SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: GUIDELINES FOR NEWBORN ASSIGNMENT TO APPROPRIATE LEVEL OF CARE POLICY #: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: PAGE: 126.652 (neonatal) 1/12 11/17 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 5 Job Title of Reviewer: Director, Women s and Children s Services PURPOSE: POLICY STATEMENT: EXCEPTIONS: To establish guidelines to assign newborn to the most appropriate level of care. The following guidelines will be used by the medical and nursing staff in making decisions regarding the assignment of newborn care according the AAP Perinatal Guidelines (2007). The Neonatologist and the director of Women and Children s or designee(s) will jointly agree upon any other exceptions. ADMISSION CRITERIA: 1. Nursing staff in the delivery room, OB ECC, recovery room, operating room or nursery are trained in assessing and recognizing problem in the newborn by: a. Continuing Competencies b. Continuing education c. Standards of practice d. Simulation 2. Newborns that require an assessment for a probable higher level of care other than normal newborn course, or meeting existing criteria for NICU admission at time of birth, include the following criterion, but are not exclusive :
Level of Care Page 2 of 5 a. Newborns in moderate respiratory distresstachypneic > 70, grunting, flaring and/or having retractions and not improving b. Newborns requiring oxygen beyond initial resuscitation. c The necessity for use of continuous monitoring equipment. d Newborns requiring IV therapy. e. The administration of any medications, other than Vitamin K, erythromycin eye ointment, EMLA crème, HIV medications and vaccines. f. The need for life support equipment. g. The need for complex medical care. 3. Newborns meeting admission criteria for higher level of care: a. Assessing nurse will communicate to attending nurse and parents that the newborn will be moved to the NICU b. Assessing nurse will transport newborn to new level of care. c. A nurse-to-nurse handoff communication will be done before care is assumed by admitting nurse. d. Document reason for transfer in SCM on Assessment flow sheet under Nursing Notes e. NICU staff will notify attending pediatrician of NICU admission. If the newborn can be transferred back to Mother, the neonatologist will call pediatrician for a physician to physician update. 4. Newborns needing to be evaluated for anything other than admission criteria: a. The bedside nurse will place a call to the attending pediatrician to communicate her assessment. b. If pediatrician requests a neonatology consult, the pediatrician will call to speak with the neonatologist directly to have a physician to physician discussing about concerns. A consult for West Coast Neonatology will be put into
Level of Care Page 3 of 5 SCM. 5. Nursing staff attending C-section in the Operating room: a. This nurse is responsible for newborn until hand off communication is complete. b. Follow NRP guidelines for resuscitation c. Assign APGARs d. Complete gross assessment e. Weigh newborn f. Apply bands g. Determine if the physical assessment findings warrant a higher level of care i. If not, newborn care will be transferred to receiving nurse for normal newborn care ii. If a higher level of care is determined, assessing nurse will transport newborn to appropriate care locations (NICU or nursery) 1. Complete hand off communication 2. Document in SCM on appropriate newborn flow sheet under Newborn Note or NICU flow sheet. RESPONSIBILITY: It will be the responsibility of the Director of Women s and Children s Services to see that all personnel are aware of, and adhere to, this policy. REFERENCE (S): American Academy of Pediatrics, American College of Obstetricians and Gynecologists. (2007).5th edition Guidelines For Perinatal Care. Evanston, IL; Washington, DC: Author.
Level of Care Page 4 of 5. The Nurses Association of the American College of Obstetricians and Gynecologists. (2005). Standards For Obstetrical, Gynecological And Neonatal Nursing. Washington, DC: Author. REVIEWING AUTHOR (S): Heather Graber, BSN, RNC,RNC, Clinical Manager, NICU Heike S. Bucken RNC-NIC, CLC, Clinical Coordinator Anthony Napolitano, MD, WCN Medical Director of the NICU Pam Beitlich, RN, DNP Director of Women and Children s Services
Level of Care Page 5 of 5 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Committee/Sections (if applicable): Date 11/1/17 Clinical Practice Council 11/13/17 Pam Beitlich, Director, Women s and Children s Vice President/Administrative Director (if applicable): Name and 11/14/17 Name and Connie Andersen, Vice President/Chief Nursing Officer