[johj]

I work in an OB unit and have questions regarding the out/pt Cytotec use. The OB/GYN's want to start this. The procedure would be that the pt. would have been recently assessed in the office to have this done. They need to be 38 weeks, other criteria also. The nurses would do an NST and once reactive give them cytotec either PO or vaginally. They would be monitored for approx 4 hrs. They would get up and walk for a bit also. Then if they fit the discharge criteria, they can go home without being seen by a physician. We do not have residents at our facility. The physician would be called initally for the medication order though. I would like to hear your thoughts on this.

[rbytsdy]

Considering the FDA and the actual manufacturer of cytotec (Searle) recommend AGAINST it's use for labor induction, this sounds like a really bad idea to me, especially since they want the patients to leave. What would happen if a patient ruptured away from the hospital?

[Jolie]

Originally Posted by johj

I work in an OB unit and have questions regarding the out/pt Cytotec use. The OB/GYN's want to start this. The procedure would be that the pt. would have been recently assessed in the office to have this done. They need to be 38 weeks, other criteria also. The nurses would do an NST and once reactive give them cytotec either PO or vaginally. They would be monitored for approx 4 hrs. They would get up and walk for a bit also. Then if they fit the discharge criteria, they can go home without being seen by a physician. We do not have residents at our facility. The physician would be called initally for the medication order though. I would like to hear your thoughts on this.

For liability and safety reasons, I think this is a really bad idea!

In what other area of the hospital is it acceptable for a doctor to send a "recently assessed" (what ever that means) patient to the hospital to be admitted, treated and discharged without any face to face contact with a physician?

This sounds to me like the OBs are attempting to shift THEIR responsibility for evaluating the patient onto the nurses. When something goes awry (and something WILL eventually go awry) it will be the nurses' fault.

I predict that a patient will either go home and deliver precipitously, or will go into fetal distress and be too far from the hospital to be delivered safely. Then the physicians will start second guessing the nurses' cervical exams and interpretation of fetal monitor strips.

If a patient is receiving Cytotec, it is because they are to be delivered. They need to stay in the hospital until that happens, or until the physician examines them and clears them for DC.

Just my 2 cents.

[Suebee6]

Originally Posted by Jolie

For liability and safety reasons, I think this is a really bad idea!

In what other area of the hospital is it acceptable for a doctor to send a "recently assessed" (what ever that means) patient to the hospital to be admitted, treated and discharged without any face to face contact with a physician?

This sounds to me like the OBs are attempting to shift THEIR responsibility for evaluating the patient onto the nurses. When something goes awry (and something WILL eventually go awry) it will be the nurses' fault.

I predict that a patient will either go home and deliver precipitously, or will go into fetal distress and be too far from the hospital to be delivered safely. Then the physicians will start second guessing the nurses' cervical exams and interpretation of fetal monitor strips.

If a patient is receiving Cytotec, it is because they are to be delivered. They need to stay in the hospital until that happens, or until the physician examines them and clears them for DC.

Just my 2 cents.

I agree!! We don't even use cytotech for a viable pregnancy induction at the hospital where I work, so I cannot even imagine this ever happening.

[rpbear]

I also think this is a VERY bad idea. We don't use cytotec often for viable babys, we use continuous monitorring for all forms of induction, pit, cytotec, and cervidil. One tragic outcome is one too many!