transferring unstable pts to postpartum

fergus51 · Jul 29, 2004

I would ask her to define unstable and what kind of patient load she has when looking after these patients. Where I have worked L&D we always kept the really unstable patients. But, that doesn't mean we haven't transferred someone to PP who went sour later or haven't transferred someone more unstable when we needed the room AND PP was capable of caring for them.

SmilingBluEyes · Jul 29, 2004

Fergus said it beautifully. What does "unstable" mean? And how flooded is L and D with patients? Sometimes I think patients get transferred due to overflow. Another reason I like LDRP so much more.

L&D_RN_OH · Jul 31, 2004

I agree with the others. What is "unstable"? Some of our PP nurses seem to think if a pt is unable to void during their recovery period, they shouldn't be moved. That is definitely not unstable.

Pts with high BPs, on Mag won't be moved. But since preeclampsia can occur days, even weeks after delivery, it's something that a PP nurse should know how to deal with. JMO.

breastfeedingRN · Jul 31, 2004

i am not sure of the exact details of them. it always seems that within an hour or 2 of being on the PP floor, they are going downhill. i just don't remember ever seeing that where i did my preceptorship and this is a frequent occurence where she works. i think that L&D overflow might be part of it, but how can you be expected to take care of 4-5 couplets when you have one that is so unstable? maybe it is just because i am so new and don't really know what goes on, but that seems scary to me for the nurse, but mostly for the patient.

thanks for the replies. :)

fergus51 · Jul 31, 2004

We generally keep patients an hour after delivery, then they go to PP if they are doing well. If they go sour 2 hours later (and that happens), that's just part of pp's job. We can't keep them for 3 hours just in case and we don't have crystal balls to tell us who is going to go bad. The pp nurse just has to deal with it (and when I was on PP, we would get some help from another nurse so the other patients we had weren't neglected and help from the docs if things were really bad).

I have a feeling your friend is just giving you the highlights. The bad cases tend to stand out and get more lip service, even though they aren't the norm.

crankyasanoldma · Jul 31, 2004

Our non-typical PP's either stay in L&D, go to the ICU, or out to antepartum and sometimes a combination of these three places. PPU won't take non-typical patients or patients who have had mag and strives to give a thorough admission assessment while L&D in still present.

finallyRN · Aug 1, 2004

We have LDRP's but have many nurses that only do PP. We will give them patients on Mag or even PPH patients they have been trained to deal with these types of patients plus Labor nurses are on the same unit if they get into trouble. I agree though that some of the problems can develop hours after delivery and we can't always predict. I think that is part of any kind of nursing though

SmilingBluEyes · Aug 1, 2004

I think PP nurses NEED to be prepared to deal all manner of PP complications. What may be "stable" 3 hours PP may NOT be 12 hours later. I have seen patients sour when one would think they should be in a safe window. This is especially true of PIH/MgS04 patients. Hemorrhage and other problems dont' always happen in the first 1-3 hours after delivery. Heck I Have even seen one PIH'er gal seize 5 days out after delivery!!!! In other words, PP personel should be prepared at least as well as L and D to deal with all these things, as well as be thoroughly versed in NRP practices.

mother/babyRN, RN · Aug 6, 2004

I concur..People can be sick or stable on mag with high blood pressures. An unstable pt with HELLP should probably stay back there for increased monitoring, but what is unstable to you is definitely not the same possibly for someone else. We routinely have mag on the floor and frequent vs....And, we do not always cath a mag pt, a fact which horrifies some nurses I work with. PLUS often all the nurses are cross trained so are just inheriting someone they would have cared for anyway...Still, I have found that sometimes people do inappropriately get turfed out due to increased labor BUT sometimes they are better off in post partum under at least a little more quiet that might possibly occur when delivery is hopping..

rpbear · Aug 7, 2004

We have a maternal special care unit that takes all of our "unstable" pp pts, pts on Mag, serious pph, or any special complication that may occur, they have two SAC beds with monitoring capabilities. We L&D nurses work this unit. It is also our intrapartum unit for any preterm labor, hyper emesis etc. It keeps out L&D unit free of these pts that may be there for days or weeks. I work high risk L&D so this type of unit is very important for those special pts.

RNmommy · Aug 9, 2004

We routinely take patients on Mag on PP. We serve an older population so we see tons of PIH. However, in order to be transferred to PP, the pt can be on 2mg/hr max. Otherwise, they are sent to the ICU due to higher acuity. Unfortunately, they are then no longer cared for by OB RNs until their mag dose is low enough to be transferred to PP. These pts are generally kept in L&D until they have recovered from childbirth (@2 hours). As for other complications, they are dealt with in L&D if they present there. Often a pt doesn't hemorrhage until hours after being transferred to PP. Our staff is fully trained to handle any high-risk patients. I am surprised by some of the other posters comments. Are not all PP RNs required to be NRP cert'd? Babies especially tend to go bad on their own time table. I've transferred many babies to the NICU well over 24 hours of age.