Source: https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=133&rl=189
Timestamp: 2019-07-15 18:56:48
Document Index: 400529423

Matched Legal Cases: ['§133', '§133', '§133', '§133', '§133', '§133', '§133']

RULE §133.189 Neonatal Designation Level IV
(a) Level IV (Advanced Neonatal Intensive Care Unit). The Level IV neonatal designated facility will:
(1) provide care for the mothers and comprehensive care of their infants of all gestational ages with the most complex and critically ill neonates/infants with any medical problems, and/or requiring sustained life support;
(2) ensure that a comprehensive range of pediatric medical subspecialists and pediatric surgical subspecialists are available to arrive on-site for face to face consultation and care, and the capability to perform major pediatric surgery including the surgical repair of complex conditions;
(3) have skilled personnel with documented training, competencies and continuing education specific for the patient population served;
(c) If the facility has its own transport program, there shall be an identified Transport Medical Director (TMD). The TMD and/or Co-Director shall be a physician who is a board eligible/certified neonatologist.
(1) Triage and assessment of all patients admitted to the perinatal service with identification of pregnant patients who are at high risk of delivering a neonate that requires a higher level of care who will be transferred to another facility prior to delivery unless the transfer is unsafe.
(4) Board certified/board eligible neonatologists whose credentials have been reviewed by the NMD and is on call, and who:
(B) have completed continuing education annually, specific to the care of neonates; and
(C) shall be on-site and immediately available at the neonate/infant bedside as requested.
(5) Pediatric anesthesiologists shall directly provide anesthesia care to the neonate, in compliance with the requirements in §133.41(a) of this title.
(6) A dietitian or nutritionist who has special training in perinatal and neonatal nutrition and can plan diets that meet the special needs of neonates in compliance with the requirements in §133.41(d) of this title.
(7) A comprehensive range of pediatric medical subspecialists and pediatric surgical subspecialists will be immediately available to arrive on-site for face to face consultation and care for an urgent request.
(8) Laboratory services shall be in compliance with the requirements in §133.41(h) of this title and shall have:
(A) appropriately trained and qualified laboratory personnel on-site at all times;
(B) perinatal pathology services;
(D) neonatal/infant blood gas monitoring capabilities.
(9) Pharmacy services shall be in compliance with the requirements in §133.41(q) of this title and shall have a pharmacist, with experience in neonatal/pediatric and perinatal pharmacology available on-site at all times.
(B) If medication compounding is done for neonates/infants, the pharmacist shall develop and implement checks and balances to ensure the accuracy of the final product.
(10) An occupational or physical therapist with neonatal expertise shall be available to meet the needs of the population served.
(11) Medical Imaging. Radiology services shall be in compliance with the requirements in §133.41(s) of this title will incorporate the "As Low as Reasonably Achievable" principle when obtaining imaging in neonatal and maternal patients; and shall have:
(A) personnel appropriately trained in the use of x-ray equipment shall be on-site and available at all times; personnel appropriately trained in ultrasound, computed tomography, magnetic resonance imaging, echocardiography and/or cranial ultrasound equipment shall be on-site within one hour of an urgent request; and fluoroscopy shall be available at all times;
(B) neonatal and perinatal diagnostic imaging studies available at all times with interpretation by radiologists with pediatric expertise, available within one hour of an urgent request; and
(12) Speech language pathologist with neonatal expertise shall be available to evaluate and manage feeding and/or swallowing disorders.
(13) A respiratory therapist, with experience and specialized training in the respiratory support of neonates/infants, whose credentials have been reviewed by the Neonatal Medical Director, shall be on-site and immediately available.
(14) Resuscitation. The facility shall have written policies and procedures specific to the facility for the stabilization and resuscitation of neonates/infants based on current standards of professional practice.
(E) A full range of resuscitative equipment, supplies and medications shall be immediately available for trained staff to perform resuscitation and stabilization on each neonate/infant.
(15) Perinatal Education. A registered nurse with experience in neonatal care, including neonatal intensive care, shall provide supervision and coordination of staff education.
(16) Pastoral care and/or counseling shall be provided as appropriate to the patient population served.
(17) Social services shall be provided as appropriate to the patient population served.
(18) The facility must ensure the timely evaluation and treatment of retinopathy of prematurity on-site by a pediatric ophthalmologist or retinal specialist with expertise in retinopathy of prematurity in the event that an infant at risk is present, and a documented policy for the monitoring, treatment and follow-up of retinopathy of prematurity.
(19) A certified lactation consultant shall be available at all times.
(20) Ensure provisions for follow up care at discharge for infants at high risk for neurodevelopmental, medical, or psychosocial complications.
Source Note: The provisions of this §133.189 adopted to be effective June 9, 2016, 41 TexReg 4011