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Example: CABC clinical evaluation

Management of care of neonates born with respiratory and/or cardiac depression

Updated February 4, 2014

In management of emergencies, CABC accreditation includes an evaluation of the management of care of neonates born with respiratory and/or cardiac depression as follows:

  1. Criteria for pulling medical records for review include the following:
    1. 1 minute Apgar score <5 or 5-minute Apgar score <7
    2. neonatal transfer for any indication
    3. newborn readmission after discharge from birth center
    4. neonatal complications not requiring transfer, including neonatal resuscitation
  2. Review of Center’s P&P’s for neonatal resuscitation and management of depressed neonates for consistency with national standards and guidelines -specifically AABC Standards for Birth Centers and AAP/AHA NRP guidelines.
  3. Review of risk criteria for inclusion of criteria for neonatal transfer or consultation regarding neonatal care for newborns falling outside normal ranges, including but not limited to 5-minute Apgar <7; newborn requiring more than brief resuscitation; congenital anomaly requiring immediate treatment or observation, respiratory issues, such as tachypnea, retractions, cyanosis.
  4. Review of neonatal transport arrangements to assure inclusion of a mechanism for safe transport of an unstable neonate (i.e.- requiring resuscitation enroute) and receiving facility with appropriate services for neonatal stabilization and/or care.
  5. Inspection of neonatal emergency supplies and equipment for adequacy, storage so readily available in emergency, and evidence of regular inspection as part of Center’s CQI program.  Must include at minimum:
    1. Epinephrine1:10,000, volume expander (Normal Saline or Lactated Ringer’s Solution), and intravenous catheters appropriate for umbilical venous administration of epinephrine and/or volume expander.
    2. Narcan (if birth center offers narcotics in labor)
    3. Oxygen
    4. Bag and Mask; intubation supplies, including:
      1. ET tubes in the appropriate sizes, (3.0, 3.5 & 4.0)
      2. laryngoscope with appropriate-sized blade(s), and extra batteries and light bulbs;
      3. neonatal laryngeal mask airways.
    5. Pulse oximeter with neonatal sensors and P&P for use during neonatal resuscitation. (Note:  If pulse oximeter is also used for CCHD screening, birth center must have a P&P for that use as well.)
    6. If oxygen blender is not in use, birth center’s P&P for neonatal resuscitation should indicate that resuscitation is initiated with room air and then oxygen titrated based on pulse oximetry readings.
  6. Review of personnel files to confirm successful completion of current NRP training, all modules including medications and intubation by all clinical staff who attend births (as primary birth attendant or as birth assistant).
  7. Confirm documentation that quarterly medical emergency drills are conducted, and include neonatal resuscitation, management of care of depressed neonate and neonatal transport.
  8. Review of general consent form and process to assure that parents are informed regarding criteria for transfer, including neonatal indications, and procedures for such transfers whether emergent or non-emergent.

CABC also reviews other relevant areas, such as policies and procedures for intermittent auscultation of fetal heart tones, review of criteria for antepartum medical referral to screen for women in whom there is a higher than average expectation of a compromised newborn.

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