Purpose: To establish the Alliance guidelines for the scope of practice and supervision of Nurse Midwives.

Transcription

1 Purpose: To establish the Alliance guidelines for the scope of practice and supervision of Nurse Midwives. Policy: Central California Alliance for Health (the Alliance) requires all Nurse Midwives to meet the Alliance s guidelines to ensure the member quality and alignment with state requirements with respect to scope of practice and supervision. Definitions: Certified Nurse Midwife: A Certified Nurse Midwife (CNM) is a registered nurse who is a graduate of a Board-approved nurse midwifery program and who possesses evidence of certification issued by the California Board of Registered Nursing. A certified nurse midwife may be known as an Advanced Practice Registered Nurse in Accordance with Business and Professions Code Section Standardized Procedures: CNMs practice in collaboration and consultation with physicians. All complications must be referred to physicians immediately (BP Code ) and the CNM is to provide emergency care until physician assistance can be obtained. Standardized procedures, developed with the supervising physician are the legal mechanism for registered nurses, including Nurse Midwives, to perform functions that would otherwise be considered the practice of medicine. The CNM will develop Standardized Procedures in collaboration with physicians and administrators in the organized health system which is to be used. Practices and procedures that overlap the practice of nurse-midwifery into medicine require a standardized procedure (e.g. episiotomy and repair of first or second degree lacerations). CNMs may not assist childbirth by any artificial, forcible, or mechanical means and may not perform version (BP Code (b)). Procedures: 1. Alliance General Guidelines a. Credentialing: The credentialing of CNMs will be processed in adherence to Policy Professional Provider Credentialing Guidelines. b. Ratios: The ratio of physicians available for supervision to CNMs will not exceed the standards outlined in Policy Verification of Physician Supervision to Non-Physician Medical Practitioners Supervision Ratios. Page 1 of 5

2 2. Scope of Practice: a. A nurse midwife that is currently certified may perform independent comprehensive management of mothers and newborns through the maternity cycle of pregnancy, labor, birth, and the immediate post-partum period, not to exceed six weeks. Nurse midwifery care requires the supervision of a licensed physician and surgeon but does not require the physical presence of a physician. b. The CNM is able to assume responsibility for the management of normal pregnant women whose medical, surgical and post-obstetrical history and present health status reveal no conditions that would adversely influence the patient's course of pregnancy or be unfavorably affected by it. Such management includes: i. Observation, assessment and treatment of patients according to approved standardized procedures; ii. Implementation of selected standardized procedures to establish a diagnosis; and iii. Management of selected deviations from normal when the diagnosis is clear with a predictable outcome. c. During the course of care, the CNM will consult with the physician when deviations from normal arise and a course of action is not already specified in the standardized procedure. If a condition requires frequent and / or continuing management by a physician, but certain aspects of care remain within the scope of nurse midwifery management, a situation of collaborative management exists. Under collaborative management, all patients will be followed by both the physician and the CNM. The CNM may institute those standardized nurse midwifery procedures that do not conflict with the aspect of care under the physician's management. Thus, collaborative management requires careful communication between the CNM and the physician, who assumes responsibility for overall provision of that care. d. Per CCR 16 Section 1463, in emergency situations the CNM will communicate the situation to the supervising physician and he/she will assume Page 2 of 5

3 care for the patient. The CNM should continue to provide supportive care until physician assistance can be obtained. 3. Physician Supervision a. A physician will provide oversight and consultation for the CNM as required by the Nurse Practice Act and will provide consultation when needed or requested by the CNM; b. The physician will assume intrapartum management or co-management of those women whose conditions are beyond the scope of midwifery practice; c. The physician will provide coverage when the CNM is unavailable; and d. A physician must be available at all times, either by physical presence or electronic communication. 4. Prescribing Authority a. A CNM may furnish drugs or devices in accordance with standardized procedures and incidentally to the provision of any family planning services, routine health care or perinatal care, or care rendered consistent with the CNM s education, training, and competency. The CNM is required to have a furnishing number by the Board of Registered Nursing. b. CNMs may prescribe Schedule II or III controlled substances under the following circumstances: i. The CNM must complete an approved course that includes Schedule II Controlled Substances content; ii. The CNM must register with the United States Drug Enforcement Administration; and iii. The CNM must furnish controlled substances only in accordance with patient-specific protocols approved by the treating/supervising physician. Page 3 of 5

4 References: Alliance Policies: Professional Provider Credentialing Guidelines Verification of Physician Supervision to Non-Physician Medical Practitioners Supervision Ratios Impacted Departments: Provider Services Medical Affairs Administration Quality Improvement Regulatory: CCR 16 Section 1463 CCR 16 Section 1474 CCR 22 Section Business and Professions Code Nurse Practice Act Sections , , (a) Nurse Midwife Practice. Board of Registered Nursing, Nov Legislative: Contractual: Medi-Cal Contract Exhibit A, Attachment 9 MMCD Policy Letter: NCQA: Supersedes: Other References: Attachments: Lines of Business This Policy Applies To Medi-Cal Alliance Care IHSS Medi-Cal Access Program (MCAP) LOB Effective Dates (01/01/1996 present) (07/01/2005 present) (02/01/2009 present) Revision History: Reviewed Date Revised Date Changes Made By Approved By 12/01/ /01/1998 Barbara Flynn, RN Barbara Flynn, RN 07/01/ /01/2000 Barbara Flynn, RN Barbara Flynn, RN 07/01/ /01/2002 Barbara Flynn, RN Barbara Flynn, RN 07/01/ /01/2006 Barbara Flynn, RN Barbara Flynn, RN 10/01/ /01/2008 Barbara Flynn, RN Barbara Flynn, RN Page 4 of 5

5 03/01/ /01/2010 Barbara Flynn, RN Barbara Flynn, RN 12/16/ /16/2011 David Altman, MD David Altman, MD 11/01/ /01/2012 David Altman, MD David Altman, MD 09/28/ /28/2013 Dale Bishop, MD, CQIW CMO 04/21/2014 Dale Bishop, MD, CQIW CMO 05/20/ /20/2015 Julio Porro, MD, CQIW Medical Director 04/18/ /18/2016 Peg Behan, RRT, CQIW QI Manager 04/07/ /07/2017 Peg Behan, RRT, QI Manager CQIW Page 5 of 5