Cervidil

[jules55]

What is everyone doing for nurse to patient ratio with patients that come in for cervidil (12 hrs) overnight? We have been doing 1 RN: 2 patients with continuous monitoring (per physician).

Thanks,

Jules

[babyktchr, BSN, RN]

They should be treated like any other induction.

[OhioMTCRN07]

We also do 1 RN to 2 inductions (cervidil); once patient reaches second stage, ratio is 1 RN to 1 patient.

[untamable07]

1RN:2 Cervidil inductions. Is it standard to have CEM on all your cervidil inductions? We monitor before and 2 hours after placement, then every 4 hours unless MD orders CEM.

[RNBelle]

We usually staff 2 RNs at night. Usually it is 1RN: 2 pts regardless of acuity. But we have been so busy lately it is just suck it up and deal with inductions, ob checks, observation pts and walk ins with no prenatal care.

[babyktchr, BSN, RN]

Be very careful with intermittent monitoring with cerividil. Continuous monitoring SHOULD be used because of the time release effect of the drug. Many many references are out there regarding monitoring and the use of cervidil and most experts agree that continuous monitoring should be standard of care. Locally many years ago, there was a 10 million dollar settlement for the plaintiff after cervidil was placed and the patient was tucked into bed without monitoring. The patient subsequently went into labor and when she was placed back on the monitor, the baby was in distress and subsequently died. Cervidil should not be treated any differently than pitocin at this stage in the game. It is an induction, not just cervical ripening anymore.

[CnukRN19]

Our policy for any cervical ripening is way crazy, and we all agree that if handed that assignment (has never happened, but the policy says it could) we will refuse, for the safety of the patients. Apparently the policy says 1 RN:4 cervical ripening patients. Ridiculous, when all it takes is one decelling baby to destroy that, and our patients are now all continuous monitoring for the most part. I didn't know this was the policy until one busy night when the day shift charge nurse said the gal that was getting the 2 4pm cervidils could take the midnight cytotec. I told her that was bull, and that I would take the midnight before I gave it to a nurse that already had 2 cervidils, and I did. She just sputtered "but it's policy!" which I said "It's a STUPID policy then!" Talk about NOT SAFE!!!!!

[klone, MSN, RN]

I agree, that policy should be changed. AWHONN guidelines recommend 1:2 for cervical ripening.

[ashleyisawesome, BSN, RN]

We place our cervical ripening inductions in triage overnight. We usually have 1-2 of them, but there are 4 triage rooms total. So the triage nurse is in charge of the inductions, plus any triage patients (up to 4 patients total). If an overnight induction ruptures or goes into active labor, she is sent out to a labor room and becomes 1:1 with an RN. Otherwise, she is sent out around 7am to a labor room and started on pitocin if appropriate.

They also aren't continuously monitored. They are on the monitor for 1 hour after the cytotec (we don't use cervidil) is placed, plus q15 b/ps, then they are taken off until the next dose.

[CnukRN19]

Thankfully, that is the only time I have been told that is the policy. 1:2 is our usual max ratio, either 2 cervical ripening patients, or a Mother/Baby couplet and 1 cervical ripening patient (we are LDRP)...and the other night shift charge nurses agree, never more than 1:2, even if an induction has be be postponed. It just blew me away when this charge nurse told me that was the policy....obviously, she has never had to take more than 2 cervical ripening patients, or she would know how hard, and unsafe, that is.