12 Va. Admin. Code § 5-410-443 - Newborn service requirements; designation of newborn service levels, service levels
A. If
a hospital intends to provide newborn services, it shall make application to
the department requesting approval for a level of newborn service as specified
in subsection B of this section. Application shall be made at least 60 days
prior to the desired date of approval. Approval is required to be renewed
annually. Newborn service level approval shall be based upon the hospital's
certification and the department's verification that the hospital meets the
requirements of this section for the level requested.
1. No approval for a general level newborn
service designation will be granted without a Certificate of Public Need (COPN)
or without documentation by the applicant that it provided general level
newborn services prior to July 1, 1992, or that the provision of general level
newborn services was found to be exempt from Certificate of Public Need review
pursuant to §
32.1-102.11 of the Code of
Virginia.
2. No approval for a
newborn service level designation higher than general level will be granted
without a Certificate of Public Need or without documentation by the applicant
that it provided a newborn service level higher than general level prior to
July 1, 1992, or that the provision of a newborn service level higher than
general level was found to be exempt from Certificate of Public Need review
pursuant to §
32.1-102.11 of the Code of
Virginia.
B. A
hospital's newborn service shall be designated as a general level, intermediate
level, specialty level, or subspecialty level newborn service. The newborn
service levels are designated as follows:
1.
A general level newborn service shall provide care to newborns of low risk as
specified within the service's medical protocol. A general level newborn
nursery shall have the capability to care for newborns who weigh at least 2000
grams at birth or who have completed 34 weeks gestation. Risk assessment shall
be provided to identify all high-risk neonates and ensure appropriate
consultation. A general level newborn nursery shall have the equipment and
staff capabilities to immediately stabilize a sick newborn prior to
transporting the newborn to an appropriate higher level nursery. The equipment
and staff to receive convalescing neonates from higher level nurseries shall
also be provided.
2. An
intermediate level newborn service shall provide care as specified within the
service's medical protocol to moderately ill neonates or stable-growing low
birthweight neonates who require only a weight increase to be ready for
discharge. In addition to the capabilities required of the general level
newborn nursery, the intermediate level nursery shall have the equipment and
staff capabilities to provide controlled temperature environments for each
neonate, the insertion and maintenance of umbilical arterial lines, hood oxygen
to 40%, continuous monitoring of blood oxygen, and assisted ventilation of a
neonate in preparation for transport utilizing a mechanical ventilator or an
ambu bag.
3. A specialty level
newborn service shall provide intensive care to high-risk neonates with
neonatal illnesses as specified in the service's medical protocol. In addition
to the capabilities required of the lower level nurseries, the specialty level
nursery shall have the equipment and staff capabilities to provide the
following: maintenance of central arterial umbilical catheters or peripheral
arterial lines with constant pressure monitoring, insertion and maintenance of
chest tubes for drainage, administration of total parenteral nutrition (TPN),
the maintenance of pressor medications, the administration of surfactant and
respiratory support to include the maintenance of hood oxygen, continuous
positive airway pressure (CPAP), and neonatal mechanical ventilation beyond the
immediate stabilization period.
4.
A subspecialty level newborn service shall provide intensive care for
high-risk, critically ill neonates with complex neonatal illnesses. The
subspecialty level newborn service shall provide, in-house, a full range of
pediatric medical and surgical subspecialists to care for critically ill
neonates. The pediatric subspecialists required as members of the hospital's
staff are those subspecialists required of a Subspecialty Perinatal Center as
referenced within the 1993 edition of Toward Improving the Outcome of
Pregnancy, March of Dimes Birth Defects Foundation, Appendix 6, Pages 114 and
115. Rarely, the availability of highly technical expertise and specialized
physicians at another subspecialty center will indicate consultation and
possibly transfer. The subspecialty level nursery shall have the capability to
care for neonates born in its facility as well as those referred from lower
level nurseries. The subspecialty level nursery shall have all of the technical
capabilities required of the lower level nurseries as well as the equipment and
staff capabilities to maintain a neonate on prostaglandin E1 (PgE1) and the
ability to perform echocardiography evaluations.
C. The hospital shall establish a written
medical protocol, approved by the governing body, that specifies all neonatal
conditions routinely managed by the newborn service as well as protocols for
those medical conditions which require consultation and may necessitate
transfer to a higher level of newborn service.
D. Physician consultation shall occur between
physicians at the birth hospital and at the referral hospital to which the
newborn may be referred.
E. The
physician at the birth hospital shall document in the newborn's medical record
any physician's consultation and any agreement to manage the newborn at the
birth hospital or to stabilize and then transfer the newborn according to the
hospital's collaboration agreement. In the event of disagreement, the attending
physician at the birth hospital shall be responsible for the management and
care of the newborn and shall document the consultation and results of
consultation in the newborn's medical record.
Notes
Statutory Authority
§ 32.1-127 of the Code of Virginia.
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