N.J. Admin. Code § 8:43G-19.12

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:43G-19.12 - Perinatal patient services

(a) A registry of all births shall be maintained through either the electronic certificate or a maternity log book located in the obstetrics area and shall include the minimum data set required by the Department in accordance with N.J.S.A. 26:8-30 and N.J.A.C. 8:2.

(b) Obstetrics anesthesia services policies and procedures shall include at least:

1. The obstetric service in consultation with the anesthesia service shall develop and implement written policies and procedures that govern anesthesia services in all labor, delivery and recovery areas. The policies and procedures shall be reviewed annually, revised and implemented.

2. All individuals who administer anesthetic agents to obstetric patients shall be credentialed in accordance with medical staff policies. The physician director of anesthesia services shall participate in the credentialing process and delineation of privileges of all personnel who administer anesthetic agents.

3. The obstetric service, in consultation with the anesthesia service, shall establish protocols governing the use of anesthetic agents for pain management. These shall include the qualifications and responsibilities of persons who administer the use of anesthetic agents for pain management. Policies and procedures shall address the use of patient monitoring equipment and identify the types and levels of agents which may be used for pain management.

4. A preanesthesia note, reflecting evaluation and classification of the patient according to American Society of Anesthesiologists (ASA) Physical Status system, shall be made or certified by the physician administering or supervising the administration of anesthesia and entered into the medical record of each patient who will be administered an anesthetic agent.

5. Anesthetic or pain control agents administered to non-surgical obstetric patients classified for anesthesia risk as an ASA Class I, II or III shall be administered and monitored in accordance with obstetric service policies and procedures governing anesthesia care.

6. Anesthetic or pain control agents administered to non-surgical obstetric patients classified for anesthesia risk as an ASA Class IV, V or Emergency shall be in accordance with the following sections of N.J.A.C. 8:43G-6, Anesthesia Services, as amended:

i.8:43G-6.1, Definitions;

ii.8:43G-6.3(d) through (k), Anesthesia qualifications for administering anesthesia;

iii.8:43G-6.5(b), Anesthesia patient services;

iv.8:43G-6.6, Anesthesia supplies and equipment; safety systems;

v.8:43G-6.7, Anesthesia supplies and equipment; maintenance and inspection; and

vi.8:43G-6.8, Anesthesia supplies and equipment; patient monitoring.

7. For patients undergoing surgical deliveries, including cesarean sections, anesthesia care shall be in accordance with all applicable sections of N.J.A.C. 8:43G-6, Anesthesia Services.

8. There shall be a program of quality assurance for anesthesia care provided in obstetric services that is integrated into the hospital and the anesthesia service quality assurance programs.

(c) There shall be written policies and procedures for the care of patients during the recovery phase of delivery. The policies and procedures shall be reviewed annually, revised as needed, and implemented. These policies and procedures shall include at least:

1. Delineation of the primary medical responsibility for postanesthesia care of the patient;

2. Monitoring of patients, including availability of monitoring equipment, and use of an objective scoring system to determine when the patient has recovered from anesthesia;

3. Requirements for documentation of patient status;

4. Protocol for patient emergencies;

5. Criteria and responsibility for discharge from recovery;

6. Recovery staff qualifications, which shall be as follows:

i. All registered professional nurses assigned to recovery services shall have training in basic cardiac life support.

ii. Recovery services shall be staffed at all times by at least one registered professional nurse with critical care training, as defined by the hospital, whenever a patient recovering from a cesarean section and/or classified as ASA Class III, IV, V or Emergency is present;

7. Recovery staff time and availability, which shall be as follows:

i. There shall be at least two health care personnel, one of whom is a registered professional nurse and the other of whom is either a registered professional nurse or a licensed practical nurse, present in recovery services whenever a patient in the recovery phase of delivery is present. The nurse identified in (c)6ii above may function as the registered professional nurse required herein.

ii. There shall be a ratio of at least one registered professional nurse present in the recovery service area for every three patients in the recovery phase of delivery; and

8. Recovery patient services, which shall be as follows:

i. Postanesthesia notes shall be entered into the patient's medical record by a member of the hospital's anesthesia team early in the postoperative period.

ii. The condition of each patient shall be continually evaluated, with an objective scoring system used to track the patient until she has recovered from anesthesia.

iii. The patient's vital signs shall be monitored and recorded at least every 15 minutes during recovery.

iv. Postanesthesia care for patients recovering from a cesarean section and/or classified as ASA Class III, IV, V or Emergency shall also follow 8:43G-35.4(a) through (i).

(d) The hospital shall develop and implement written policies and procedures using evidence-based resources regarding perinatal patient care, which address:

1. Allowing the newborn to remain with the mother or a primary caregiver as the preferred source of body warmth during the critical first hour following delivery, unless such contact is contraindicated or not accepted by the mother;

2. Performing newborn assessments while the newborn is with the mother or primary caregiver, unless contraindicated;

3. Offering support to mothers who wish to breastfeed their newborns and assisting, as necessary, to facilitate positioning and latch during the first hour after an infant's birth; and

4. Reviewing these policies and procedures every three years and making revisions at any time as necessary.

N.J. Admin. Code § 8:43G-19.12

Amended by 50 N.J.R. 552(b), effective 1/16/2018