OAR 333-520-0060: Maternity Services

(1) General hospitals are required to comply with this rule. A low occupancy acute care hospital shall comply with this rule if it offers maternity services. (2) A hospital that provides maternity services shall have separate maternity facilities and a maternity care department that: (a) Has labor, delivery, recovery, postpartum, and nursery rooms that conform to the applicable requirements of OAR chapter 333, division 535; (b) Requires every person in the delivery room during a delivery to be appropriately attired according to the hospital's Infection Control Policy; (c) Has appropriate resuscitation equipment immediately available to rooms where deliveries are planned and where newborn infants are kept; (d) Has a warmed blanket or incubator for newborns to prevent thermal loss; (e) Has incubators for premature infants equipped with a governor to control the flow of oxygen at 40 percent or under, and an oxygen analyzer; (f) Has an accurate scale for weighing of infants; and (g) Includes a nursery and a separate bassinet for each infant with a clean mattress covered with suitable sheeting, washable pads, and bed linen that is kept clean at all times. (3) A health care practitioner attending the birth of a newborn shall evaluate and treat a newborn at risk for chlamydial or gonococcal ophthalmia neonatorum in accordance with OAR 333-019-0036. (4) A parent or legal representative that refuses to allow prophylaxis for an infant shall be informed by the attending health care practitioner of the risks of the refusal and must sign a witnessed affidavit that attests they have been so informed and nonetheless refuse to allow prophylaxis. (5) A hospital shall ensure that all newborns are given Vitamin K at birth as required by ORS 433.303 through 433.314 and in accordance with OAR chapter 333, division 021. (6) A hospital shall ensure that every newborn infant born in the hospital is tested for Metabolic Diseases as required by OAR 333-024-1000 through 333-024-1050 and instructions to the parents or legal representative regarding the testing that be documented in the medical record. (7) A hospital shall ensure that every newborn infant born in the hospital receives a newborn hearing screening test and cytomegalovirus screening as required by ORS 433.321 and OAR chapter 333, division 20. (8) A hospital must perform pulse oximetry screening on every newborn infant delivered at the hospital before discharging the newborn infant in conformance with the following requirements: (a) The pulse oximetry screening must be performed using evidence-based guidelines such as those recommended by Strategies for Implementing Screening for Critical Congenital Heart Disease, AR Kemper et al., Pediatrics 2011;128(5): e1259–1267. (b) The hospital must have policies and procedures based on the guidelines required by subsection (a) of this section for: (A) Determining what is considered a positive screening result; and (B) Determining what follow-up services, treatment, or referrals must be provided if a newborn infant has a positive screening result. (c) A Federal Drug Administration (FDA) approved motion tolerant pulse oximeter must be used. (d) The pulse oximetry screening must be performed no sooner than 24 hours after birth or as close to discharge of the newborn infant as possible. (e) If a newborn infant is admitted to a hospital as the result of a transfer from another hospital or Birthing Center before a pulse oximetry screening is performed, the hospital from which the newborn infant is discharged to home is responsible for performing the screening. (f) The hospital must provide the following notifications and document them in the newborn infant’s medical record: (A) Prior to the pulse oximetry screening, notify a parent or legal representative of the newborn about the reasons for the screening and the risks and consequences of not screening. (B) Following the pulse oximetry screening, notify the health care provider responsible for the newborn infant and the infant’s primary care provider of the results of the screening. (C) Following the pulse oximetry screening and prior to discharge, notify a parent or legal representative of the newborn infant of the screening result, an explanation of its meaning and, if it is a positive screening result, provide information about the importance of timely diagnosis and intervention. (g) A parent or legal representative of a newborn infant may decline pulse oximetry screening and, if screening is declined, the hospital must document the declination in the newborn infant’s medical record. (h) Following the pulse oximetry screening, the hospital, in accordance with the applicable standard of care, must provide any appropriate follow-up services or treatment for the newborn infant if necessary or provide a referral to a parent or legal representative of the newborn for follow-up services or treatment if necessary. (i) The hospital must document in the newborn infant’s medical record that the screening was performed, the screening result, the names of the health care providers who were notified of the screening result, and any follow-up services or treatment or referral for services or treatment. (j) No newborn infant may be refused screening because of the inability of a parent or legal representative to pay for the screening. (9) Every infant born in a hospital shall be marked for identification before the infant is removed from the place of delivery and such identification shall not be removed from the infant until the infant is discharged. (10) A hospital shall not admit visitors to a delivery room, maternity rooms, wards, units, or the nursery except in accordance with the hospital's visiting policy. (11) A hospital shall ensure that persons entering the nursery are attired according to the hospital infection control policy and that hands are washed before touching an infant. (12) A hospital shall follow its infection control policy when handling and storing linens. (13) Formula feedings and any other feedings shall be given only as prescribed in writing by the physician or certified nurse midwife. (14) A hospital shall maintain and preserve a log of births giving date of birth, name of newborn, and birth parent's name and chart number, in addition to complying with the requirements of the Oregon Health Authority’s Center for Health Statistics. (15) A hospital may use a part of the maternity department for selected, non-communicable non-obstetrical patients as defined by hospital policy and approved by the hospital's infection control program under the following conditions: (a) Patients admitted or transferred to the maternity department shall be instructed by appropriate maternity service personnel as to their responsibilities regarding use of the facility. (b) Patients admitted to the maternity department shall be limited to obstetrical patients admitted for delivery, patients with obstetric complications, and selected non-communicable, non-obstetrical patients. (c) Obstetrical patients and medical/surgical patients shall not occupy the same room. (d) If necessary, one or more medical/surgical patients shall be transferred to another service in order to admit obstetrical patients. (16) A hospital shall adhere strictly to the guidelines for standard precautions developed by the Hospital Infection Control Practices Advisory Committee (HICPAC) when caring for obstetrical patients with infectious conditions. Patients with infectious conditions requiring strict isolation according to the above guidelines shall be transferred out of the maternity department following delivery, and given care in an area of the hospital where that isolation can be provided. If a maternity patient is found to have an infectious condition during surgery or delivery, the patient shall be returned to the maternity department and isolated according to hospital infection control policy. (17) A delivery room suite may be used for surgical procedures on non-obstetrical patients if approved by the Chief of Obstetrics in accordance with medical staff rules and regulations. (18) A hospital with maternity services may place stable postpartum patients and stable newborns, as those terms are defined in OAR 333-500-0010, on another acute care unit on a periodic basis under the following conditions: (a) When a postpartum patient or newborn to be transferred out of the obstetrics (OB) unit meet the hospital's criteria for care on another unit as described in this rule; (b) Where the decision to place a postpartum patient or newborn on another unit is based on currently accepted postpartum and newborn care standards and the ability of that unit to meet the needs of the patient; and (c) When nursing staff on the non-OB unit have received training required by this rule and have demonstrated continuing competence. (19) A hospital that provides care to postpartum patients and newborns on non-OB units shall: (a) Develop and implement policies and procedures that include but are not limited to: (A) The transfer of postpartum patients and newborns to non-OB units including a delineation of the authority for medical, clinical and administrative nursing staff, and, when applicable, nurse practitioner staff to make the decision; (B) Staffing guidelines for the nursing care of postpartum patients and newborns on the non-OB unit; (C) Provision of information to maternity patients of possible or intended placement on a non-OB unit; (D) Provision of consumer information related to the availability and location of specialty maternity services; (E) Infection control practices including the use of standard precautions; (F) Procedures for patient placement, privacy, and safety that prohibit postpartum patients and newborns from occupying the same room as non-obstetrical patients; (G) Protocols for the placement of newborns without birth parents; (H) Procedures to assure the inclusion of the care of postpartum patients and newborns on non-OB units in the hospital's quality assurance program; and (I) Delineation of hospital protocols for the return of postpartum patients and newborns to the OB unit, including addressing situations when safe care can no longer be provided on the non-OB unit. (b) Develop and implement staff training, continuing education, and continuing competency program that includes but is not limited to: (A) Postpartum nursing care; (B) Nursing care of the newborn; (C) Newborn resuscitation; (D) Newborn feeding; (E) Maternal and family education; (F) Infection control practices including the use of standard precautions; and (G) Maternity services policies and procedures including those required in subsection (19)(a) of this rule.