awhonn guidelines

  1. It came across email today that awhonn is now saying that its safe practice for 5 m/b couplets. I am trying to find that information. Specifically as well what it says regarding pts on mag, antepartums, etc in relation to the 5 couplet recommendation. We are likely going to 5 couplets on an as-needed basis (budget issues being the cited reason). I need to be sure I am performing safe practice. I love my floor and my coworkers but politics are getting weird.
    Why does budget have to affect patient ratios? Isn't it more expensive for a pt. to win a free trip to ICU from a complication, rather than have extra nurses on hand? I am sick to my stomach thinking about this change at work...our c-sects need hourly checks X12h, and mag patients are traditionaly just seen as one couplet out of four. Now they will be one out of five!
    Anyway, looking for info about awhonn's guidelines. I looked on the site but couldn't find it. thanks.
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  2. 20 Comments

  3. by   SmilingBluEyes
    WOW could you please share that email with me? This is the first I have heard of this.
  4. by   tntblonde
    I have not seen any info from awhonn regarding numbers of couplets, I find it unusual that your email made that statement as awhonn doesnt usually attach numbers like that to their guidelines it seems to me that five couplets and a large assignment and not much teaching or quality care could be given... I however am somewhat spoiled. Our hospital uses 3 couplets as a full assignment on the day shift,4 at night and mag patients are a one on one..!
  5. by   MIA-RN1
    oh I am sorry for not making myself clearer--I just reread my post.
    I didn't get the email from AWHONN, it came from management where I work, and said that AWHONN feels one nurse to five couplets is safe and that is what we will be doing. It was part of an email about how over-budget we are with our nurse's salaries etc. I am sorry for not making myself clear. I just want to find those guidelines that management referred to.
  6. by   MemphisOBRNC
    You may want to ask management for a copy. I have never heard this, either. We do vital on CS as follows: once out of recovery, q 30 x 2, q hour x 2 and q 4 for the remainder of 24 hours.
  7. by   mitchsmom
    this may be helpful to you for staff ratio info - (i would also want to see where your management got their info):

    there is a chart from awhonn's perinatal nursing: co-published with awhonn: books: kathleen rice simpson,patricia a creehan


    i have a photocopy of the chart, from p.42, it is labeled "recommended nurse to pt ratios according to the guidelines for perinatal care (aap & acog 1997) and the standards and guidelines for professional nursing practice in the care of women and newborns (awhonn, 1998).

    "intrapartum:
    1:2 pts in labor
    1:1 pts in 2nd stage
    1:1 pts w/ med or ob complications
    1:2 pit induction or aug of labor
    1:1 coverage for initiating epidurals
    1:1 circulation for c/s

    antepartum/postpartum:
    1:6 antepartum or pp pts without complications
    1:2 pts in postoperative recovery
    1:3 antepartum or pp pts with complications but stable
    1:4 recently born infants & those requiring close observation

    newborns:
    1:6-8* newborns requiring only routine care
    1:3-4 normal mother-newborn couplet care
    1:3-4 newborns requiring continuing care
    1:2-3 newborns requiring intermediate care
    1:1-2 newborns requiring intensive care
    1:1 newborns requiring multisystem support
    1:1 or greater -unstable newborns requiring complex critical care

    *this ratio reflects traditional newborn nursery care. if couplet care or rooming-in is used, a professional nurse who is responsible for the mother should coordinate and administer neonatal care. if direct assignment of the nurse is also made to the nursery to cover the newborn's care, there should be double assigning (ie, one nurse for the mother-baby couplet and one for just the neonate, if returned to the nursery). a nurse should be available at all times, but only one nurse may be necessary, because most neonates will not be physically present in the nrusery. direct care of neonates in the nursery may be provided by ancillary personnel under the nurses's direct supervision. an adequate number of staff members are needed to respond to acute and emergency situations."
    Last edit by mitchsmom on Mar 6, '07
  8. by   MIA-RN1
    Quote from MemphisOBRNC
    You may want to ask management for a copy. I have never heard this, either. We do vital on CS as follows: once out of recovery, q 30 x 2, q hour x 2 and q 4 for the remainder of 24 hours.
    our c/s vitals are q30 X2, q1h X2, q2h X2, q4X 48h then q shift til discharge. But their respirs are hourly until 12h past duramorph, so usually the first 8-9h on the pp side.
  9. by   MIA-RN1
    Quote from mitchsmom
    this may be helpful to you for staff ratio info - (i would also want to see where your management got their info):

    there is a chart from awhonn's perinatal nursing: co-published with awhonn: books: kathleen rice simpson,patricia a creehan


    i have a photocopy of the chart, from p.42, it is labeled "recommended nurse to pt ratios according to the guidelines for perinatal care (aap & acog 1997) and the standards and guidelines for professional nursing practice in the care of women and newborns (awhonn, 1998).

    "intrapartum:
    1:2 pts in labor
    1:1 pts in 2nd stage
    1:1 pts w/ med or ob complications
    1:2 pit induction or aug of labor
    1:1 coverage for initiating epidurals
    1:1 circulation for c/s

    antepartum/postpartum:
    1:6 antepartum or pp pts without complications
    1:2 pts in postoperative recovery
    1:3 antepartum or pp pts with complications but stable
    1:4 recently born infants & those requiring close observation

    newborns:
    1:6-8* newborns requiring only routine care
    1:3-4 normal mother-newborn couplet care
    1:3-4 newborns requiring continuing care
    1:2-3 newborns requiring intermediate care
    1:1-2 newborns requiring intensive care
    1:1 newborns requiring multisystem support
    1:1 or greater -unstable newborns requiring complex critical care

    *this ratio reflects traditional newborn nursery care. if couplet care or rooming-in is used, a professional nurse who is responsible for the mother should coordinate and administer neonatal care. if direct assignment of the nurse is also made to the nursery to cover the newborn's care, there should be double assigning (ie, one nurse for the mother-baby couplet and one for just the neonate, if returned to the nursery). a nurse should be available at all times, but only one nurse may be necessary, because most neonates will not be physically present in the nrusery. direct care of neonates in the nursery may be provided by ancillary personnel under the nurses's direct supervision. an adequate number of staff members are needed to respond to acute and emergency situations."
    thank you for that! i think mgmt is citing new guidelines though. i don't think its regulated in ny, but i am trying to figure out awhons logic behind going up to 5 couplets.
  10. by   mitchsmom
    I can never find AWHONN ratio guidelines on the website, I just emailed my local AWHONN person about accessing that info, so I'll let you know if I hear anything.

    I had not heard anything new.
  11. by   MIA-RN1
    Quote from mitchsmom
    I can never find AWHONN ratio guidelines on the website, I just emailed my local AWHONN person about accessing that info, so I'll let you know if I hear anything.

    I had not heard anything new.
    Thanks, I appreciate it. I have not joined AWHONN and may not if I decide to leave my current position.
  12. by   SmilingBluEyes
    As a member of AWHONN this is the first time I Have heard anything like this. And the info mitchsmom presents, THINK I WILL STICKY THAT!

    THANKS to mitchsmom!!!
  13. by   magz53
    We recover our own C/S patients......Our Duramorph recover is q 5min x 30 min or until stable, q15x 4, q30 x 4, followed by q 1 hour x 24 hours !! We have a flow sheet, but still requires what I call intensive care. I think even AWHONN guidelines are just that.......guidelines, there can be so many variables.......even a "routine" patient can be a lot of care. How about the "routine" C/S given Hemabate in the OR as the doc's "routine".....( don't ask ) who generates liquid stool for HOURS during recovery ??? Again, bottom line is $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
  14. by   MIA-RN1
    UPDATE: I received an email in response to my inquiry from an AWHONN rep. She addressed the ratio guidelines this way:

    In re the couplet numbers: the guidelines state 1:6 for antepartum and postpartum patients without complications, 1:3 for antepartum and postpartum patient with complications but in stable condition; 1-3-4 for normal mother-newborn couplet care.

    So I am thinking, if its 1:6 does it include babies? And I am not sure the difference between AP and PP w/o complications vs normal couplet care.
    She also cites a monograph that can be purchased that addresses this issue on the website but I haven't found it yet.
    Just an update. Not sure exactly what this will mean....in a meeting last week we were told our 1:5 couplet ratio is temporary until the new budget year in July.

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