THE MARYLAND PERINATAL SYSTEM STANDARDS Revised April 2019
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THE MARYLAND PERINATAL SYSTEM STANDARDS Revised April 2019 Recommendations of the Perinatal Clinical Advisory Committee 2 MEMBERS OF THE PERINATAL CLINICAL ADVISORY COMMITTEE Pablo Argeles, MD Ann B. Burke, MD, FACOG Ernest Graham, MD Chair, Department of Obstetrics and Vice President, Medical Affairs Department of Gynecology and Obstetrics Gynecology Holy Cross Hospital Johns Hopkins Hospital University of Maryland Baltimore American College of Obstetricians and Level IV Washington Medical Center Gynecologists - Maryland Section Level II Christopher R. Harman, MD Sherrie Burkholder, MSN, MHA, RNC- Chair, Department of Obstetrics, Robert Atlas, MD OB, C-EFM Gynecology and Reproductive Services Chair, Department of Obstetrics and Education Specialist, Perinatal Services University of Maryland School of Gynecology Adventist HealthCare Shady Grove Medicine Mercy Medical Center Medical Center Level IV MedChi, The Maryland State Medical Chair, AWHONN Maryland Section Society Association of Women’s Health, Obstetric Lynn M. Harris, MSN, RN and Neonatal Nurses (AWHONN) Assistant Director of Nursing, Women and Susan W. Aucott, MD Infants Associate Division Director, Neonatology Susan J. Dulkerian, MD, FAAP MedStar Harbor Hospital Medical Director, NICU Chair, Department of Pediatrics Level II Johns Hopkins Children’s Center Director of Newborn Services Level IV Mercy Medical Center Robert H. Imhoff III, MPP American Academy of Pediatrics President and CEO Carla L. Bailey, PhD, RN Maryland Patient Safety Center Director, Perinatal Programs Dina El-Metwally, MD, FAAP, PhD Maryland Institute for Emergency Medical Medical Director, NICU Desirée L. Israel, LMSW Services Systems (MIEMSS) Associate Professor, University of Reproductive Psychotherapist Maryland School of Medicine National Association of Social Workers, Tuvia Blechman, MD Level IV Maryland Chapter Chief, Division of Neonatology Chairman, Department of Pediatrics Eileen Fleck, MPP Howard County General Hospital Chief, Acute Care Policy and Planning Level III Maryland Health Care Commission 3 Nia Jewell Leak, MD, FACOG Jeanne Murphy, PhD, CNM, FACNM Bharti Razdan, BSc., MD, FAAP Director, Department of Obstetrics and Assistant Professor, The George Vice-Chair, Department of Pediatrics Gynecology Washington University School of Nursing Medical Director, NICU Medical Director, Labor and Delivery Certified Nurse-Midwife, University of Frederick Memorial Hospital Howard County General Hospital Maryland St. Joseph Medical Center Level III Level III American College of Nurse-Midwives – Maryland Affiliate Edina Veselovsky, MD Jocelyn Leung, MD Director, Special Care Nursery Medical Director, Neonatology Katherine M. Murray, MSN, RN, NEA-BC Adventist HealthCare Washington University of Maryland Prince George’s Women’s and Children’s Service Line Adventist Hospital Hospital Center Director Level II Level III Frederick Memorial Hospital Level III Renee B. Webster, REHS Esther K. Liu, MD, FAAP Assistant Deputy Director, Non Long Term Chair, Pediatrics and Neonatal Care Unit Teresa O’Sullivan, BSN, RNC-OB Care Federal Programs University of Maryland Baltimore Nurse Manager, Family Birthplace and Office of Health Care Quality Washington Medical Center Special Care Nursery Level II University of Maryland Upper Chesapeake Tiffany Wedlake, MD, MPH, FAAPM Medical Center Physician Adviser and Medical Director David A. Mann, MD, PhD Level II Acute Care and HealthChoice Epidemiologist Administration Maryland Department of Health Tabitha F. Perry, MD, FACOG Maryland Department of Health Office of Minority Health and Health Vice-Chair, Department of Obstetrics and Maryland Medicaid Disparities Gynecology Adventist HealthCare Washington S. Lee Woods, MD, PhD, FAAP Fernando Mena, MD Adventist Hospital Medical Director, Maternal and Child Chief, Section of Neonatology Level II Health Bureau MedStar Franklin Square Medical Center Director, Office of Surveillance and Level III Webra Price-Douglas, PhD, CRNP, Quality Initiatives IBCLC Maryland Department of Health Russell W. Moy, MD, MPH Coordinator Health Officer Maryland Regional Neonatal Transport Justin Ziombra, RN, MBA Harford County Health Department Program Director, Policy and Data Analytics Maryland Association of County Health Maryland Hospital Association Officers 4 THE MARYLAND PERINATAL SYSTEM STANDARDS REVISED APRIL 2019 STANDARD TITLE SUMMARY I Organization Refers to the administration of a hospital perinatal program Obstetrical Unit Refers to the resources of equipment, supplies, and personnel needed for the II Capabilities delivery unit within the hospital Refers to the resources of equipment, supplies, and personnel needed for the III Neonatal Unit Capabilities neonatal units within the hospital Describes the roles, responsibilities, and availability of obstetrical personnel in the IV Obstetrical Personnel perinatal program Describes the roles, responsibilities, and availability of pediatric personnel in the V Pediatric Personnel perinatal program Describes the roles, responsibilities, and availability of other personnel in the VI Other Personnel perinatal program Refers to the resources of equipment, supplies, and personnel needed for the VII Laboratory laboratory unit within the hospital Diagnostic Imaging Refers to the resources of equipment, supplies, and personnel needed for diagnostic VIII Capabilities imaging capabilities within the hospital IX Equipment Refers to the availability of specific equipment needed for the perinatal program X Medications Refers to the availability of specific medications needed for the perinatal program Refers to the need for education for all health care providers involved in providing XI Education Programs perinatal care and to the roles and responsibilities of the hospitals in education Describes the quality improvement process that is required for hospital perinatal XII Quality Improvement programs Identifies the administrative and medical policies and protocols that shall be in XIII Policies and Protocols place for a perinatal program 5 LIST OF DEFINITIONS I Level I hospitals have perinatal programs that provide basic care to pregnant women and infants, as described by these standards. These hospitals provide delivery room and well newborn nursery care for physiologically stable infants ≥ 35 weeks gestation. Other than emergency stabilization pending transport, the neonatal services do not provide positive pressure ventilatory support. Physicians board-certified in pediatrics, neonatal-perinatal medicine, or family medicine have programmatic responsibility for these services. These neonatal services do not provide pediatric subspecialty or emergent neonatal surgical specialty services. Maternal and fetal care is limited to gestations of ≥35 weeks. Level I facilities provide care to women who are low risk and are expected to have an uncomplicated birth. Level I facilities have the capability to perform routine intrapartum and postpartum care that it is anticipated to be uncomplicated. Level I facilities have the ability to detect, stabilize, and initiate management of unanticipated maternal-fetal or neonatal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a facility at which specialty maternal care is available. Board-certified physicians or active candidates for board-certification in obstetrics/gynecology, or board-certified physicians in family medicine with advanced training and privileges for obstetrical care with a formal arrangement with a physician board- certified or an active candidate for board-certification in obstetrics/gynecology, have programmatic responsibility for obstetrical services. These hospitals do not receive primary infant or maternal transports. II Level II hospitals have perinatal programs that provide specialty care to pregnant women and infants, as described by these standards. These hospitals provide delivery room and acute specialized care for moderately ill infants ≥ 1500 grams and ≥ 32 weeks gestation with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis. Board-certified neonatal-perinatal medicine subspecialists have programmatic responsibility for the neonatal services. Level II nurseries may provide mechanical ventilation for a brief duration (less than 24 hours) until the infant’s condition soon improves or the infant can be transferred to a higher-level facility. A level II facility may provide continuous positive airway pressure as long as the infant is improving. The neonatal services may provide limited pediatric subspecialty services. They do not provide emergent neonatal surgical specialty services. Maternal and fetal care is limited to term and preterm gestations of ≥ 32 weeks that are maternal risk appropriate, as well as stabilization and transfer of high-risk women who exceed level II care capabilities. Board-certified obstetricians have responsibility for programmatic management of obstetrical services. These hospitals do not receive primary infant or maternal transports except under limited circumstances as described by these standards. III Level III hospitals have perinatal programs that provide subspecialty care for pregnant women and infants, as described by these standards. These hospitals provide acute delivery room and neonatal intensive care unit (NICU) care for infants of all birth weights and gestational ages. Board-certified neonatal-perinatal medicine subspecialists have programmatic responsibility