L&D unit with no policy and procedures in place

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    I am currently working at a hospital that appears to have no unit specific L&D policy and procedures in place. We have a new manager and I have asked her where they are...she cannot find any! I am not new to L&D but am new to this hospital. I have never worked anywhere where there were not unit specific policy and procedures. Is this a violation of JCAHO or CMS? I am just trying to see what weight I have in getting things started. Thanks for any info you may have!
    lindarn likes this.
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  3. 4 Comments so far...

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    I worked at a hospital like that. Coming from nursing school where I was at a hospital that was very regimented it was quite a change.

    Obviously it's a huge liability to the hospital and it makes things really hard for the nurses and even causes confusion for the patients. I am not sure what the rules are but I would think the hospital's risk management would be all over it. Maybe a comment or question to them (without leaving your name) could get the ball rolling?
    lindarn likes this.
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    Doesn't sound very wise on the hospitals part does it? Huge liability risk for a labor and delivery unit to have no P & P manuals. My thought is that the manager is new also and simply doesn't know where to find them...which is also not good. There is an excellent possibility that all of the info you are looking for is electronic...on a shared drive in the hospital computer system. It is very convenient for a nurse to review a procedure with a click of the mouse at her workstation rather than go to another room and thumb through a large notebook.
    lindarn likes this.
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    For procedures try mosbys on line, document carefully. it sounds kind of weird, maybe you should run the other way....
  7. 0
    It would seem to present you with 2 choices : ) RUN!! or take the opportunity to effect change and mold this unit. Join the perinatal nursing list (you can google it). All of us freely share P&P's between the institutions we work for. We also have a yahoo group with the P&P's there and many power points for teaching.
    Good luck.


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