Does your postpartum unit assign acuity scores?

BSNbeauty, BSN, RN · May 21, 2017

We don't use any scores. We do have a patient census sheet that lists things like : S/P PPH, IDDM, NAS, Pre-eclampsia and etc. This gives a visual of the acuity on the floor which helps when making assignments.

MoshRN · May 23, 2017

Everybody on our unit gets a 2, unless c/s fresh (or mag pt) gets a 3. Funny thing, we will still get a mag pt with 3 other couplets.

pinkgrl · May 27, 2017

We don't use acuity scoring like other ip units. But we, in general, don't take any mag pts on our PP floor after a sentinel event when pt was found over sedated aka mag toxic, and hemorrhaged transferred to icu a couple years ago. Mag is a high alert drug, CNS depressant and smooth muscle relaxant. These pts should never be on a floor where standard of care is observation/intervention is q4h i.e. PP floor. BP measured on Mag is q30 mins - q1h depending on BP; RR, LOS, foley output q1h; DTRs q4h with fundus, full vitals. We also don't do insulin drips or massive transfusion (LD staff, OB come up, resume care of this pt until stable enough to go back to LD or ICU). These pt stay in LD until high alert meds are d/c. Rarely, LD when on diversion will try to send a mag pt. which I will then take no more than 3 pts, our normal is 4 couplets. I love being a nurse, sacrificed time, money to become licensed, and I will protect my treasured livelihood at all costs. Some PP nursses though will take 7 pts plus the mag pt. and I see them struggling, neglecting their pts... I try to help them. Our hospital is very protocol/policy driven so if a nurse accepts an unsafe assignment, he/she better handle it, bc if something happens to that pt and the nurse cut corners or didn't document, escalate concerns timely, she accepts full responsibility.

klone, MSN, RN · May 27, 2017

Mag is a high alert drug, CNS depressant and smooth muscle relaxant. These pts should never be on a floor where standard of care is observation/intervention is q4h i.e. PP floor. .

Nobody here is suggesting that. Why wasn't the patient on mag protocol with hourly assessments? They can easily be on a PP floor as long as the nurse caring for the patient realizes they're not a "normal" pp patient and needs more frequent assessments. That's why a patient on MgSO4 gets a higher acuity score, per AWHONN staffing guidelines. On our unit, if a nurse is assigned a postpartum Mag patient, they would get only one other couplet.

The staffing in your unit sounds unsafe. Why would a charge nurse assign a nurse 7 patients in the first place?

A lot of hospitals have an LDRP setup - there is not a separate postpartum department.

pinkgrl · May 27, 2017

Yes, someone did suggest that. I was replying to MoshRN who stated that they get assigned to a pp mag pt plus 3 couplets (which is 7 pts). And yes, a PP mag can easily be taken care of on a PP floor if staffed appropriately and she's stable on mag. Just like any high alert drip like an insulin, narcan drip, heparin drip could technically be cared for in any IP unit, doesn't mean it's safe. When I worked a medical step down floor I would do insulin drips, heparin drips, argatroban drips, blood, high fall, postassium/mag runs, low alert chemo infusions, radiation tx on a normal day, but our 24 bed unit was always staffed with 8 RNS, and we were never given more than 3 pts, sometimes just 2 if the charge had to take 1 bc of acuity. Our PP unit is not staffed/budgeted for MB nurses to take 3 pts, doesn't make sense, we are staffed to take 3-4 couplets (which is 6-8 total pts). SO, if a mag pt comes up then someone will have to be called in or the charge will have to take the mag pt. Rarely, does this happen on our unit, and when it did, I refused to take a full load with a mag pt, told the charge she could either take the mag pt or take the other couplets. And, after she called the manager she took the mag pt. The intention in my original post is that if you are given an unsafe assignment, then don't take it, regardless of what anyone says, escalate it, it's not worth your license. We are generally staffed according to census, and per the hospital admin policy, high acuity pts are not allowed to be on floor and they define high acuity as a pt requiring VS/interventions/observations/assessments more frequently than q4h along with some other stipulations.

Most hospitals in GA are not LDRP, esp the larger ones. I've only seen the very small community hospitals have LDRP set here. Even Northside, which delivers 18,000 babies annually doesn't have LDRP.