Posts Tagged ‘Midwives’

AAP Issues Home Birth Guidelines

May 3rd, 2013

The American Academy of Pediatrics put out a new policy statement called “Planned Home Birth” this week.  The Policy Document summarizes the standards of care for newborn infants born at home.  It’s designed to help pediatricians provide supportive, informed advice to women considering home birth.

The AAP Report says they agree with the American College of Obstetricians and Gynecologists that hospitals and birthing centers are the safest settings for birth- but they thought it was important to put out guidance out of respect for the right of women to make a medically informed decision about their delivery.  The report says that… “the goal of providing high-quality care to all newborn infants can best be achieved through continuing efforts by all participating health care providers and institutions to develop and sustain communications and understanding on the basis of professional interaction and mutual respect throughout the health care system.”

That’s also what we’re trying to accomplish as we finish our licensing standards for Certified Professional Midwives in Arizona.  Our next Midwifery Scope of Practice Advisory Committee Meeting will be from 4 to 6 pm on Wednesday, May 15 in our Laboratory conference room at 250 N 17th  Avenue, Phoenix.  The meeting will again be broadcast live on Livestream.

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April Midwifery Scope of Practice Meeting

March 22nd, 2013

The next meeting of the Midwifery Scope of Practice Advisory Committee will be from 4:00 p.m. to 6:00 p.m. on Wednesday April 3, 2013 at the State Laboratory Conference Room located at 250 N. 17th Avenue in Phoenix.   Here’s the agenda for the meeting.  Our Rules team is still working on the set of draft rules that we’ll be discussing at the April 3 meeting.  We expect the next iteration of the straw draft rules to be posted on our rules website by close of business on March 27.

Those of you that have been following the developments of our regulatory reform effort for our licensed midwives know that we’re in a kind of transition period.  While we won’t be finished with our regulatory reform rules package for midwife licensing until the end of June…  we still need to make sure that we’re administering our current regulations as efficiently as possible.

Our midwife licensing team recently noticed that the midwife quarterly reports have been submitted using as  many as 3 different forms.  Last week our team sent out the appropriate current quarterly reporting form to be sure that we’re getting the right information under the current regulations.   I think there’s been some confusion among the folks that got the form last week.  To be clear…  the form that our team sent out last week is the current quarterly report form- not the reporting requirement that will ultimately be required under our future rules (the new reporting will be 100% electronic). 

Also, the requirement in the current form for documentation of medical backup is a current requirement.  Whether or not we continue to require that kind of documentation hasn’t been determined yet- but the draft rules that we have discussed this far don’t include that specific requirement.  We regret any confusion or concern that the updated form may have raised.

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Next Midwifery Meeting

February 7th, 2013

Our next Midwifery Scope of Practice Advisory Committee meeting will be Monday (February 11th) from 5-8 pm in the Lab conference room.  The expanded Agenda will have more time for presentations and comments.  We’ll have presentations from some of the advisory committee members, a discussion of the latest iteration of the working draft regulations and more time for the public to comment.  The meeting will be broadcast live on our Livestream site and we’ll have an opportunity for folks to follow the conversation live on Twitter with #azmidwives.

 

Find out what’s in store at the upcoming meeting:

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Evidence-Based Decision-Making: A Key Regulatory Benchmark

November 19th, 2012

The role of a surveyor can be a difficult one. Our team of licensing surveyors need to maintain neutrality as regulators and be able to apply the Arizona Administrative Code (otherwise known as “the rules”) to a wide variety of facilities within the healthcare system.  Part of our surveillance includes investigating complaints- which can be generated from an array of internal and external sources.  When the complaints come because of TV or other media coverage- it can pose unique challenges for our team.  But…  no matter where the complaint comes from, our job is to use facts and evidence to drive our investigation, decision-making, and interventions. 

There are 3 forms of evidence that we use to substantiate an allegation made in a complaint: 1) observation; 2) documentation; and 3) interviews. Two of these forms of evidence need to be present before we find that a complaint is “substantiated”.  By using these tried and true evidence-based tools we put ourselves in the best position to identify real health and safety problems without jumping to conclusions.

Focusing on facts and evidence (and not allowing one’s self to be driven by media coverage) is a good start…  but there are a few things that both surveyors and healthcare professionals can do to keep focus on providing a healthy and safe environment. Keep good records, document, sign and store up to date data, maintain consistent supervision for those that require it, follow your agency’s policies and procedures without fail, report what’s required, be proactive (not reactive), and seek out ongoing education in your field.  Don’t cut corners when it comes to care… and don’t be afraid to admit a mistake or that you do not have all the answers. 

So, if you happen to hear or see a TV story about a facility, keep in perspective that the story might focus on anecdotes and what the reporter thinks they know or even just their opinion- not necessarily what the evidence demonstrates.  In a time when information is disseminated second by second rather than day by day, let’s remember that we all share the same goal, to promote Health and Wellness for all Arizonans, which includes providing surveyors, community, clients and staff accurate and factual information.

Curious about the real scoop on how all of our licensed facilities are doing?  Check out our AZ Care Check website which has the details about our evidence-based investigations and surveys.

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Midwives file report

June 8th, 2012

As I mentioned before, one of the great things about this country is the ability to get involved in your government to make things happen.  Well, today was another important step for the midwife group as they fulfilled an important part of the process outlined in a bill that was successfully run through the legislative process this year. 

A group of midwives submitted their request and report to me that outlines the changes they want to see in our administrative rules and the science behind their reasons.  Technically the bill doesn’t take effect until August 2nd, but now that we have one report in hand, we have also posted a simple web form that folks can submit in order to be considered for the advisory committee that will make recommendations about the scope of practice.   There are some qualifications and limited number of slot to be on the committee, but if you are interested, be sure to sign up for consideration.

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Midwifery & the Democratic Process

March 28th, 2012

Here’s a short story about using the democratic process to get things done.  Some of you might remember a protest last December in front of our 150 Building.  About 100 folks or so were carrying placards in front of our building asking us to make it easier to have a home-birth in AZ. 

Many of you probably didn’t know that ADHS licenses 60 Midwives who practice in Arizona.  Our licensing rules for Midwives were last revised in the mid 1990’s and are out of date; the application is too complicated.  That day last December, Colby Bower and I met with 2 community folks, Allyson Fernstrom and Sarah Macklin, and 2 midwives including Connie Canada, during the demonstration- and we had a productive discussion.  We set up a dialog so we could come up with a solution together.  Allyson and Sarah followed through with flying colors, built an effective coalition, worked with our team (Colby and Rohno Geppert) and the state legislature- and shepherded a bill through the process that will go a long way toward solving some of the issues they were concerned about. 

The Governor signed the bill yesterday- providing us with exempt rulemaking authority to overhaul our rules for licensing AZ Midwives and setting up an advisory committee and process to review the official “Scope of Practice” for AZ Midwives.  You can check out the final bill online. We’ll also have some information up on our Midwife website shortly that will highlight where we go from here.

It just goes to show you that the democratic process works…  that ordinary folks, like Allyson and Sarah, can get together, organize, and petition their government and elected officials to get things done.  The key is working within the process, staying involved, and applying the most important skill anybody can have- working well with others (the most important grade any of us get in our academic career).  Well done all.

P.S. There was a study published in the British Medical Journal recently suggesting that there’s little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals vs. those who gave birth at home with a midwife.  Of course- the article is more complicated than that- so visit the journal website.

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Home Birth Protest

December 6th, 2011

Those of you that were working at our downtown campus last Wednesday afternoon may have seen the 100 or so folks carrying placards in front of our 150 Building.  They were asking us to make it easier to have a home-birth in AZ.  How can we do that, you ask? 

Many of you probably didn’t know that we license the 50 or so Midwives that practice in Arizona.  Our licensing rules for Midwives were last revised in the mid 1990’s, our rules are out of date, and the application is too complicated.  I met with 4 of the community folks upstairs during the demonstration- and we had a productive discussion.  Basically- they asked us to consider revising our Midwife licensing rules to simplify the application process and consider revising their scope of practice.  We talked during our meeting about the rulemaking process (both exempt and regular), gave them a realistic forecast of how quickly we could revise the rules using each approach, and set up a dialog so we could come up with a solution together. 

Coincidently- there was a study published in the British Medical Journal this week regarding the safety etc. of home births. The study basically suggests that there’s little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals vs. those who gave birth at home with a midwife.  Of course- the article is more complicated than that- so visit the journal article for more info…

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ADHS Aces FY ’10 Licensing Timeframes

August 23rd, 2010

Did you know that we issue nearly 20,000 licenses every year- on everything from hospitals to childcare centers, midwives, trauma centers and sanitarians?  We’re required to have meet certain time-frames for each license or approval the Department issues- and we issue a lot of licenses.  If we don’t process the license within the timeframe, we’re required to return any application or license fee.  We’re also required to complete a report every year that summarizes our performance.  Most of our licenses are issued by our Assurance and Licensure Division- but we issue plenty of others in our laboratory licensing program, EMS, and in environmental health.

 

We did fantastic during FY ’10- we hit the mark on 99.6% (19,275/19,467) of all of our licenses. The full report is on our Administrative Rules Homepage.  Remember- you did this in the midst of the biggest budget crisis in the state’s history and despite all of our budget reductions. Sweet job.

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State-of-the-Art Online Complaint System

March 23rd, 2010


Our Licensing & Operations Divisions went live with our new Online Complaint Form system.  It took some old fashioned elbow grease and creativity to put together this new time saving application- that will allow our licensing folks to more efficiently take and track complaints- and to more efficiently get back with folks that file them.  It will save considerable staff “phone time”- as folks that want to make complaints can directly enter their information into our database- and we can electronically get back with them with our findings.  Links to forms for each area in licensing are located at: http://www.azdhs.gov/als/index.htm.

Our next automation task for Licensure is to complete our work with electronic applications including renewal applications, which will save time with data entry, but also administrative time spent tracking down information that’s needed on the application but that’s forgotten when people use paper applications.

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