born of mothers suspected of harboring infectious disease shall be cared for in the mother's private room, an observation or transition room, or in the primary care area with careful attention to proper aseptic technique of attending personnel and to conditions described in subsection (g)(2)(I) of this Section.

 

K)        The physician in charge and the nursing supervisor with the Infection Control Committee should establish a program of disinfection for patient areas.  Clear descriptions of cleaning and disinfection methods should be incorporated into the patient care procedures manual.  Incubators and bassinets are to be disinfected upon an infant's discharge, and other nursery and delivery equipment cleaned and sterilized by specific procedures consistent with recommendations of the American Academy of Pediatrics, American College of Obstetrics and Gynecology and outlined in the unit's procedures manual.

 

h)         Combined Facilities

 

1)         Obstetric and clean gynecologic service facilities may be combined in accordance with a plan that complies with the requirements of this Subpart.  The combined service program, its functional operations and detailed rules and regulations must be approved by the Hospital Maternity and Newborn Service, Medical Staff and Governing Authority.

 

2)         In combined programs, Cesarean section and obstetrically related surgery other than vaginal delivery may be carried out in a designated and approved operating or delivery room.  In combined programs, vaginal deliveries may be carried out only in designated and approved delivery rooms or designated and approved operating rooms used solely for obstetric and/or clean gynecologic procedures.

 

3)         Gynecologic service and maternity service may be provided for in a combined Maternity and Gynecologic Service, or clean gynecologic cases may be admitted to the postpartum nursing unit of a maternity service in accordance with the hospital's Maternity Service Plan.

 

4)         Only members of the medical staff with appropriate privileges may admit and care for patients in such combined service areas.  Such admissions must be strictly controlled and be subject to the final authority delineated in the medical staff bylaws and approved by the hospital governing authority.  There shall be close surveillance of the services by the hospital's infection committee.

 

5)         Patients admitted to combined service facilities of hospitals with approved programs shall be limited to:

 

A)        Obstetric patients admitted for delivery.

 

B)        Clean obstetric complications (regardless of month of gestation). Refer to Section 250.1830(g)(2).

 

C)        Other noninfectious complications of pregnancy.

 

D)        Selected clean gynecologic patients.

 

6)         Patients not eligible for admission include those:

 

A)        with an active, acute or chronic infectious condition;

 

B)        patients housed on other services of the hospital;

 

C)        requiring radium or radiation isotope therapy, excluding external radiation therapy.

 

7)         There shall, on a daily basis, be unoccupied reserve beds in the combined facilities in readiness for use by obstetric patients.  This unoccupied reserve shall be not less than 10% of the average daily census for obstetric patients.

 

8)         Patients admitted to the combined services may be taken to x-ray or other hospital facilities for diagnostic procedures, before or after surgery, so long as there is no evidence that such procedures may be hazardous to the patient or to other patients on the combined service.

 

9)         Patients may receive postpartum or immediate postoperative care in the general recovery room prior to being returned to the combined service floor if the following conditions prevail (refer to Section 250.1320(a)):

 

A)        The recovery room or intensive care unit is a separate unit adjacent to or part of the general surgical operating suite and/or delivery suite.

 

B)        The recovery room or intensive care unit contains no patients with known or suspected infectious or communicable disease or other adverse conditions.

 

C)        The recovery room is under the direct supervision of the chairman of anesthesiology of the hospital.  In separate maternity recovery rooms such supervision is provided by the obstetrician in charge or a qualified designated physician.

 

10)       Nursing care of all patients shall be supervised by a registered professional nurse qualified to provide such supervision.

 

11)       Nursing care of all patients may be given by the same personnel.

 

12)       Visiting regulations for obstetric patients shall apply to all patients admitted to the combined facilities.  Refer to Section 250.1830(k).

 

i)          Activity Records

 

1)         The hospital shall establish and keep the necessary daily records, including a Patient Log and the Maternity Services Daily Census Report, from which required reports can be prepared.

 

2)         The Patient Log shall contain, as a minimum, the following data on each patient admitted to the department other than maternity patients:

 

A)        Name of patient or hospital patient number

 

B)        Age

 

C)        Attending physician's name

 

D)        Date of admission

 

E)         Admitting diagnosis

 

F)         Operative procedure

 

G)        Discharge diagnosis

 

H)        Date of discharge

 

I)          Days stay

 

J)         Transferred off floor

 

            Yes        Date       ; No        

 

K)        Reason for transfer

 

3)         A Maternity Service Daily Census Report shall be kept, which for each day of the month gives the patient census (at the census taking hour) of

 

A)        obstetric patients, including patients with clean obstetric complications,

 

B)        gynecologic patients,

 

C)        empty beds in the department, and

 

D)        total patients.

 

4)         The hospital shall submit required reports including a supplement to its monthly Perinatal Activities Report to the Department.  The report form shall be provided by the Department.  Refer to Section 250.1830(i)(1).

 

(Source:  Amended at 20 Ill. Reg. 3234, effective February 15, 1996)