[rUmad2]

I work in a small rural hospital where anesthesia can become unavailable due to unexpected situations. Although rare, there have been times when a mother experiences hypotension from a labor epidural and needs ephedrine but anesthesia has become tied up elsewhere. Does anyone know if it's okay for L&D nurses to push ephedrine IV if needed in a situation like this?

Thanks much in advance!
Beth

[bagladyrn]

Generally in this situation I've had standing orders from anesthesia for parameters of bp and dose of ephedrine to be pushed, frequency, etc.

[klone]

At our hospital, there is a standing order for ephedrine in cases such as these. I imagine whether it's okay for you depends upon your BON and hospital guidelines.

[Suebee6]

We have standing orders for it for the first time, if we need a second dose the order reads to call anesthesia (although they just say to give another dose usually)..the third time they will come LOL..

[babyktchr]

anesthesia should provide you with that order.

[RNnL&D]

Funny, we just had this issue come up. We don't have a clear cut policy. Before, our anesthesia providers have always come up and dosed the pts themselves, if needed. The nurses have never pushed it.

Interesting to see what other facilities do.

[SmilingBluEyes]

IF you do not have a policy, you need one, ASAP.

Otherwise, have the CRNA/ MDA draw it up for you in a labeled syringe and write the order. BEFORE HE/SHE LEAVES THE UNIT. Make it your habit to do this everytime. After a bit of nagging and doing this, I bet you will have a policy soon enough.

[RNnL&D]

Originally Posted by SmilingBluEyes

IF you do not have a policy, you need one, ASAP.

Otherwise, have the CRNA/ MDA draw it up for you in a labeled syringe and write the order. BEFORE HE/SHE LEAVES THE UNIT. Make it your habit to do this everytime. After a bit of nagging and doing this, I bet you will have a policy soon enough.

See, that's how we do it. The come up, draw it up, dose the pt, on the unit. Which is why I assume we don't have a clear cut policy. It just says that the nurse may give a dose if anesthesia is busy with another epidural.

[rUmad2]

Thank you all for your great advice!! I think for our small unit, the policy of having anesthesia mixing/labeling it and writing the order is what will be best!
Thanks again!
Beth

[SmilingBluEyes]

Yes, that is ok. but if your policy does not state that the MDA/CRNA must do this, then who is to make them do so?

That is why a policy needs to be written.