IOM report & K. Rice Simpson article on Magnesium Sulfate & nursing care

Specialties Ob/Gyn

Published

Specializes in L0-high risk OB, PP/NBN, Med/Surg.

Hi All!

It is so good to read & "talk" to other nurses about providing the best care for our patients in this ever changing profession. I am just curious if any of you have seen changes in policies & procedures or nursing care since these articles came out discussing our desensitization to the risks of magnesium sulfate on AP, IP & PP. When are you transferring moms still on mag to the PP unit? Or are you keeping them on AP as high-risk requiring more 1:1 or 2: care than possible on most PP floors? Have you changed to pre-mixed magnesium sulfate & at the new lower dilution? I need to hear what is happening across the country as we try to impliment evidence based practice in a "doctors know best" environment. Thanks sisters!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Welcome to the OB/Midwifery Forums Kathie.

Since I am in an LDRP unit, I am not sure I can help you, as our patients do not go elsewhere. We care for them throughout their stay in the same room. I do know, whenever possible, patients on "mag" are under the care of a nurse who has a very light load---either her only patient or just one other very uncomplicated couplet. Our policies call for q1hour vital signs, q2hour neuro checks and I/O, so this can be a bit labor intensive. This standard holds whether the patient is pregnant or delivered.

As far as mag concentrations, ours are premixed by pharmacy at the lower dilution you speak of. We do NOT keep mag on the unit or mix our own. There is pre-mixed "mag" in the pharmacy at all hours for our use.

The same holds true for pitocin---the bags are premixed by pharmacy at a 30 units her 500 ml of NS concentration (just thought I would toss that in).

Hope this helps you somewhat. I am sure others who have separate L/D and MBU/PP units can answer you here soon. Again, welcome to the forums.

Deb,

Moderator, OB/GYN and Nurse Midwifery Forum

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PP pts on mag are transferred to our high risk unit where the staff ratio is generally 1:2 or 3...of course that could fluctuate based on acuity.

We mostly use the pre-mixed bags of mag, but sometimes a doc wants something not pre-mixed. In that case, pharmacy mixes it for us. In extreme situations, if the mag must be mixed on the unit, two RNs are involved in each sep of calculating and mixing in an effort to reduce the chances of a med error.

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We use premixed bags supplied by the pharmacy.

We are an LDRP unit but have PP for overflow. We do not have a high risk antepartum unit, we are it. :) We usually hang onto our Mag pts in L&D. However, since PP pts can present with pre eclampsia and require Mag days after delivery, it is something that PP nurses need to be able to handle. We had two readmissions this week to PP, of pts who had delivered several days before.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I definately agree PP nurses need to be able to handle mag patients.

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