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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 133HOSPITAL LICENSING
SUBCHAPTER KHOSPITAL LEVEL OF CARE DESIGNATIONS FOR MATERNAL CARE
RULE §133.209Maternal Designation Level IV

    (F) a portable ultrasound machine available in the labor and delivery and antepartum unit.

  (17) Pharmacy services must comply with the requirements found in §133.41 of this title and must have a pharmacist with experience in perinatal pharmacology available at all times.

  (18) Respiratory Therapy Services must comply with the requirements found at §133.41 of this title and must have a respiratory therapist immediately available on-site at all times.

  (19) Obstetrical Services.

    (A) The ability to begin an emergency cesarean delivery within a time period consistent with current standards of professional practice and maternal care.

    (B) Ensure the availability and interpretation of non-stress testing, and electronic fetal monitoring.

    (C) A trial of labor for patients with prior cesarean delivery must have the capability of anesthesia, cesarean delivery, and maternal resuscitation on-site during the trial of labor.

  (20) Resuscitation. The facility must have written policies and procedures specific to the facility for the stabilization and resuscitation of the pregnant or postpartum patient based on current standards of professional practice. The facility:

    (A) ensures staff members, not responsible for the neonatal resuscitation, are immediately available on-site at all times who demonstrate current status of successful completion of ACLS, or a department-approved equivalent course, and the skills to perform a complete resuscitation; and

    (B) ensures that resuscitation equipment, including difficult airway management equipment for pregnant and postpartum patients, is readily available in the labor and delivery, antepartum and postpartum areas.

  (21) The facility must have a written hospital preparedness and management plan for patients with placenta accreta spectrum disorder who are undiagnosed until delivery, including educating and training hospital and medical staff who may be involved in the treatment and management of placenta accreta spectrum disorder about risk factors, diagnosis, and management.

  (22) The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of:

    (A) massive hemorrhage and transfusion of the pregnant or postpartum patient in coordination of the blood bank, including management of unanticipated hemorrhage or coagulopathy;

    (B) obstetrical hemorrhage, including promoting the identification of patients at risk, early diagnosis, and therapy to reduce morbidity and mortality;

    (C) placenta accreta spectrum disorder, including team education, risk factor screening, evaluation, diagnosis, fostering telemedicine medical services and referral as appropriate, treatment, and multidisciplinary management of both anticipated and unanticipated placenta accreta spectrum disorder cases, including postpartum care;

    (D) hypertensive disorders in pregnancy, including eclampsia and the postpartum patient to promote early diagnosis and treatment to reduce morbidity and mortality;

    (E) sepsis or systemic infection in the pregnant or postpartum patient;

    (F) venous thromboembolism in the pregnant and postpartum patient, including assessment of risk factors, prevention, early diagnosis and treatment;

    (G) shoulder dystocia, including assessment of risk factors, counseling of patient, and multidisciplinary management; and

    (H) behavioral health disorders, including depression, substance abuse and addiction that includes screening, education, consultation with appropriate personnel and referral.

  (23) The facility must have nursing leadership and staff with training and experience in the provision of maternal critical care who must coordinate with respective neonatal services.

  (24) The facility must have a program for genetic diagnosis and counseling for genetic disorders, or a policy and process for consultation referral to an appropriate facility.

  (25) Perinatal Education. A registered nurse with experience in maternal care, including moderately complex and ill obstetric patients, must provide the supervision and coordination of staff education. Perinatal education for high risk events must be provided at frequent intervals to prepare medical, nursing, and ancillary staff for these emergencies.

  (26) Support personnel with knowledge and skills in breastfeeding to meet the needs of maternal patients must be available at all times.

  (27) A certified lactation consultant must be available at all times.

  (28) Social services, pastoral care and bereavement services must be provided as appropriate to meet the needs of the patient population served.

  (29) Dietician or nutritionist available with training and experience in maternal nutrition and can plan diets that meet the needs of the pregnant and postpartum patient and critically ill maternal patient must comply with the requirements in §133.41 of this title.


Source Note: The provisions of this §133.209 adopted to be effective March 1, 2018, 43 TexReg 875; amended to be effective January 8, 2023, 47 TexReg 8986

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