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- by at your cervix Aug 21, '02I am curious to know what other hospitals are doing. According to AWHONN guidelines, a pt that is low risk should have fhr documented q30 min in active first stage of labor, however, it should be q15 min if high risk. Does having an epidural make a pt high risk? I can't seem to find anything that defines having an epidural as high risk, however, I have heard it through the grapevine. SO, any thoughts??
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- Aug 22, '02 by anitameWe have a list of things our unit has designated as high risk including use of Pitocin, epidural, NRHFR, no PNC and a multitude of others I can't seem to dig out of my head tonight. All of our epidural patients remain on continuous monitoring.
- Aug 22, '02 by SmilingBluEyesRead up on AWHONN standards to find out how often you do this. There are clear cut standards that say when , e.g, in active labor, early labor, under epidural anesthesia, pit drips, etc. That is your standard of care that you need to follow to know if you are doing right and is defensible in court. Your policies and protocols should at the VERY LEAST be meeting this standard; if not you could be in trouble later on. That is your best bet! Good luck!
(addendum: duh am I STUPID, I re-read your post to see you HAD looked at AWHONN standards....sometimes I can be so stupid, I scare myself! soooo sorry. Anyhow, I will tuck my head down, pick up my sign and go. I have nothing at all to add here that was not already said. Again, I am so sorry! I must have lost my brain! Hope I find it by tomorrow when I go to work!) I am so embarassed!Last edit by SmilingBluEyes on Aug 22, '02
- Aug 24, '02 by AnaclaireOur L&D unit had their policies for FHR/strips documenting in place. Their policy said they should document every ____ minutes. (I don't know the details.) One super busy evening they happened to have a baby born who had evidently been in distress and was severly brain damaged as a result of lack of oxygen during the delivery. Until the delivery occurred, everything looked like a textbook vaginal delivery would be expected. The family took the hospital to court and won because the nurse didn't document the FHR/strips as their protocol instructed.
After that law suit, the L&D unit changed their protocols. The new protocols are more "flexible" now while at the same time following AWHONN standards.
I was working on the Mother-Baby unit when the child was born (I'm not an L&D nurse) and in the NICU when the case went to court a few years later.
I agree with finding out the AWHONN standards. Also, be sure to know what YOUR facility's protocol states. In the case I mentioned above, the only thing that caused the nurse and hospital to loose was the hospital's protocol.
By the way, the L&D nurse caring for that patient no longer works as a nurse. I don't know why, but I do know she quit nursing altogether. Very sad for the family as well as the nurse...Last edit by Anaclaire on Aug 24, '02
- Aug 24, '02 by shay#1, we document per AWHONN standards.
#2, no an epidural does not equal "high risk."
#3, I would leave nursing all together if I were sued too. Some days this job makes me wanna leave with all the people out there just waiting to sue you.
- Aug 27, '02 by mother/babyRNWe also document on the strip q half an hour for low risk and q 15 for high risk. Yes, epidurals and pit, at least in our facility count as high risk. We document the fh, ltv or plain variability if there is an internal, iupc pressures and relationship to the baseline, whether or not the fetus is active and th uc pattern inclusive of duration, pain level of the pt ( on a scale of 1-10) and whatever else the nurse feels is pertinent...
- Sep 12, '02 by StefdelrnI know that once active or on pit we're supposed to do it q15, but noone does. We just do q30 until complete then doc FHT's q5 unitl delivery.
- Jun 13, '12 by MKS8806Does anyone have a link to AWHONN's recommendations?? I've been googling, but can't find what I'm looking for....
- Jun 14, '12 by AlikatzThere are recommendations in this link (towards the bottom on the 4th page): https://docs.google.com/viewer?a=v&q...QQfRW-eDNfPSVA
Hope that helps a little.