Home Health Agencies. Ante & Postpartum Members

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1 FIRST PRIORITY HEALTH /FIRST PRIORITY LIFE INSURANCE COMPANY BLUE CROSS OF NORTHEASTERN PENNSYLVANIA CREDENTIALING CRITERIA FOR OBSTETRIC NURSES IN HOME CARE ADMINISTRATIVE PRACTICE GUIDELINE PROVIDER TYPE: SCOPE: TARGET POPULATION: Home Health Agencies The credential requirement for nurses performing home obstetric skilled nursing visits Ante & Postpartum Members OUTCOME/PROCESS INDICATOR(S): Compliance with the guideline. GUIDELINE: One hundred percent (100%) of obstetric and postpartum skilled nursing visits will be performed by licensed registered nurses meeting the credentialing requirements: Certification in obstetric and/or neonatal nursing specialty through a nationally recognized and approved body such as: The American Nurses Credentialing Center or National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing Specialties. -OR- Documentation of 2000 hours of direct patient care experience in obstetrics and/or neonatal nursing, within the last two (2) years. -AND- Documentation of successful completion of structured education with verification of clinical skills. (See Attachment I and II.) TOOL(S): N/A REFERENCES: American Nurses Credentialing Center Didactic Content and Clinical Skills Verification for Professional Nurse Providers of Perinatal Home Care. AWHONN: Association of Women s Health, Obstetric, and Neonatal Nurses, National Certification Corporationwww.nccwebsite.org

2 APPROVAL: Approved: Medical Director 04/16/97 Audit Committee 06/03/97 Medical Director/OB Consultant 09/27/99 Audit Committee 05/04/01 Credentialing Committee (Format Changes) 09/17/02 Audit Committee 03/07/03 Credentialing Committee 03/18/03 Credentialing Committee 03/15/05 Credentialing Committee (Format changes) 03/20/07 Credentialing Committee 01/15/08 Credentialing Committee (Review w/o changes) 03/16/10 Credentialing Committee 03/20/12

3 Attachment 1 CLINICAL LEARNING SKILLS VERIFICATION FOR LOW-RISK ANTEPARTUM HOMECARE NURSING Components comprising evaluation of learning and verification of clinical skills in the area of low-risk antepartum homecare nursing include the following: Evaluation of maternal status: Reviewing history to differentiate among low-risk, at-risk, and high-risk pregnancies. Performing maternal assessment: Vital signs to include blood pressure Weight gain Presence of edema Vaginal discharge Uterine activity Cervical status as indicated Spontaneous Rupture of Membranes (SROM ) when indicated Applying knowledge of laboratory tests to: Recognize and distinguish between normal and abnormal values Demonstrate appropriate collection and transport procedures Explain purpose, procedure, and results to client Evaluation of fetal status by: Assessing fetal heart rate using fetoscope, ultrasonic stethoscope, or electronic fetal monitor. Assessment: Assessing fetal position using Leopold s maneuvers Assessing fetal activity based on maternal report. Assessing fetal growth based on fundal height Education of self-care activities Adequate diet, fluid intake and activity during pregnancy Medications: Ability to self-administer Direct effects and side effects on pregnancy Remedies for minor discomforts of pregnancy Counseling client and partner in regard to desired birthing plan. Evaluating client s understanding of: Warning signs of common pregnancy complications

4 Signs of preterm labor Normal fetal activity and development Kick counts Normal fetal growth pattern Normal labor and delivery process Postpartum changes and involution Parenting and infant care Evaluation of family support by: Identifying support person(s). Assessing family interaction, dynamics, and support system. Attachment 2

5 CLINICAL LEARNING SKILLS VERIFICATION FOR POSTPARTUM HOMECARE NURSING Components comprising evaluation of learning and verification of clinical skills for postpartum homecare nursing include the following: Evaluation of maternal adaptation by: Reviewing antepartal, intrapartal, and immediate postpartal histories that take into account perinatal events Demonstrating postpartum maternal assessment of: Physical adjustment to postpartum Vital signs with blood pressure Breast changes, milk production, and milk suppression Uterine involution Perineal healing Return to normal bowel and urinary elimination Incisional healing, where appropriate Signs of post delivery complications Lochia Homan s sign Psychosocial adjustment to early motherhood Self-confidence Postpartum blues and/or depression Specific concerns Maternal Infant Bonding Evaluation of the neonate by: Reviewing perinatal history and neonatal assessment of: Vital signs Weight Color Skin Head Cord stump Circumcision where appropriate Feeding patterns Elimination Identifying problems that require intervention or referral per protocol: Respiratory difficulties Hyperbilirubinemia Effects of birth trauma Feeding difficulties Elimination difficulties Signs of infection Applying knowledge of laboratory tests Demonstrating appropriate collection and transport procedures

6 Explaining purpose, procedure, and significance of results to family Performing responsibilities related to technologies used in the home setting for neonate Transporting, setting up, and operation per protocol Explaining operation of and troubleshooting to family Evaluation of family adaptation Observing for positive family adjustments and role changes Observing dynamics of influential extended family members Client education Health promotion activities in the postpartum Rest and exercise Nutrition and adequate fluid intake Medications Remedies for pain Postpartum blues/depression Instructing in regard to newborn care Demonstrating aspects of infant care to mother and family Assessing mother s and family s abilities to perform skills Reinforcing importance of postpartum follow-up appointments for both mother and infant Counseling in regard to plans for contraception and family planning

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