Definition of Level II Nursery? - page 2

1. 
   May 2, '07

   Joined: May '07; Posts: 4

   LEVEL IV: Admission Criteria Neonatal Intensive Care
   Stage 1:
   
   The following clinical elements/interventions must be documented in the medical record:
   

   • Invasive CPM (Cardiopulmonary Monitoring) and/or
   • Ventilatory support and/or
   • ECMO (Extracorporeal Membrane Oxygenation) AND
   • NPO/Intravenous fluid
   • Isolette
   • Apnea/Bradycardia

   
   LEVEL IV Stage 2:
   The following clinical elements/interventions must be documented in the medical record:
   

   • Invasive CPM (Cardiopulmonary Monitoring) and/or
   • Non-invasive CPM
   • Weaning from Ventilatory support
   • ECMO (Extracorporeal Membrane Deoxygenation monitoring) has been discontinued
   • NPO/Intravenous fluid
   • Receiving Total Parenteral Nutrition (TPN)
   • Isolette
   • Apnea/Bradycardia

   
   Discharge Criteria Stage 1, Stage 2
   
   

   • Patient no longer has documentation of unstable oxygenation requiring ECMO, ventilatory support or invasive monitoring
   • Patient does not require constant one on one nursing with continued cardiopulmonary and other intensive care support for severely ill infants.

   
   Level III
   Admission Criteria Neonatal Intermediate Level of Care
   Stage 3:
   

   • Non-invasive CPM
   • Continuous Positive Airway Pressure (CPAP) and/or
   • Oxygen Nasal Cannula
   • NPO/Intravenous fluid and/or receiving Total Parenteral Nutrition (TPN)
   • Isolette
   • Apnea/Bradycardia

   
   Level III
   Stage 4:
   

   • Non-invasive CPM
   • Wean CPAP and/or
   • Oxygen Nasal Cannula
   • Wean Total Parenteral Nutrition
   • NG (Nasogastric)/NJ Tube
   • Isolette
   • Apnea/Bradycardia

   
   Level III
   Discharge Criteria Stage 3, Stage 4
   
   

   • Patient does not meet the above criteria for Stage 3 or Stage 4 however continues to receive: intravenous total parenteral nutrition (TPN).
   • These neonates do not require intensive care but require 6-12 hours of intermediate level of nursing care each day.

   
   Level II
   Admission Criteria Neonatal Continuing Care Level
   Stage 5
   

   • Non-invasive CPM
   • Wean CPAP and or
   • Oxygen Nasal Cannula
   • NG/NJ tube feedings and/or
   • PO (oral) intake
   • Wean from Isolette to open crib
   • Apnea/Bradycardia

   
   Level II
   Stage 6
   

   • Non-invasive CPM
   • HO (Hood Oxygen) or Nasal Cannula Oxygen
   • Wean NG/NJ or
   • PO (oral) intake
   • Wean from Isolette to open crib
   • Apnea/Bradycardia

   
   Level II
   Stage 7 : Discharge to home anticipated
   

   • Non-invasive CPM
   • HO (Hood Oxygen) or Nasal Cannula Oxygen
   • Wean NG/NJ
   • PO (oral intake)
   • Wean from Isolette to open crib
   • Apnea/Bradycardia

   
   Level II
   Stage 8 Revenue Code 172:
   

   • Non-invasive CPM
   • HO (Hood Oxygen) or Nasal Cannula Oxygen
   • PO (oral intake)
   • Open Crib
   • Apnea/Bradycardia

   
   Level II
   Discharge Criteria Stage 5, Stage 6, Stage 7, Stage 8:
   

   • Patient does not meet criteria for Stage 5 through Stage 8 but continues on enteral or PO (oral) feedings
   • Stable body temperature in an open crib
   • Tolerating oral feedings or if long term plan is tube feedings (NG or NJ), feedings are tolerated and the family has been thoroughly trained.
   • No apneas or bradycardias for 5 days or discharge with an apnea monitor as long term plan.
   • Demonstrating a weight gain trend.

   
   
   
   References:
   

   1. American Academy of Pediatrics Committee on Fetus and Newborn, Standards and Recommendations for Hospital Care of Newborn Infants, 2974-2977, 6th ed. Evanston, Ill.
   2. Milliman Care Guidelines, Inpatient and Surgical Care, 9th edition.
2. 
   May 2, '07

   Joined: May '07; Posts: 4

   Oh... And Level I
   
   This is your normal nursery after birth. Baby can sleep in mother's room and visitors must be mom or dad. Basically the diaper change, blood draw, feeding area, I think of this a post birt observation only. No real medical needs in a Level I.
3. 
   May 4, '07

   Occupation: Nurse of course! Specialty: NICU, PICU, educator ; From: US ; Joined: Feb '04; Posts: 1,838; Likes: 1,115

   Level III
   Admission Criteria Neonatal Intermediate Level of Care
   Stage 3:
   

   • Non-invasive CPM
   • Continuous Positive Airway Pressure (CPAP) and/or
   • Oxygen Nasal Cannula
   • NPO/Intravenous fluid and/or receiving Total Parenteral Nutrition (TPN)
   • Isolette
   • Apnea/Bradycardic

   I have to disagree with this...we are a designated level III and we take everything but ECMO, we do all surgeries except cardiac, and use nitric. I think each state may also differ in what the units take. I know that many level II here do not have a neonate doc in house or a fellow for the night.

   Last edit by BittyBabyGrower on May 4, '07
4. 
   May 4, '07

   Joined: May '07; Posts: 4

   I have to disagree with this...we are a designated level III and we take everything but ECMO, we do all surgeries except cardiac, and use nitric. I think each state may also differ in what the units take. I know that many level II here do not have a neonate doc in house or a fellow for the night.
   
   Level III
   Admission Criteria Neonatal Intermediate Level of Care
   Stage 3:
   
   There is no real certification for a level IV that I am aware of so some Level 3 certified NICUs are actually providing level IV care(Revenue Code 174). Level IV is basically intensive care. Level three (Revenue Code 173) is intermediate care that involves 6-12 hours of nursing per day.
   
   When I first began researching the differances I assumed that Level 3 care (Intermediate and non-intensive care) was intensive care. In fact it is not. Your facility most likely provides Level four care. One way to verify that is to ask your billing department if they send out claims with revenue code 174 on them for the cases you are describing.
5. 
   May 4, '07

   Joined: May '07; Posts: 4

   Bet you didn't know you can now put Level IV NICU experiance on you Resume
6. 
   May 4, '07

   Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,420; Likes: 3,761

   I work in a Level 2 now (after retiring from a Level 3 stage i-don't-know). I typically get 2 or 3 pts. Three is the MAX! It's only 10 beds, and 2 beds are "transition" beds. Newborns come in, get admission assessments (weighed, measured, physical assessment), get bathed, eyes and thighs, etc....
   
   We do get sick babies, and need to be able to stabilize, including intubation, ventilation and umbi lines, until the Neo and/or transport team gets there. One nurse on each shift is "ALS", has rec'd extra training to be able to do that stuff. They go to deliveries where problems are suspected, along w/an RT.
   
   After the baby has gone to the Level 3, and is convalescing, they can come back to us for care til they're ready to go home.
   
   I gotta say, @ my stage of life and nursing career, I absolutely LOVE Level 2.
7. 
   Apr 16, '10

   Joined: Apr '10; Posts: 1

   Do you need a NICU department to have a Level II Nursery? Can a hospital just have a Leve II Nursery department?
8. 
   Apr 19, '10

   Occupation: RN II Specialty: 24 year(s) of experience in ICN ; From: US ; Joined: Dec '08; Posts: 146; Likes: 33

   I always wondered if there was a level IV nursery--if so, I think that is what mine would be called. We have the smallest mircopreemies and everything up to big, sick newborns. Five types of ventilators (HFOV, jet, ECMO, CPAP, high flow nasal cannula and conventional vents), we do all kinds of surgeries including cardiac--but not transplants, we care for all the genetic anomalies for most of the state, and every baby the other hospitals can't or won't care for.
   
   We do keep the babies until they go home (sometimes for over a year) and mix sick and 'stable' feeders together. By state law, we can only have one to one or two to one assignments.
   
   I've never worked in a level II nursery, so I don't know how that would be different.

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