314.410 Board of Nursing to promulgate administrative regulations based upon
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/ky/314-410A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
recommendations of the council -- Recommendations to include regulatory
framework to support consultation and collaboration between licensed
certified professional midwives and other appropriate licensed health care
providers -- Specifications to be included in regulatory framework --
Management of clients whose conditions may preclude them from being
considered at low risk -- Board to enforce specified safety precautions before
administrative regulations are in place.
(1)Within one
(1)year of June 27, 2019, the council shall make recommendations to
the board for the promulgation of administrative regulations by the board regarding
requirements for the management of clients who may have a condition that
precludes the clients from being considered at low risk of an adverse outcome for
the mother, her fetus, or her newborn. These recommendations shall include:
(a)A regulatory framework to support consultation and collaboration between
licensed certified professional midwives and other appropriate licensed health
care providers with expertise in obstetrical and neonatal care, in order to
optimize obstetrical and neonatal outcomes in whatever setting a client
chooses for birth. The regulatory framework shall specify:
1. Processes and infrastructure to facilitate collaboration and consultation
with other licensed healthcare providers who possess the appropriate
medical expertise;
2. Processes and infrastructure to facilitate co-management with, or
transfer of primary management responsibility to, other licensed
healthcare providers who possess the appropriate medical expertise;
3. Processes and infrastructure for transfer of clients to facilities with a
higher level of care, as developed by the Transfer Guidelines Work
Group established in KRS 314.414, and as updated by the council;
4. Processes for the provision of required or routinely recommended
screening and disease prevention measures, if not provided directly by
the licensed certified professional midwife; and
5. Other collaborative processes deemed necessary by the council or the
board to optimize obstetrical and neonatal outcomes;
(b)A list of conditions or symptoms associated with a risk of death or serious
permanent harm affecting a mother, fetus, or newborn, as assessed by a
licensed certified professional midwife exercising reasonable skill and
knowledge, and:
1. Requirements for collaborative management with, or referral of primary
management responsibility to, a physician or other appropriate licensed
healthcare provider, of a client with conditions or symptoms specified
under this paragraph, to protect the health and safety of a mother, fetus
or newborn. Separate regulatory requirements shall be developed for
each or any condition on the list, if clinically appropriate; and
2. Requirements for management of a client with conditions or symptoms
specified under this paragraph who refuses to consent to
recommendations intended to prevent death or serious permanent harm,
including requirements for informed refusal by the client. The
requirements for informed refusal shall be tailored to the specific
condition or symptom, and shall reflect maximal effort to protect the life
and health of the mother, her fetus, and her newborn; and
(c)A list of conditions or symptoms associated with a more than minimal risk of
adversely affecting a mother, fetus, or newborn, but not a significant risk of
death or serious permanent harm, as assessed by a licensed certified
professional midwife exercising reasonable skill and knowledge, and:
1. Requirements for consultation, collaborative management, or referral of
primary management responsibility of a client with conditions or
symptoms specified under this paragraph, for each condition or
symptom on the list, to ensure the health and safety of a mother, fetus, or
newborn; and
2. Requirements for documentation of an informed refusal by a client with
conditions or symptoms specified under this paragraph of recommended
consultation, referral of care, or other management, including the
information to be provided to a client that is necessary to enable
informed refusal of recommended care.
(2)The council's recommendations shall be considered by the board to form the basis
for any requirements or restrictions imposed by the board on the provision of
certified professional midwifery services to a client whose condition is not
classified as low-risk. The recommendations shall be based on evolving medical
evidence published in peer-reviewed medical literature and with consideration to
the likelihood of serious harm or death to the mother or newborn.
(3)Until such time as the council has conveyed superseding recommendations to the
board and the board has promulgated superseding administrative regulations, the
following shall be enforced by the board:
(a)If on initial or subsequent assessment, one
(1)of the following conditions
exists, the licensed certified professional midwife shall arrange for
consultation and either collaboration or referral in accordance with KRS
314.400 to 314.414, and document that recommendation in the licensed
certified professional midwife's record:
1. Complete placenta previa, or partial placenta previa persisting after
twenty eight
(28)weeks;
2. HIV infection;
3. Cardiovascular disease, including hypertension;
4. Severe psychiatric illness that may result in self-harm or harm to others;
5. History of cervical incompetence;
6. Pre-eclampsia or eclampsia;
7. Intrauterine growth restriction, oligohydramnios or polyhydramnios in
the current pregnancy;
8. Known potentially serious anatomic fetal abnormalities;
9. Any type of diabetes requiring insulin or other medication for
management;
10. Gestational age greater than forty-three
(43)weeks; or
11. Any other condition or symptom which could threaten the life of the
mother or fetus, as assessed by a licensed certified professional midwife
exercising reasonable skill and knowledge;
(b)The licensed certified professional midwife may continue to participate in the
care of a client requiring transfer, in a collaborative fashion and as mutually
agreed upon with the accepting physician, to the extent permitted by hospital
regulations and if it is beneficial to the client. If a client with a condition listed
in paragraph
(a)of this subsection declines to accept a medically indicated
consultation or referral, the licensed certified professional midwife shall
document such refusal in writing and shall endeavor to transition the client to
an appropriate higher level of care. If the condition mandating transfer occurs
during labor or delivery, or the client is otherwise acutely in jeopardy but
refuses transfer, then the midwife shall call 911 and provide care at least until
relieved by another appropriate licensed health care provider; and
(c)If on initial or subsequent assessment, one
(1)of the following conditions
exists, the midwife shall arrange for consultation and either collaboration or
referral in accordance with KRS 314.400 to 314.414, and document that
recommendation in the midwifery record:
1. Prior cesarean section or other surgery resulting in a uterine scar;
2. Multifetal gestation;
3. Non-cephalic presentation after thirty-six
(36)weeks gestation; and
4. History of severe shoulder dystocia as documented by objective
findings.
(4)The board shall, at the earliest opportunity, promulgate administrative regulations
specific to the conditions listed in subsection (3)(c) of this section, including the
minimum requirements for informed refusal by the client of otherwise mandatory
consultation and either collaboration or referral.
(5)If the client has complied with administrative regulations promulgated by the board
for informed refusal, then the licensed certified professional midwife may pursuant
to subsection
(4)of this section, continue to assume primary management
responsibility for the client unless and until the client subsequently consents to
collaborative care or referral.