We are in the planning stages for a new hospital that will be completed in about 5 years. We are currently debating between LDRs with family suites to follow on the M/B unit or LDRPs. We are a level 3 hospital that does about 3000 deliveries a year.
The nurses strongly want LDRs. We have had visitor control problems in the past and in fact have just instituted a stricter visitor policy in L&D based upon patient requests.
We don't see how we can keep this control with post partum visitors in the mix. We also have staffing concerns based upon how laboring patients will be spread out on the unit as it will be very large.
The L&D and M/B staff have strong desires to continue in their areas of expertise and not do it all in an LDRP unit.
Any thoughts for us as we make these decisions?
I hadn't found many moms complained about what type of unit they were on because they knew they were not guranteed a LDRP anyways. It can be a bit of a bummer for moms who really want it, but in the end it never seems to be a really big thing because a healthy baby is the most important part of the event. They would be asked if they had a preference at admission and we would try to accomodate those who had their hearts set on LDRP, but most didn't even care. I got a lot of "Whatevers" when I worked admission!
Those with simple health issues were not automatically kept from the LDRP rooms and were only moved if they had to go to the OR, same as those on high risk. The screening occured at admission and wherever they went was stuck with them, so LDRP rooms would occasionally have emergencies. The staff working LDRP are expected to be able to handle an emergency same as those in high risk, because like you say any labor can become an emergency.
The high risk unit was for reeeaaaaalllllyyyyy high risk patients (24 weekers, drug users, PIHers on mag, etc.) that would automatically be sent there after being screened at admission. This unit was placed the closest to the OR. It made more sense to have high risk patients clustered near the OR than all over a big unit.
The type of unit seems much more important to the staff than it ever does to the moms. Us L&D nurses worked in both high and low risk, so it was never an issue of being "stuck" with one.
I have worked where LDRP was the only model. The problems were that staff were not adequately trained and visitors not respecting the visiting hours. We wound up getting REALLY strict on our visiting policy (support person allowed 24 hours a day and the support person can change, other visitors between 4 and 8 pm ONLY). Moms really liked the restrictions because they could actually rest, but you need a staff commited to enforcing them and people willing to see that family centred does not mean allowing 16 people to visit at 2 am.
As for the training, the hospital wound up paying for courses and preceptorships, but they still lost a fair number of staff. Some people will never be able to work all areas and you have to decide if that is an acceptable loss to your facility.
Last edit by fergus51 on Sep 26, '03
Having worked in small and large LDRP, LDR-P, L, D, R, P and large ultra high risk LDRP units, I would like to make this suggestion. Put yourself in the patient's position. Suppose you delivered this afternoon and you are trying to sleep, but the lady next door is having a very painful posterior delivery and is quite vocal.
Same patient in labor and you are a severe pre-eclamptic. Suppose that you are in labor, and have been for 24 hours. You are finally ready to deliver, and your nurse wants to move you to the delivery room.
Now Suppose you have labored, delivered a beautiful baby, and recovered, taken a shower and are ready to get some well deserved rest. Wouldn't it be nice to move to a new cool clean different bed?
I vote for LDR-P and so far as the High risk OB patients, they could be on a specified area of the labor unit (that could be closed off if needed) or in a completely separate unit, depending on how much room you anticipate needing. I have worked in both and they both worked well.:kiss
Last edit by judy ann on Sep 28, '03