AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NO.:RULE TITLE:
59A-3.249Neonatal Intensive Care Units (NICU)
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 47 No. 249, December 28, 2021 issue of the Florida Administrative Register.
The following sections of the proposed rule will be changed to read:
59A-3.249 Neonatal Intensive Care Units (NICU).
Each hospital with an obstetrical department as described in Rule 59A-3.244(2), F.A.C., must have a neonatal nursery to provide Level I neonatal services. Level I neonatal services means well-baby care services including sub-ventilation care, intravenous feedings, intravenous medications, and gavage to neonates, as needed. Services in a Level I neonatal nursery are restricted to neonates born at 35 weeks gestation or later and who are considered low risk and physiologically stable. Ventilation assistance must not be provided except for resuscitation and stabilization. Upon beginning ventilation, the hospital must implement a patient treatment plan which includes the transfer of the neonate to a hospital providing Level II, III, or IV NICU services at such time that it becomes apparent that ventilation assistance will be required beyond the neonate’s resuscitation and stabilization. A hospital only providing Level I neonatal services must establish a triage procedure to assess the need for transfer of obstetrical patients to hospitals providing Level II, III, or IV NICU services prior to their delivery when there is an obstetrical indication that resuscitation will be required for their neonates.
(1) through (4) no change
(5) Level II Neonatal Intensive Care Services.
(a) Hospitals that are licensed for Level II NICU services may only provide care for infants at greater than or equal to 30 weeks’ gestation and/or have reached a weight of greater than or equal to 1250 grams.
(b) through (e) no change
(f) Personnel. Each Level II NICU must have physically present in the facility at all times, a board certified or board eligible neonatologist or other neonatal provider with demonstrated competence in the management of severely ill infants as evidenced by completion of the Neonatal Resuscitation Program and continuing education requirements specific to the care of infants., Other neonatal providers, for the purposes of this subsection, must be either pediatric hospitalists, neonatal physician assistants, or neonatal advanced practice registered nurses. If the personnel present at the facility at any time pursuant to this paragraph is not a board certified or board eligible neonatologist, at all such times a neonatologist must be available for consultation and must be available to arrive onsite within 30 minutes of an urgent request. If the neonatologist designated to be either at the facility or available for consultation and arrival upon an urgent request is covering more than one facility, the facility must ensure that a back-up neonatologist be available, documented in an on-call schedule and readily available to facility staff, for consultation or to arrive within 30 minutes upon an urgent request.
(g) through (h) no change
(i) Neonatal Nursing.
1. Supervision. The nursing staff must be under the supervision of a registered professional nurse with experience and training in neonatal intensive care nursing.
2. Training and Qualifications. Nurses must be trained to administer cardio-respiratory monitoring, assist in ventilation, administer intravenous fluids, provide pre-operative and post-operative care of patients requiring surgery, manage patients being transported, and provide emergency treatment of conditions such as apnea, seizures, and respiratory distress. All nurses must maintain current certification in the Neonatal Resuscitation Program.
3. Staffing.
a. There must be at least one nurse for every four three patients receiving Level II neonatal intensive care services.
b. At least one-half of the nursing personnel assigned to each work shift in Level II NICUs must be registered professional nurses.
(j) no change
(k) Level II NICU Bed Equipment. Each bed must have:
1. An incubator or radiant warmer;
2. One heated humidifier and humidified oxygen delivery systems;
1.3. One cardiopulmonary monitor and pulse oximeter;
2.4. At least one resuscitation bag and mask; and
3.5. At least one infusion pump.; and
6. At least one neonatal portable suction device.
(l) Level II NICU Equipment. Each unit must have available on demand:
1. At least one oxygen analyzer for every three occupied beds;
2. At least one non-invasive blood pressure monitoring device for every three occupied beds;
3. At least one ventilator for every three occupied beds;
4. An EKG machine with printout capability;
5. Continuous blood pressure measurement equipment; and
6. A portable digital x-ray capable of directly displaying radiography and digital images in the NICU;.
7. An incubator or radiant warmer for each occupied bed;
8. One heated humidifier and humidified oxygen delivery systems for each occupied bed; and
9. At least one neonatal fixed or portable suction device for each occupied bed.
(6) No change
(7) Level IV Neonatal Intensive Care Services.
(a) through (f) no change
(g) Onsite Pediatric Surgical Subspecialties. Each Level IV NICU must provide the following pediatric surgical subspecialties onsite:
1. Craniofacial surgery;
2. General surgery; and
3. Neurosurgery.; and
(h) through (l) no change
(8) This rule is in effect for five years from its effective date.
Rulemaking Authority 395.1055, FS. Law Implemented 395.1055, FS, 408.0455, FS. History–New________.
