Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 40 - Professional licensing and facility regulation › Subchapter 10 - Facility regulation › Part 4 - Licensing of Hospitals › Section 216-RICR-40-10-4.10 - Appendix A: Universal Perinatal Screening Protocol

Current through June 14, 2024
A. Discharge after Delivery of a Normal
				  Newborn
1. A perinatal hospitalization is
				  unique in that proper medical care involves two patients at the beginning of a
				  crucial long-term relationship. The medically necessary care of the mother and
				  infant at birth includes the assessment, documentation and management of
				  patient needs in the domains of maternal health, infant health and development
				  and nurturance. Early perinatal discharge is only appropriate if an assessment
				  is complete, all significant patient needs have been addressed and a mechanism
				  is in place to ensure follow-up. Discharge of mothers and infants should be
				  coordinated so that the pair leave the hospital together, unless the medical
				  condition of one requires a significantly longer hospital stay.
2. The following risk factors shall be
				  evaluated and appropriate follow-up care plans and/or referrals documented in
				  the medical record prior to discharge.
a.
				  Maternal Health
(1) The mother has stable
				  vital signs, is ambulatory, eating and voiding;
(2) The uterus is firm, the perineum intact
				  or sutured and there is no significant active post-partum bleeding;
(3) Post-partum exam and lab work completed,
				  treatment and instructions given;
(4) Rhogam and/or rubella vaccine given, if
				  required;
(5) Other maternal health
				  problems documented and addressed.
b. Infant Health && Development
(1) Successful feeding x 3, voiding and
				  defecating;
(2) Vital signs stable
				  for at least 12 hours;
(3) Physical
				  examination completed;
(4)
				  Metabolic, hemoglobinopathy, Level 1, and hearing screening and other lab work
				  completed;
(5) Eye prophylaxis,
				  hepatitis B vaccine and Vitamin K given as required;
(6) Other infant health and development
				  issues documented and addressed, parent instructions given, follow-up
				  appointments arranged;
(7) Birth
				  certificate completed.
c.
				  If the infant weighs less than 2,500 grams or has a 5-minute APGAR score less
				  than seven, or if the mother is known to have a risk factor (e.g., diabetes,
				  streptococcal carrier, hepatitis or illicit drug use) for early post-natal
				  complications, discharge in less than 48 hours after birth may be
				  contraindicated.
d. Nurturance:
(1) There is a responsible adult available to
				  assist the mother and infant at home for at least twenty-four hours;
(2) There is a telephone in the home, and a
				  caregiver who speaks the mother's language is available to provide telephone
				  assistance;
(3) The home is
				  reasonably safe, food, and heat if needed, is available;
(4) Appointments for follow-up care are
				  complete, including home visits, family support referrals and primary care
				  visits;
(5) If the mother is under
				  17 years of age, has less than a high school education, has other impairments,
				  a history of neglect or other significant risk for poor nurturance or
				  developmental problems such as those identified by Universal Level 1 Newborn
				  Screening, appropriate family support arrangements have been
				  completed.