Ohio Administrative Code|Rule 3701-7-11 | Freestanding children's hospitals with level III or level IV neonatal care services.

                                                
(A) A freestanding children's
		  hospital with a level III neonatal care service shall provide care for for
		  newborns, including:
(1) Low-risk
			 newborns;
(2) Convalescing and
			 moderately ill newborns;
(3) Extremely low birth weight
			 infants;
(4) Newborns who require advanced
			 respiratory care, other than extracorporeal membrane oxygenation, such as
			 high-frequency ventilation and inhaled nitric oxide; and
(5) Newborns who require major surgery
			 other than surgical repair of serious congenital cardiac malformations that
			 require cardiopulmonary bypass.
(B) A freestanding children's
		  hospital with a level IV neonatal care service shall provide care for for
		  newborns and fetuses, including:
(1) Low-risk
			 newborns;
(2) Convalescing and
			 moderately ill newborns;
(3) Extremely low birth
			 weight infants;
(4) Newborns who require
			 advanced respiratory care, including extracorporeal membrane
			 oxygenation;
(5) Newborns who require
			 major surgery, such as surgical repair of serious congenital cardiac
			 malformations that require cardiopulmonary bypass;
(6) Newborns at extreme
			 high-risk;
(7) Newborns receiving specialized
			 services such as:
(a) Cardiac surgery;
(b) Organ transplants; or
(c) Treatments of rare inborn metabolic
				errors.
(C) Written service plan. Each freestanding children's
		  hospital with a level III or level IV neonatal care service shall, using
		  licensed health care professionals acting within the scopes of their practice,
		  develop a written service plan for the care and services to be provided. The
		  written service plan shall be based on the "Guidelines for perinatal
		  care" and address, at minimum:
(1) The specialized
			 services provided by the service based on the:
(a) Patient population;
(b) Acuity of patients;
(c) Volume of patients; and
(d) Competency of staff;
(2) Criteria for
			 determining those conditions that can be routinely managed by the
			 service;
(3) Admission to the unit;
(4) Discharge from the unit;
(5) Patient care in accordance with
			 accepted professional standards;
(6) Referrals for obtaining public
			 health, dietetic, genetic, and toxicology services not available
			 in-house;
(7) Minimum competency requirements for
			 staff in accordance with recognized national standards and ensure that all
			 staff are competent to perform services based on education, experience and
			 demonstrated ability;
(8) Administration of blood and blood
			 products;
(9) Provision of
			 phototherapy;
(10) Provision of respiratory
			 therapy;
(11) Unit-based surgeries and surgical
			 suite-based surgeries;
(12) Post-mortem
			 care;
(13) Provision of a formal education
			 program for staff that includes, at minimum:
(a) The neonatal resuscitation program. The service shall
				ensure all labor and delivery registered nurses and any other practitioner
				likely to attend a high risk delivery receive training in the neonatal
				resuscitation program;
(b) A post resuscitation program. The service shall ensure
				individuals caring for newborns receive training in a post resuscitation
				program to include, at minimum:
(i) The identification
				  and treatment of signs and symptoms related to hypoglycemia, hypothermia, and
				  pneumothorax;
(ii) Blood pressure
				  (normal ranges, factors that can impair cardiac output);
(iii) Lab work, including
				  perinatal and postnatal risks factors and clinical signs of
				  sepsis;
(iv) Principles of assisted ventilation, continuous positive
				  airway pressure, positive pressure ventilation, assisting and securing
				  endo-tracheal tube insertion, and chest x-rays;
(v) Emotional support to
				  parents with sick infants; and
(vi) Quality improvement
				  to identify problems and the importance of debriefing to evaluate care in the
				  post-resuscitation period; and
(c) Ongoing continuing education;
(14) Provision of direct care staff to
			 provide care to individuals in other areas of the hospital, including, but not
			 limited to the emergency department and the intensive care unit;
(15) Risk assessment of neonatal patients
			 to ensure identification of appropriate consultation requirements or referral
			 of high-risk patients;
(16) Follow-up services to patients or
			 refer patients for appropriate follow-up;
(17) Infection control, consistent with
			 current infection control guidelines issued by the United States centers for
			 disease control and prevention;
(18) Consultation or referral of neonatal
			 transport;
(19) Coordination and facilitation of
			 neonatal transports from referring hospitals on a twenty four hour
			 basis;
(20) Consultation for neonatal care
			 services on a twenty-four hour basis;
(21) Developmental follow-up of at-risk
			 newborns in the service or refer such newborns to appropriate
			 programs;
(22) Provision of developmental follow-up
			 of at-risk newborns in the service or refer such newborns to appropriate
			 programs;
(23) Continuing education for referring
			 hospital;
(24) Provision of opportunities for
			 graduate medical education such as pediatric residencies or neonatal medicine
			 fellowships;
(25) Provision of opportunities for
			 clinical experience for purposes of graduate nursing education, or continuing
			 education, or both;
(26) Participation in basic or clinical
			 neonatology research on an ongoing basis; and
(27) Provision of multidisciplinary
			 planning related to management and therapy for newborn care.
(D) Each provider shall, in accordance with accepted
		  standards of practice, develop and follow written policies and procedures to
		  implement the written service plan required by paragraph (C) of this
		  rule.
(E) Support services. Each provider shall
		  have the following staff and services on-site on a twenty-four hour
		  basis:
(1) Clinical laboratory,
			 capable of providing any necessary testing;
(2) Blood, blood products
			 and substitutes;
(3) Diagnostic imaging,
			 including:
(a) X-ray; and
(b) Computed tomography;
(4) Portable ultrasound
			 visualization equipment for diagnosis and evaluation;
(5) Pharmacy;
(6) Respiratory therapy and pulmonary;
			 and
(7) Anesthesia.
(F) On a twenty four hour basis, each
		  provider shall have the following services on-site, with staff necessary to
		  provide the service on-call:
(1) Diagnostic imaging,
			 including:
(a) Magnetic resonance imaging;
(b) Fluoroscopy; and
(c) Echocardiography; and
(2) Biomedical
			 engineering.
(G) Each provider shall have qualified individuals on-staff
		  appropriate for the services provided including:
(1) A board certified
			 neonatologist as director of the neonatal care service. The director shall
			 coordinate and integrate the following, including:
(a) A system for consultation;
(b) In-service education programs;
(c) Coordination and communication with support
				services;
(d) In collaboration with other members of the neonatal
				team, define and establish appropriate protocols and procedures for newborn
				patients; and
(e) Treatment of patients in the neonatal intensive care
				unit who are not under the care of other physicians;
(2) A single, designated
			 registered nurse with a bachelor's degree in nursing and a master's
			 degree responsible for leading the organization and supervision of nursing
			 services in the neonatal care service; and
(3) A registered nurse
			 with a master's degree in nursing and an area of specialization in
			 neonatal health to provide clinical nursing expertise commensurate with the
			 patient acuity and services provided.
(H) Specialists. Medical, surgical, radiological and
		  pathology specialists shall be on-call based on the medical needs of the
		  patients.
(I) Sub-specialists. Each freestanding children's
		  hospital with a level III or level IV neonatal care service shall have, either
		  on-site or at a nearby closely related hospital or institution, qualified
		  sub-specialists that may include:
(1) Pediatric:
(a) Nephrologists;
(b) Hematologists;
(c) Metabologists;
(d) Endocrinologists;
(e) Gastroenterologists;
(f) Nutritionists;
(g) Infectious disease;
(h) Pulmonologists;
(i) Immunologists; and
(j) Pharmacologists;
(2) Pediatric
			 surgical:
(a) Orthopedic surgeons;
(b) Urologic surgeons; and
(c) Otolaryngologic surgeons; and
(3) For a freestanding
			 children's hospital with a level IV neonatal care service, additional
			 pediatric surgical:
(a) Cardiovascular surgeons; and
(b) Neurosurgeons.
(J) Each provider shall have sufficient registered nurses
		  with the appropriate education and demonstrated competence, commensurate with
		  the acuity and volume of patients served, on-duty at all times to provide
		  direct supervision of newborns.
(K) Other disciplines. Each provider shall have the
		  following practitioners on-staff:
(1) At least one licensed
			 social worker to provide psychosocial assessments, family support services, and
			 medical social work. Additional social workers shall be provided based upon the
			 size and needs of the patient population;
(2) A licensed dietitian with knowledge
			 of maternal and newborn nutrition, and knowledge of parenteral/enteral
			 nutrition management of at-risk newborns; and
(3) A certified lactation
			 consultant. Additional certified lactation consultants shall be provided based
			 upon the size and needs of the patient population.