Standing orders for newborn care in a hospital

* § 2803-v. Standing orders for newborn care in a hospital. 1. A
hospital may establish standing orders for the care of newborns in the
hospital until the discharge of the newborn from the hospital following
the birth, which may authorize an attending nurse to provide services
and care to healthy newborns.

2. As used in this section, unless the context clearly requires
otherwise:

(a) "Hospital" means a hospital that routinely provides perinatal care
to newborns.

(b) "Attending practitioner" means the physician, nurse practitioner,
physician assistant or midwife, acting within his or her lawful scope
and terms of practice, attending the birth or postnatal care of a
newborn in a hospital.

(c) "Attending nurse" means a registered nurse attending the postnatal
care of a newborn, acting within his or her lawful scope of practice.

(d) "Standing order" means a non-patient specific order for the care
of healthy newborns in the hospital, established under this section.

3. A standing order may be implemented in the case of any newborn when
(a) directed by the attending practitioner, or (b) in the absence of a
specific direction by the attending practitioner, the attending nurse
determines, in his or her professional judgment, that implementing the
standing order for the newborn is clinically appropriate and consistent
with the standing order, the hospital's policies and applicable
regulations. The standing order shall not be implemented in a specific
situation where the hospital's policies, the standing order, or
applicable regulations provide otherwise.

4. (a) A standing order shall provide for the circumstances in which
the condition or change in condition of the newborn or the newborn's
mother, or other circumstances relating to providing services and care
to the newborn, require departure from the terms of the standing order.

(b) Where an attending nurse implementing a standing order becomes
aware of circumstances that, in his or her professional judgment,
reasonably indicate a need to depart from the terms of the standing
order, he or she shall so advise the attending practitioner. In such
circumstances, if the attending nurse determines, in his or her
professional judgment, that the health of the newborn requires departing
from the standing order prior to receiving direction from the attending
practitioner, the attending nurse may do so, consistent with his or her
lawful scope of practice, the hospital's policies and applicable
regulations.

(c) The standing order shall provide, including the times and manner,
that an attending practitioner shall review and acknowledge in writing
the services and care provided to the newborn under the standing order
and the condition of the newborn.

5. (a) A standing order may provide for circumstances in which it
shall not be implemented, or implemented only at the order of an
attending practitioner, which may include but not be limited to:

(i) lack of or inadequate prenatal care;

(ii) a birth not attended by an attending practitioner;

(iii) a birth not occurring in a hospital; or

(iv) a premature or low birth weight birth.

(b) A standing order shall be dated, timed, and authenticated promptly
in the patient's medical record by the attending practitioner acting in
accordance with law, including scope-of-practice laws, hospital
policies, and medical staff bylaws, rules and regulations.

6. A standing order may be implemented only if the implementing
hospital:

(a) establishes that the order has been reviewed and approved by the
hospital's medical staff and nursing and pharmacy leadership, and signed
by a physician affiliated with the hospital or, in the case of a
midwifery birth center, by a midwife affiliated with the hospital;

(b) demonstrates that the order is consistent with nationally
recognized evidence-based guidelines; and

(c) ensures that the periodic and regular review of the order is
conducted by the hospital's medical staff and nursing and pharmacy
leadership to determine the continuing usefulness and safety of the
order.

7. A standing order is a medical regimen; it shall be consistent with
the lawful scope of practice of a registered nurse.

8. The commissioner may make regulations governing the terms,
procedures and implementation of standing orders.

* NB There are 2 § 2803-v's