Epidurals and attending in house

imenid37 · Jan 7, 2004

My facility requires ob doc in house prior to epidural placement. Ob's don't like it. This past weekend Ob doc was saying if pt. had a reaction to anesthesia, she would need to be stabilized by anesthesia before he could do anything for her. I can see his point in one respect, but I'd rather have ob doc there for multip in case she flies after epid., as often happens. On the other hand, we have an ob who refuses to come in at night for pt. to have epid. If he didn't have to come in, then he'd probably just let his pt's have it.

SmilingBluEyes · Jan 7, 2004

Originally posted by L&D_RN_OH
Does your anethesia dept require a doc in house when placing epidurals? Ours prefers it. The other night, one of our not so reg. docs ordered an epidural for her pt. She was on her way back to the hosp but not in house at the time. Anesthesia wouldn't come to place the epidural until she was back. Fine by me. This pt had a funky strip anyway.

Well, this doc went on and on about how the other facility she delivers at doesn't require the doc to be there, and they don't have to come in to place IUPC's, and they don't have to come in for AROM, and they don't have to come in until the baby's crowning..........

Have you seen different policies?

no our policy does NOT require OB doc in-house for epidural placement.

tntrn, ASN, RN · Jan 7, 2004

Our OB's do not have to be in house for epidural placement, either.

Dave ARNP · Jan 7, 2004

No OB in house. Some live quite a bit away and if this were required, someone would have to take house call every night.

Dave

NurseMegA · Jan 7, 2004

We always have "A" doctor in house but it is not neccesarily the doc of the patient so that isn't really an issue. I don't think our docs would go for that at all.

L&D_RN_OH · Jan 7, 2004

Originally posted by MD Terminator
someone would have to take house call every night.

We do have someone on call every night, and generally they are in house. From our biggest practice anyway (LS). Whoever is on call usually spends the night in the call room, although they may go home for dinner. This night though, there wasn't a doc there for LS because the one on call lives 5 min from the hosp, and she didn't have a pt at the time. The others might go home for dinner, but they always spend the night.

This other doc, is from another practice, and assumed that LS practice are paid by the hosp to always be there. Uh, no. Anyway, she was pretty ticked about having to be there. I agree with anesthesia needing to stabilize their pts, but I also would want a doc in house for a baby that bradies down and doesn't recover. It's happened before.

So those of you that don't have an OB in house for epidurals, do you not always have a doc in house? We are a teaching facility, so we always have a resident and the attending, except in the above circumstances.

fourbirds4me · Jan 7, 2004

Our OB docs do not have to be in house.

webbiedebbie · Jan 8, 2004

The first hospital I worked, we had CRNA's who placed the epidurals. An anesthesiologist always had to be inhouse. OB did not.

Second hospital was a teaching hospital. There was always an OB doc around.

Where I am at now, OB doc does not need to be there.

Seems all hospitals have different policies for everything!

Dayray, RN · Jan 11, 2004

Where I work now we have anesthesia on deck at all times as well as at least an OB resident and many times an attending, so its not an issue.

When I worked for smaller hospitals without dedicated OB anesthesia I found that they hated placing epidurals and would find any excuse not to do it.

IUPCs have to be placed by an MD/CNM but the resident can do it. We don't call our docs until we have to to get them there for delivery they like to be in and out in under 30 min.

BETSRN · Jan 11, 2004

OB doc has to be inhouse during placement.

Betsy

L&D_RN_OH · Jan 12, 2004

Originally posted by BETSRN
OB doc has to be inhouse during placement.
Betsy

Thanks. I was beginning to think we were weird.

I'm just wondering what happens if you get a prolonged decel after epidural placement that doesn't respond to postioning, bolusing, O2, etc......... That is why we require an OB to be available. Not saying it happens alot, but it has happened.