PURPOSE: This rule specifies the requirements for obstetrical and newborn services in a hospital. SENIOR SERVICES

1. (1) Obstetrical services, if provided, shall be under the medical direction of a qualified physician member of the medical staff and appointed by the governing body. This physician shall be responsible for implementing the rules of the medical staff governing obstetrical privileges, quality of obstetrical care and patient safety.
2. (2) Obstetrical services shall be supervised by a qualified registered professional nurse with relevant education, experience and demonstrated current competency.
3. (3) The obstetrical nursing supervisor shall have the authority to implement and enforce hospital policies and procedures governing obstetrical services and shall have the responsibility for evaluating the competency of nursing personnel assigned to obstetrical services.
4. (4) Facilities for obstetrical services shall be designed to prevent unauthorized traffic.
5. (5) Undelivered patients receiving intravenous oxytocin shall be under continuous observation by trained personnel. Induction or augmentation of labor with oxytocin may be initiated only after a qualified physician has evaluated the patient, determined that induction or augmentation is beneficial to the mother, fetus, or both, recorded the indication and established the plan of management. The physician initiating these procedures shall be readily accessible to manage complications that arise during infusion and a physician who has privileges to perform Caesarean deliveries shall be in consultation and readily accessible in order to manage any complications that require surgical intervention.
6. (6) There shall be provision for isolation of infants with known or suspected infections or communicable diseases. Policies and procedures regarding isolation shall be integrated with the hospital infection control program.
7. (7) Each newborn shall be identified by an acceptable method which includes the name, date and time of birth, the infant’s sex and the mother’s hospital number.
8. (8) A delivery room record shall be maintained.
9. (9) A nursery shall be provided for care of the newborn.
10. (10) Hospitals with an obstetrical service shall have at least one (1) premature-care incubator by an independent testing laboratory.
11. (11) All cases of acute infectious conjunctivitis (Ophthalmia neonatorum) shall be reported immediately to the individual(s) responsible for the infection control program and to the local or district health department in accordance with section 210.080, RSMo.
12. (12) All cases of epidemic diarrhea of the newborn shall be reported immediately to the individual(s) responsible for the infection control program and the local or district health department.
13. (13) Resuscitation, suction, oxygen, monitoring and newborn temperature control equipment shall be available for the care of newborn. Supplies for the proper care of newborn shall be available.
14. (14) An incubator or bassinet with controlled temperature shall be available for each delivery room and for transport to the nursery.
15. (15) Space shall be provided for the preparation or the handling and storage of formula. Separate refrigeration shall be provided for formula.
16. (16) Eye care of newborn shall be in accordance with section 210.070, RSMo.
17. (17) Written policies and procedures shall be established to provide safe transport of infants within the hospital or to another health-care facility.
18. (18) Written policies and procedures governing special care programs shall be approved by the medical staff and governing body.
19. (19) There shall be a mechanism for the review and evaluation on a regular basis of the quality of obstetrical and newborn services provided.

AUTHORITY: sections 192.006 and 197.080, RSMo 2000 and 197.154, RSMo Supp. 2007.* This rule previously filed as 19 CSR 30-20.021(4)(E). Original rule filed June 27, 2007, effective Feb. 29, 2008. *Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo 2004.