Classification of emergency obstetric and gynecologic

services (a) Level IV. A Level IV facility shall provide basic obstetric and gynecologic services, including emergency delivery, with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site twenty-four (24) hours a day. A hospital shall be classified at Level IV for emergency obstetric and gynecologic services if it meets the following requirements: (1) Clinical services and resources. No diagnostic, surgical, or OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 185 September 13, 2019 medical specialty services are required. (2) Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician shall be on site twenty- four (24) hours a day. In the absence of a physician, licensed independent practitioner, registered nurse, or paramedic level emergency medical technician, at least one of the practitioners on duty shall have received training in evaluating obstetric risk factors and protocols for immediate transfer of high risk obstetric cases shall be established and followed. (A) If the facility is licensed as a General-Medical Surgical Hospital it shall also meet the personnel and staffing requirements at OAC 310:667-29-1 and any other applicable parts of this Chapter. (B) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Psychiatric, it shall also meet the personnel and staffing requirements at OAC 310:667-33-2 and any other applicable parts of this Chapter. (C) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Rehabilitation, it shall also meet the personnel and staffing requirements at OAC 310:667-35-3 and any other applicable parts of this Chapter. (D) If the facility provides emergency medical services and is licensed as a Critical Access Hospital, it shall also meet the personnel and staffing requirements at OAC 310:667-39-14 and any other applicable parts of this Chapter. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: (A) Obstetrics pack; (B) Nitrazine (pH) paper for detecting amniotic fluid when membranes are ruptured; (C) Equipment to monitor fetal heart rate and pattern electronically or by auscultation; (D) Heat source or procedure for infant warming; and (E) Ophthalmic antiseptics for neonates. (4) Agreements and policies on transfers. (A) The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. Written policies and procedures shall include where and how neonates shall be cared for until transfer to an appropriate facility can be completed. (B) The facility shall have a written agreement with a hospital, or obstetrician-gynecologist, or group of obstetrician- gynecologists to provide immediate consultative services for obstetric and gynecologic patients twenty-four (24) hours a day. Such services shall include the immediate interpretation of obstetric and neonatal risk factors and providing instructions for the initiation of appropriate therapy and/or patient transfer. (b) Level III. A Level III facility shall provide emergency medical services with an organized emergency department. A physician and OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 186 September 13, 2019 nursing staff with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. A hospital shall be classified at Level III for emergency obstetric and gynecologic services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent obstetric or gynecologic patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (ii) For a hospital licensed as a critical access hospital, emergency services shall also comply with OAC 310:667-39-14. (B) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (C) Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (D) Operating suite. An operating suite with thermal control equipment for patients and infusion of blood and fluids shall be available twenty-four (24) hours a day. (E) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. (F) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. (G) Diagnostic imaging. The hospital shall have diagnostic x-ray and ultrasonography services available twenty-four (24) hours a day. A radiology technologist and staff designated as qualified to perform ultrasonography shall be on duty or on call and immediately available twenty-four (24) hours a day. The diagnostic imaging service shall provide at least the following services: (i) Ultrasonography. (ii) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 187 September 13, 2019 (iii) For a hospital licensed as a critical access hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (H) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products, including Rho (D) immune globulin shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing including urine and serum assays for the beta subunit of human chorionic gonadotropin (β-hCG) and quantitative or semiquantitative urine protein; (iii) Coagulation studies including: (I) Prothrombin time (PT) and activated partial thromboplastin time (aPTT); (II) Fibrinogen; and (III) Assay for fibrin degradation products or an equivalent test; (iv) Blood gas/pH; (v) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (vi) Drug and alcohol screening. (vii) For a hospital licensed as a general medical surgical hospital or a specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (viii) For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (I) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel. (A) Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (B) Obstetrician-gynecologist. A physician board certified, board eligible, or residency trained in obstetrics and gynecology shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four (24) hours a day. (3) Supplies and equipment. (A) Emergency department. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 188 September 13, 2019 equipment and supplies for use in the management of emergent obstetric, gynecologic, and neonatal patients on site, functional, and available in the emergency department, including at least the following: (i) Obstetrics pack; (ii) Nitrazine (pH) paper for detecting amniotic fluid when membranes are ruptured; (iii) Equipment to monitor fetal heart rate and pattern electronically or by auscultation; (iv) Heat source or procedure for infant warming; (v) Ophthalmic antiseptics for neonates; (vi) Pulse oximetry with adult and pediatric probes; (vii) Drugs necessary for care of the emergent obstetric or gynecologic patient including: (I) Oxytocic agents; (II) Tocolytic agents; (III) Prostaglandins; (IV) Ergotic agents; (V) Antihypertensives; and (VI) Magnesium sulfate. (viii) Drugs necessary for care of the depressed neonatal patient including: (I) Epinephrine; (II) Volume expanders (III) Sodium bicarbonate; (IV) Dextrose solutions; and (V) Naloxone hydrochloride. (ix) Sterile procedure trays for episiotomy; and (x) Supplies, equipment, and written protocols for the examination of sexual assault victims and for the collection of specimens and the preservation of the chain of evidence including: (I) Preassembled sexual assault examination kits; (II) Consent, chain of evidence, and sexual assault examination forms; and (III) Long-wave ultraviolet lamp; (B) Post-anesthesia recovery unit. The post-anesthesia recovery unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Pulse oximetry; (iii) End-tidal CO2 determination; and (iv) Thermal control equipment for patients and infusion of blood, blood products, and other fluids. (C) Intensive care unit. The intensive care unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Cardiopulmonary resuscitation cart; (iii) Electrocardiograph-oscilloscope-defibrillator-pacer; (iv) Sterile surgical sets for: OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 189 September 13, 2019 (I) Airway control/cricothyrotomy; (II) Thoracotomy; (III) Vascular access; and (IV) Chest decompression. (4) Agreements and policies on transfers. (A) The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. Written policies and procedures shall include where and how neonates shall be cared for until transfer to an appropriate facility can be completed. (B) The facility shall have a written agreement with a hospital, or obstetrician-gynecologist, or group of obstetrician- gynecologists to provide immediate consultative services for obstetric and gynecologic patients twenty-four (24) hours a day. Such services shall include the immediate interpretation of obstetric and neonatal risk factors and providing instructions for the initiation of appropriate therapy and/or patient transfer. (c) Level II. A Level II facility shall provide emergency medical services with organized emergency and obstetrics-gynecology and departments. A physician and nursing staff with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. The facility shall have a dedicated obstetrics unit as well as a newborn nursery and shall have the capability to provide immediate delivery by emergency cesarean section. Laparoscopy and laparotomy procedures shall be immediately available when required for obstetric and gynecologic emergencies. A hospital shall be classified at Level II for emergency obstetric and gynecologic services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent obstetric or gynecologic patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (ii) For a hospital licensed as a critical access hospital, emergency services shall also comply with OAC 310:667-39-14. (B) Obstetrics and gynecology. The facility shall have an organized obstetrics-gynecology service with appropriately credentialed physicians experienced in obstetric and gynecologic procedures on call and immediately available twenty-four (24) hours a day. Physician members of the obstetric-gynecology service shall be board certified, board eligible, or residency trained in obstetrics and gynecology. On call physicians shall respond as required by the hospital's policy. (C) Obstetrics unit. The hospital shall have a dedicated obstetrics unit available twenty-four (24) hours a day. Labor, delivery, and recovery areas shall be appropriately equipped to OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 190 September 13, 2019 manage high-risk pregnancies and deliveries including equipment and medications necessary for maternal and neonatal resuscitation procedures. Labor, delivery, and recovery areas shall be staffed with nursing personnel with special capability in obstetric and neonatal care. (D) Newborn nursery. The hospital shall have a dedicated newborn nursery appropriately equipped and staffed with nursing personnel with special capability in neonatal care. (E) Pediatrics. A physician board certified, board eligible, or residency trained in pediatrics and deemed competent in the care of pediatric emergencies shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four hours a day. (F) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (G) Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (H) Operating suite. An operating suite with adequate staff and equipment shall be immediately available twenty-four (24) hours a day. The hospital shall define and document in writing the minimum staffing requirements for the operating suite. An on call schedule for emergency replacement staff shall be maintained. (I) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. (J) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. (K) Diagnostic imaging. The hospital shall have diagnostic x- ray, computerized tomography, and ultrasonography services available twenty-four (24) hours a day. A radiologic technologist, computerized tomography technologist, and staff designated as qualified to perform ultrasonography shall be on duty or on call and immediately available twenty-four (24) hours a day. A single technologist designated as qualified in both diagnostic x-ray and computerized tomography procedures by the radiologist may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. The diagnostic imaging service shall provide at least the following services: (i) Ultrasonography; OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 191 September 13, 2019 (I) Transabdominal; and (II) Endovaginal. (ii) Computed tomography; (iii) Magnetic resonance imaging; (iv) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. A radiology technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. (v) For a hospital licensed as a critical access hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (L) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products, including Rho (D) immune globulin shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing including urine and serum assays for the beta subunit of human chorionic gonadotropin (β-hCG); (iii) Tests for fetal lung maturity; (iv) Serum hormone tests including: (I) Progesterone; (II) Follicle stimulating hormone; (III) Leutinizing hormone; and (IV) Prolactin. (v) Coagulation studies including: (I) Prothrombin time (PT) and activated partial thromboplastin time (aPTT); (II) Plasminogen; (III) Factor assays; (IV) Fibrinogen; and (V) Assay for fibrin degradation products or an equivalent test; (vi) Blood gas/pH; (vii) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (viii) Drug and alcohol screening. (ix) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 192 September 13, 2019 (x) For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (M) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators shall be available twenty-four (24) hours a day. Respiratory therapy services shall comply with OAC 310:667-23-6. (N) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel. (A) Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (B) Obstetrics-gynecology services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in obstetrics and gynecology and credentialed to provide obstetric and gynecologic care as obstetric-gynecology services director. (C) Pediatric services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in pediatrics and credentialed to provide care as pediatric services director. (D) Newborn nursery services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in pediatrics and credentialed to provide pediatric care as the newborn nursery services director. The pediatric services director may also serve as the newborn nursery services director. (E) Physician qualifications. Physician members of the obstetrics-gynecology service shall be board certified, board eligible, or residency trained in obstetrics and gynecology. (F) Training. Emergency room, obstetrics unit, and newborn nursery nursing personnel shall have completed the Pediatric Advanced Life Support Program (PALS) offered through the American Heart Association or have equivalent training. (3) Supplies and equipment. (A) Emergency department. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies for use in the management of emergent obstetric, gynecologic, and neonatal patients on site, functional, and available in the emergency department, including at least the following: (i) Obstetrics pack; (ii) Nitrazine (pH) paper for detecting amniotic fluid when membranes are ruptured; (iii) Equipment to monitor fetal heart rate and pattern electronically; (iv) Ophthalmic antiseptics for neonates; (v) Pulse oximetry with adult and pediatric probes; (vi) Drugs necessary for care of the emergent obstetric or gynecologic patient including: (I) Oxytocic agents; (II) Tocolytic agents; OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 193 September 13, 2019 (III) Prostaglandins; (IV) Ergotic agents; (V) Antihypertensives; and (VI) Magnesium sulfate. (vii) Drugs necessary for care of the depressed neonatal patient including: (I) Epinephrine; (II) Volume expanders (III) Sodium bicarbonate; (IV) Dextrose solutions; and (V) Naloxone hydrochloride. (viii) Radiant warmer; (ix) Sterile procedure trays for episiotomy; and (x) Supplies, equipment, and written protocols for the examination of sexual assault victims and for the collection of specimens and the preservation of the chain of evidence including: (I) Preassembled sexual assault examination kits; (II) Consent, chain of evidence, and sexual assault examination forms; and (II) Long-wave ultraviolet lamp; (B) Obstetrics unit. The obstetrics unit shall have the following supplies and equipment on site, functional, and available for use: (i) Cardiopulmonary resuscitation cart; (ii) Electrocardiograph-oscilloscope-defibrillator-pacer; (iii) Equipment for continuous electronic fetal monitoring; (iv) Equipment for external tocography (v) An open, stable area under a radiant warmer with available oxygen and suction and the following equipment for use in neonatal resuscitation: (I) Bulb syringe; (II) Assorted suction catheters; (III) Neonatal oral airways of various sizes; (IV) Neonatal endotracheal tubes of various sizes and stylets; (V) Neonatal ventilation masks and bag-mask resuscitator; (VI) Neonatal laryngoscope with #0 and #1 blades; and (VII) Neonatal orogastric tube. (vi) Drugs necessary for care of the depressed neonatal patient including: (I) Epinephrine; (II) Volume expanders (III) Sodium bicarbonate; (IV) Dextrose solutions; and (V) Naloxone hydrochloride. (C) Operating suite. The operating suite shall have the following supplies and equipment on site, functional and available for use: (i) Thermal control equipment for patients and infusion of blood, blood products, and other fluids; (ii) X-ray capability including c-arm intensifier; and (iii) Endoscopes. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 194 September 13, 2019 (D) Post-anesthesia recovery unit. The post-anesthesia recovery unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Pulse oximetry; (iii) End-tidal CO2 determination; and (iv) Thermal control equipment for patients and infusion of blood, blood products, and other fluids. (E) Intensive care unit. The intensive care unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Cardiopulmonary resuscitation cart; (iii) Electrocardiograph-oscilloscope-defibrillator-pacer; (iv) Sterile surgical sets for: (I) Airway control/cricothyrotomy; (II) Thoracotomy; (III) Vascular access; and (IV) Chest decompression. (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (d) Level I. A Level I facility shall provide emergency medical services with organized emergency, obstetrics-gynecology and neonatology departments. A physician and nursing staff with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. The facility shall have a dedicated obstetrics unit as well as a newborn nursery and neonatal intensive care unit. The hospital shall have the capability to provide immediate delivery by emergency cesarean section. Laparoscopy and laparotomy procedures shall be immediately available when required for obstetric and gynecologic emergencies. A hospital shall be classified at Level I for emergency obstetric and gynecologic services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent obstetric or gynecologic patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in obstetric and gynecologic care shall be on site twenty-four (24) hours a day. For hospitals licensed as general medical surgical hospitals or specialty hospitals, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (B) Obstetrics and gynecology. The facility shall have an organized obstetrics-gynecology service with appropriately credentialed physicians experienced in obstetric and gynecologic procedures on call and immediately available twenty-four (24) hours a day. Physician members of the obstetric-gynecology service shall be board certified, board eligible, or residency trained in obstetrics and gynecology. On call physicians shall OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 195 September 13, 2019 respond as required by the hospital's policy. (C) Neonatology. The facility shall have an organized neonatology service with appropriately credentialed physicians experienced in the care of the seriously ill neonatal patient on call and immediately available twenty-four (24) hours a day. Physician members of the neonatology service shall be board certified, board eligible, or residency trained in neonatology. On call physicians shall respond as required by the hospital's policy. (D) Obstetrics unit. The hospital shall have a dedicated obstetrics unit available twenty-four (24) hours a day. Labor, delivery, and recovery areas shall be appropriately equipped to manage high-risk pregnancies and deliveries including equipment and medications necessary for maternal and neonatal resuscitation procedures. Labor, delivery, and recovery areas shall be staffed with nursing personnel with special capability in obstetric and neonatal care. (E) Pediatrics. A physician board certified, board eligible, or residency trained in pediatrics and deemed competent in the care of pediatric emergencies shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four hours a day. (F) Newborn nursery. The hospital shall have a dedicated newborn nursery appropriately equipped and staffed with nursing personnel with special capability in neonatal care. (G) Neonatal intensive care unit. The hospital shall have a dedicated neonatal intensive care unit appropriately equipped and staffed with nursing personnel with special capability in neonatal care. A board certified, board eligible, or residency trained neonatologist or senior resident deemed competent and appropriately credentialed by the hospital shall be on site twenty-four (24) hours a day at all times when patients are in the unit. If a senior neonatology resident is staffing the unit, an attending neonatologist shall be on call and promptly available twenty-four (24) hours a day. (H) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (I) Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (J) Operating suite. An operating suite with adequate staff and equipment shall be immediately available twenty-four (24) hours a day. The hospital shall define and document in writing the minimum staffing requirements for the operating suite. An on call schedule for emergency replacement staff shall be maintained. (K) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 196 September 13, 2019 from post-anesthesia care. (L) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. (M) Diagnostic imaging. The hospital shall have diagnostic x- ray, computerized tomography, and ultrasonography services available twenty-four (24) hours a day. A radiologic technologist, computerized tomography technologist, and staff designated as qualified to perform ultrasonography shall be on duty or on call and immediately available twenty-four (24) hours a day. A single technologist designated as qualified in both diagnostic x-ray and computerized tomography procedures by the radiologist may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. The diagnostic imaging service shall provide at least the following services: (i) Ultrasonography; (I) Transabdominal; and (II) Endovaginal. (ii) Angiography; (iii) Computed tomography; (iv) Magnetic resonance imaging; (v) Neuroradiology; and (vi) Nuclear medicine imaging. (vii) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (N) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products, including Rho (D) immune globulin shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing including urine and serum assays for the beta subunit of human chorionic gonadotropin (β-hCG); (iii) Tests for fetal lung maturity; (iv) Serum hormone tests including: (I) Progesterone; (II) Follicle stimulating hormone; OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 197 September 13, 2019 (III) Leutinizing hormone; and (IV) Prolactin. (v) Coagulation studies including: (I) Prothrombin time (PT) and activated partial thromboplastin time (aPTT); (II) Plasminogen; (III) Factor assays; (IV) Fibrinogen; and (V) Assay for fibrin degradation products or an equivalent test; (vi) Blood gas/pH; (vii) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (viii) Drug and alcohol screening. (ix) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (O) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators shall be available twenty-four (24) hours a day. Respiratory therapy services shall comply with OAC 310:667-23-6. (P) Acute hemodialysis. The hospital shall have the capability to provide acute hemodialysis services twenty-four (24) hours a day. All staff providing hemodialysis patient care shall have documented hemodialysis training and experience. (Q) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel. (A) Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (B) Obstetrics-gynecology services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in obstetrics and gynecology and credentialed to provide obstetric and gynecologic care as obstetric-gynecology services director. (C) Pediatric services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in pediatrics and credentialed to provide care as pediatric services director, (D) Newborn nursery services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in pediatrics and credentialed to provide pediatric care as the newborn nursery services director. The pediatric services director my also serve as the newborn nursery services director. (E) Neonatology services director. The medical staff shall designate a physician board certified, board eligible, or residency trained in neonatology and credentialed to provide neonatal care as neonatology services director. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 198 September 13, 2019 (F) Physician qualifications. (i) Physician members of the obstetrics-gynecology service shall be board certified, board eligible, or residency trained in obstetrics and gynecology. (ii) Physician members of the neonatology service shall be board certified, board eligible, or residency trained in neonatology. (G) Training. Emergency room, obstetrics unit, newborn nursery, and neonatal intensive care unit nursing personnel shall have completed the Pediatric Advanced Life Support Program (PALS) and or the Neonatal Advanced Life Support Program (NALS) offered through the American Heart Association or have equivalent training. (3) Supplies and equipment. (A) Emergency department. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies for use in the management of emergent obstetric and gynecologic patients on site, functional, and available in the emergency department, including at least the following: (i) Obstetrics pack; (ii) Nitrazine (pH) paper for detecting amniotic fluid when membranes are ruptured; (iii) Equipment to monitor fetal heart rate and pattern electronically; (iv) Ophthalmic antiseptics for neonates; (v) Pulse oximetry with adult and pediatric probes; (vi) Drugs necessary for care of the emergent obstetric or gynecologic patient including: (I) Oxytocic agents; (II) Tocolytic agents; (III) Prostaglandins; (IV) Ergotic agents; (V) Antihypertensives; and (VI) Magnesium sulfate. (vii) Drugs necessary for care of the depressed neonatal patient including: (I) Epinephrine; (II) Volume expanders (III) Sodium bicarbonate; (IV) Dextrose solutions; and (V) Naloxone hydrochloride. (viii) Radiant warmer; (ix) Sterile procedure trays for episiotomy; (x) Supplies, equipment, and written protocols for the examination of sexual assault victims and for the collection of specimens and the preservation of the chain of evidence including: (I) Preassembled sexual assault examination kits; (II) Consent, chain of evidence, and sexual assault examination forms; and (III) Long-wave ultraviolet lamp; (B) Obstetrics unit. The obstetrics unit shall have the OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 199 September 13, 2019 following supplies and equipment on site, functional, and available for use: (i) Cardiopulmonary resuscitation cart; (ii) Electrocardiograph-oscilloscope-defibrillator-pacer; (iii) Equipment for continuous electronic fetal monitoring; (iv) Equipment for external tocography; (v) An open, stable area under a radiant warmer with available oxygen and suction and the following equipment for use in neonatal resuscitation: (I) Bulb syringe; (II) Assorted suction catheters; (III) Neonatal oral airways of various sizes; (IV) Neonatal endotracheal tubes of various sizes and stylets; (V) Neonatal ventilation masks and bag-mask resuscitator; (VI) Neonatal laryngoscope with #0 and #1 blades; and (VII) Neonatal orogastric tube. (vi) Drugs necessary for care of the depressed neonatal patient including: (I) Epinephrine; (II) Volume expanders (III) Sodium bicarbonate; (IV) Dextrose solutions; and (V) Naloxone hydrochloride. (B) Operating suite. The operating suite shall have the following supplies and equipment on site, functional and available for use: (i) Cardiopulmonary bypass capability; (ii) Operating microscope; (iii) Thermal control equipment for patients and infusion of blood, blood products, and other fluids; (iv) X-ray capability including c-arm intensifier; and (v) Endoscopes. (C) Post-anesthesia recovery unit. The post-anesthesia recovery unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Equipment for the continuous monitoring of intracranial pressure; (iii) Pulse oximetry; (iv) End-tidal CO2 determination; and (v) Thermal control equipment for patients and infusion of blood, blood products, and other fluids. (D) Intensive care unit. he intensive care unit shall have the following supplies and equipment on site, functional, and available for use: (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange; (ii) Cardiopulmonary resuscitation cart; (iii) Electrocardiograph-oscilloscope-defibrillator-pacer; (iv) Sterile surgical sets for: (I) Airway control/cricothyrotomy; OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 200 September 13, 2019 (II) Thoracotomy; (III) Vascular access; and (IV) Chest decompression. (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.