pitocin protocol,help:) please

[mark_LD_RN]

well I would like to hear what your pitocin protocol is. we are having some debate rewritting our policy and procedure manual. and want to see what other hospitals are doing. help me by answer the following questions. please!

1) is patient on strict bed rest, or do you allow them to have use of the bathroom.

2) is patient allowed to sit up in rocking chair or stand up in room?

3) does patient have to be on full time fetal monitoring?

does anyone know the awhonn guidelines for the above questions?

thanks mark!

[bagladyrn, RN]

Most of the places I've worked require continuous monitoring, except for when oob to the bathroom. I've never had anyplace object to me having pts. up in the rocker or standing at the bedside as long as we can maintain monitoring. The women really do appreciate those times oob.

[at your cervix]

1) is patient on strict bed rest, or do you allow them to have use of the bathroom. MAY GET UP TO BR

2) is patient allowed to sit up in rocking chair or stand up in room? YES, AS LONG AS ON EFM

3) does patient have to be on full time fetal monitoring? YES, EXCEPT WHEN UP TO BR

I had a pt that needed augmentation because membranes had been ruptured for several hours, baby looked good and she had a birth plan that refused fetal monitoring, I was able to talk her in to intermittent fhm. I just could never figure out why she agreed to pit (rom and no uc's for about 18 hrs) but wouldn't agree to continuous monitoring. I followed AWHONN's guidelines for intermittent fhm and had her sign a refusal for continuous monitoring consent.

[NellieNurse]

AWHONN says you can't do pit unless yo do continuous FHMing. If the patient consents to Pit, it needs to be that she has to have continuous moitoring...otherwise, no pit.

They may get up to BR (as long as intact) and may sit in chair with monitor on.

[layna]

Hi Mark,

Our patients are kept on continuous EFM. They are allowed out of bed as long as they remain on continuous EFM and the FHR is reactive. They are off EFM if they are up to the BR. If they want to walk around, we have a telemetry fetal monitor. Your main concern is safety here. Also important is documented informed consent. We have forms that the docs fill out that indicates Bishop score, reason for induction and that the patient is fully informed.

Good luck!

[OBNurseShelley]

actually, according to AWHONN, anyone on PIT is in the HIGH-risk category, that means EFM every 15 minutes in the 1st stage and every 5 min in 2nd stage, therefore, on pit, technically they can get up and walk for 15 min, heart tones are checked with a doppler then they can walk for 15 more min, etc. HOWEVER, I try not to leave someone off EFM for more than 30 min on pit, with intervals of walking/sitting/shower/etc. PROVIDED they had a reactive strip to begin with, of course......