Section 22-B2614. OPERATING PROCEDURES

 

2614.1Every maternity center, regardless of size, shall have written Practice Guidelines establishing procedures for both normal and emergency care. These guidelines shall be consistent with the Practice Guidelines of the American College of Nurse-Midwives and District of Columbia laws and regulations relating to midwifery practices, and shall indicate the areas of responsibility of medical, nurse-midwifery and nursing personnel and the extent to which the responsibility of physicians can be delegated. These Practice Guidelines shall be available to all members of the center and shall be reviewed annually.

 

2614.2There shall be written Practice Guidelines that establish standards for the services provided by the maternity center. Practice Guidelines shall be developed by and approved by the governing entity, reviewed at least annually, revised as necessary, dated to indicate the time of last review, signed by the Director of Medical Affairs and the Director of the maternity center, and enforced by the Director of the center.

 

2614.3The Practice Guidelines shall describe the scope and conduct of maternity care provided in the center. Practice Guidelines shall relate to at least the following:

 

(a)Organizational structure, which delineates lines of authority, communications, and Practice Guidelines for admission and discharge responsibilities to patients; and

 

(b)Screening criteria and procedure for identifying:

 

(1)Low-risk maternity patients who shall be eligible for all services offered by the maternity center;

 

(2)Individuals who shall be ineligible for delivery services at the center;

 

(c)Plans and procedures for consultation, back-up services, transport of a newborn infant or patient to a hospital where appropriate care is available;

 

(d)Routine and emergency care of the patient, fetus and/or newborn infant, discharge planning, and post-partum follow-up until completion of care at the maternity center or transfer to other levels of care;

 

(e)Confidentiality of records;

 

(f)Role of medical, nursing and midwifery staff;

 

(g)Maintenance of required records, reports and statistical information;

 

(h)Infection control, including housekeeping, cleaning, sterilization, sanitation, storage of equipment and supplies, and health of personnel;

 

(i)Pertinent safety practices, including fire drills;

 

(j)The adoption, revision and implementation of Practice Guidelines;

 

(k)Regulation of persons visiting the maternity center;

 

(l)Roles and functions of maternity center personnel;

 

(m)Requirements for labor and birth room services and equipment;

 

(n)Quality assurance plan, with system for program review and evaluation, follow-up for correction of deficiencies, for improvement in services and functions;

 

(o)Written personnel staffing plan;

 

(p)Initiation of cardiopulmonary resuscitation;

 

(q)Administration of medications;

 

(r)Receiving, transcribing, safeguarding and management of narcotics and anesthetic agents;

 

(s)Prophylactic treatment of the eyes of newborn infants; and

 

(t)Footprinting of newborn infants and fingerprinting of the infants' mothers; and

 

(u)Security measures.

 

2614.4The Practice Guidelines for maternity center intrapartum care shall be developed jointly by the Director of the center, Director of Medical Affairs, and Director of Midwifery Services of the maternity center and include but not be limited to procedures for:

 

(a)Intrapartum admission;

 

(b)Intrapartum management/risk assessment;

 

(c)Intrapartum transfers;

 

(d)Birth/Delivery procedure;

 

(e)Episiotomy/Laceration repair;

 

(f)Emergency events:

 

(1)Medical emergency procedures;

 

(2)Emergency equipment;

 

(3)Resuscitation of newborn infants;

 

(4)Hemorrhage;

 

(5)Prolapsed cord; and

 

(6)CPR Review;

 

(g)Birth Certificate.

 

2614.5A certified nurse-midwife, or a physician with special training in obstetrics, shall attend each patient in labor from the time of admission, during labor, during birth and through the immediate postpartum period. Such attendance may be delegated only to another certified nurse-midwife or physician.

 

2614.6At least two attendants must be present at every birth, one of whom is a physician or certified nurse-midwife. Both attendants shall be currently certified in adult CPR equivalent to the American Heart Association Class C basic life support, and neonatal CPR equivalent to the American Academy of Pediatrics/American Heart Association.

 

2614.7Qualified personnel, to include at a minimum a licensed nurse-midwife and/or a Board certified physician on the premises or on call, shall be on duty at all times when patients are admitted.

 

2614.8The Director of the Maternity Center shall develop and adopt rules and procedures, subject to the approval of the governing entity, which shall include:

 

(a)Program for ensuring compliance by center personnel, including orientation, in-service education, and attendance at outside programs;

 

(b)Standard Practice Guidelines for providing safe and appropriate plans of care to meet the needs of each patient, her family and her newborn infant in keeping with current professional standards for uncomplicated pregnancy, intrapartal care, and postpartal and newborn care; and

 

(c)Delivery Practice Guidelines shall be consistent with the current professional standards of the National Association of Childbearing Centers, the Commission for the Accreditation of Birth Centers and the American College of Nurse Midwives.

 

2614.9Each maternity center shall have a written quality assurance plan program designed to objectively and systematically monitor and evaluate the quality and appropriateness of services provided by the maternity center.

 

2614.10The quality assurance plan shall describe the organization, objectives, scope and mechanism for overseeing the effectiveness of monitoring, evaluation and problem solving activities of the maternity center. The plan shall be evaluated at least annually and revised as necessary. Findings, conclusions, recommendations, actions taken and results of actions taken shall be documented and available for inspection by licensing and accrediting agencies.

 

2614.11Each maternity center shall have a written practice agreement with at least one board-certified or board eligible obstetrician/gynecologist and a board certified or board eligible pediatrician or neonatologist for the provision of 24-hour consultation, referral and transfer to an appropriate hospital facility for obstetric or newborn care under their direction.

 

2614.12Each maternity center shall have written policies for the management of emergencies including, but not limited to, the following:

 

(a)Written procedures that clearly specify consultation and referral policies, notification of the receiving hospital, Practice Guidelines for when to initiate emergency procedures, and updating and transfer of the patient's medical report;

 

(b)A written transfer agreement with a hospital that provides for the transfer of patients to that hospital when they are no longer considered "low risk." The hospital must be accredited by the Joint Commission on Accreditation of Health Care Organizations and be capable of providing the following:

 

(1)Management of all obstetrical complications;

 

(2)Provision of a neonatal support system with facilities for high-risk newborn care or the capability for newborn stabilization and prearranged transport to a neonatal intensive care nursery elsewhere; and

 

(3)Prior written agreement with the hospital to allow for prompt admission.

 

2614.13Each maternity center shall provide for adequate emergency transportation services which shall include the following:

 

(a)A written agreement between the maternity center and a transport service that can provide vehicles with equipment necessary to meet the needs of obstetric and newborn infant patients;

 

(b)Arrangements with a transport service to provide personnel with training in obstetrical and newborn infant emergency care; and

 

(c)Alternative transport vehicles such as private automobiles, police cars, ambulances and other vehicles for hire.

 

source

Notice of Final Rulemaking published at 46 DCR 2779 (March 19, 1999); as amended by Corrected Notice of Final Rulemaking published at 46 DCR 3970 (April 30, 1999).