FY21 and FY22 UK Infant Intensive Care

A. Operate as a Regional Perinatal Center (RPC) 1. Ensure 24-hour availability of telephone consultation and referral services by obstetric and newborn sub-specialists for hospitals and obstetric, neonatal and pediatric physicians and nurses within the region. 2. Provide 24 hour per day, 7 days per week availability for referring physicians/facilities requesting consultation regarding transport of a neonatal patient and transport services when appropriate. 3. Evaluate innovative or new technologies as appropriate, using specific protocols and appropriate supervision. 4. Provide a system to ensure follow up for Newborn Hearing Screening, Newborn Metabolic Screening, Retinopathy of prematurity (ROP) screening, and the Kentucky Birth Surveillance Registry (KBSR). 5. Provide for specialty referral of infants and mothers who require special services after discharge. 6. Coordinate the handoff of care to the local medical home, including transfer of records including diagnosis, medications, screenings done, referrals made, and follow-up needs. 7. Maintain availability for coordination of services and information with community hospitals, physicians, and medical home. 8. Ensure infants and their families are provided appropriate case management, which may include discharge planning, age-appropriate screenings, continuity of care, follow-up arrangements, specialty referral, and appropriate referral to and coordination with First Steps, Health Access 9. Nurturing Development Services (HANDS) program and other community services. 10. Establish a quality improvement program for their center and assist other perinatal services in their area in participating in local, regional, and statewide efforts to improve perinatal care. B. Conduct Neonatal Follow Up 1. Provide multi-disciplinary neurodevelopmental assessments at center-based and community outreach clinics for Neonatal Intensive Care Unit (NICU) infants and graduates. 2. Identify and track NICU infants referred and those needing further services for newborn metabolic screens, newborn hearing screens, ROP screens and specialty referrals; interpret findings to patient families and initiate specialty referrals and provide other appropriate consults when necessary for patients. 3. Provide developmental and intensive evaluations for children in the First Steps program who are of appropriate age for evaluation but were not patients of the NICU. 4. Develop a tracking system and procedures to decrease the number of infants that do not receive follow-up care. This will ensure NICU graduates have access to expert developmental follow-up services and provide data on outcomes from NICU graduates with high-risk courses that shall be used for evaluating care. 5. Maintain data to monitor and track outcomes of NICU graduates; provide at least annually a report to DPH in a format determined by the Division of Maternal and Child Health. C. Provide Perinatal Outreach, Education and Training for Providers 1. Provide education & training for hospitals, medical, and community based providers on standards of care, new therapies, stabilization and transport of acutely ill children, and issues related to continuity of care after discharge. These providers may include physicians, nurses, physician assistants, nurse practitioners, respiratory therapists, other professionals, and providers of services to children in their region. Whenever possible, these trainings shall be approved for continuing education units for the providers attending. 2. Conduct evaluations of trainings to identify topics, location and type of educational sessions needed; address educational needs including, at a minimum, updates of neonatal resuscitation and stabilization programs, and other topics as identified. 3. Identify educational needs from monitoring patient referrals by type and geographic areas, as well as by requests from facilities and providers. 4. Utilize state of the art technology as appropriate, for communication and education of community based health care providers, e.g. video conferencing. 5. Document policies and procedures to facilitate transport systems and provide outreach education in their area. D. Address Quality Improvement 1. Establish and maintain an internal quality improvement program in the NICU. 2. Review mortality, morbidities, and outcomes of NICU graduates used to design quality improvement initiatives within the NICU. 3. Evaluate new therapies by monitoring morbidity and mortality and long-term follow-up of NICU patients. 4. Analyze and evaluate regional data, including data on perinatal complications and outcomes and make recommendations to the Department for Public Health on opportunities for improvement. 5. Assist other perinatal services in the area by participating in local, regional, and statewide efforts to improve perinatal care. 6. Evaluate needs and gaps in transport services in the regional area and monitor for unfavorable or unintended events. 7. Participate as requested in State quality initiatives such as Fetal-Infant Mortality Review: Maternal Mortality Review; Newborn Metabolic Screening, Universal Newborn Hearing screening; Kentucky Birth Surveillance Registry; perform medical record abstraction and data collection as appropriate to support such initiatives. 8. Maintain a database on all NICU admissions and a database on Neonatal Follow-up clinic patients. E. Participate in a Perinatal Quality Collaborative: 1. Provide a leadership role in the establishment and ongoing maintenance of the Perinatal Quality 1. Collaborative. 2. In collaboration with the University of Louisville Division Of Neonatology, UK will plan communications, meetings, projects, data collections, and reporting for a Kentucky Perinatal Quality Collaborative. 3. Serve as Kentucky State Group Coordinator for the Vermont Oxford Network, including providing information and forms to new neonatal intensive care units and paying the annual fee to Vermont Oxford for the group report when it is required. Participate in the Vermont Oxford Network (VON), including the Kentucky State VON Network. F. Address Neonatal Abstinence Syndrome (NAS) as set forth below: In accordance with KRS 211.676, all cases of NAS diagnosed among Kentucky resident births shall be reported to the Kentucky Department for Public Health (DPH) by the facility where NAS is diagnosed. The report shall be made at the time of NAS diagnosis pursuant to guidance issued by DPH. The facility where NAS is diagnosed is designated in the statute to complete and submit the NAS Reportable Disease Form. UK will have a designated contact person to ensure the NAS screening is completed in the NlCU and at each Well Child visit. UKRF shall continue to implement the Neonatal Abstinence Syndrome (NAS) protocol for follow-up of all infants under one (1) year of age experienced NAS. 1. Documentation at each visit must include, in addition to standard elements of the history and physical exam, the status of the caregiver, any child protective service involvement or placement, and the substance abuse treatment status of the mother. The protocol will also include visit frequency and recommended measurement tools to be used at each neonatal intensive care unit (NICU) follow up visit. Both Universities shall agree on measurement tools that reflect: infant behavior, the home environment, attachment of the mother-infant dyad, parenting scales, maternal mental health (including perinatal depression), maternal substance abuse status, referrals, and patient satisfaction. 2. The protocol will incorporate the Plan of Safe Care and case management. Documentation at each visit must include, in addition to standard elements of the history and physical exam, the status of the caregiver, any child protective service involvement or placement, and the substance abuse treatment status of the mother. At each visit, the wellness assessment will be completed and safe sleep materials will be reviewed and provided to the parents/ caregiver through the first year of life. The wellness assessment shall include screening for maternal depression, domestic violence and socioeconomic risks. G. A multidisciplinary follow up program for high-risk infants shall be able to provide: 1. Medical/neurologic evaluation (Medical Doctor or Nurse Practitioner) 2. Nutritional assessment (Dietician as needed) 3. Early motor/sensory assessment and parent education (Physical Therapist and/or Occupational 1. Therapist) 4. Feeding evaluation and parent education as needed (speech/feeding specialist or program) 5. Developmental testing when appropriate with Bayley Scales of Infant 6. Development (at least through two years corrected age, preferable three years if resources available) 7. Social work assessment (mandatory for NAS infants, preferable for other families at risk for psychosocial problems)