New rule- must call MD before doing anything. How about at your hospital.

[OBERrural]

Our hospital just gave us a new rule that states we are no longer able to do ANYTHING with a patient until we speak to a doctor. We cannot put them on the monitor, check their cervix, or triage them at all. I find it a bit humiliating to call the doctor, tell them I have a rule out labor and then ask for orders. I'm used to being able to triage my patient before calling the physician.

So, I'm wondering, is it like this everywhere now or just at our hospital?

[NurseNora, BSN, RN]

Probably has something to do with doing away with standing orders. Make sure the docs know that they will be getting 3am calls requesting orders to take vital signs, check FHR, and evaluate for labor. Then another call with the results. Getting the docs on your side will be most helpful and those middle of the night calls will be good incentive for them to get involved.

In some places, patients call doc first, doc calls hospital saying Jane Doe is coming in and gives evaluation orders at that time.

Your department can develop a policy stating all pregnant patients presenting to OB shall have certain actions taken (EFM, VS, VE, speculum exam, UA, whatever you can get your providers to agree upon).

[babyktchr, BSN, RN]

what preciptatied this? was there an incident?

[Katie71275]

WOW! That would be very aggravating. We have residents on our floor at all times, so I just call into the doc lounge or wherever they happen to be and let them know we have a new patient, but unless something serious is going on, I've usually already gotten them on the monitors to get a good start on a 20min strip, vitals, etc. That would be a pain if I had to ask the doc every time before I did that.

[sadiemae1123]

The hospitals I've worked at always state that for a patient presenting with complaints of labor, an RN can perform the medical screening. It's covered by EMTALA.

[OBERrural]

We were told that it is part of "meaningful use" and must be done in order to get a grant they are applying for. We are a critical access hospital and get reimbursed differently than large hospitals, but I was wondering if this was something specific to our hospital or if it came with Obamacare.

I'm not liking it at all!

[GerberaDaisy]

"Meaningful use" is related to the HITECH Act, which was part of the ARRA (American Recovery and a Reinvestment Act of 2009), and not the Affordable Care Act (Obamacare) which was signed by the president in 2010.

[sadiemae1123]

I thought meaningful use was primarily tied to Medicare reimbursment. You don't generally see people on Medicare in L&D. It still seems like it could be considered a delay in treatment from an EMTALA standpoint.

[APL&D]

I am sorry about this. They always come up with stupid rules the nurses should follow so that the hospitals can get more money. How about asking doctors and nurses first. People making such rules apparently never did any bedside nursing. Similar things are happening in my hospital as the administration decided that we should become baby-friendly. It's all about money and status. Sick of it.

[Janinern84]

We were told that when I worked night shift. I think it is to cover their butts because nurses cannot treat without orders. Truthfully, the new nurses listened, the experienced ones still triaged like we always do...

[lovemyjoblandd]

My hospital kind of tried doing this. The docs HATED it. We have a standard protocol now for RO labor. We can put them on the monitor and do VS, but we are suppose to call the doc before sending a UA or any other treatments. Usually we will collect a UA on admission but not send it until we call the doc. That being said, if i have a woman coming in huffing and puffing looking like a for real labor, I will check her cervix to know if we need to get moving or if we have time. Usually if it's a for real labor one of us will stay in and start her IV, get a cbc, and do our our predelivery orders while another nurse calls the doc and lets them know the situation. We also now have to call the doc before every single epidural which really irritates some of them. They will say when we first call them "she can have her epidural whenever she wants, you don't have to call me," but we aren't suppose to accept that and still have to call them before doing it. Beaurocracy....

[IamSusan]

Seems like a set up for the hospital to get sued to me. What are you supposed to do stand there while a patient precips or codes and say... but I don't have orders? Your hospital isn't backing you up with protocols and if they are putting you between that kind of a rock and a hard place then I would say find another job. What the others are saying about EMTALA is true. You really can't legally use this as an excuse not to provide needed care legally. But if your manager can't see that there is a big problem. Good luck!