High-risk long-term antepartum patients, what do you do?

[studentnurserachel]

It has been a long time since I have posted, but I am curious about what other facilities do with the long-term antepartum patients. We have a high-risk antepartum patient who is on continuous monitoring and mag, expected to be here for the next 6 weeks, we do not have a high-risk antepartum ward, though I'm not sure if she would qualify for that even if we had one because of the extent of her monitoring requirements, (she is essentially a 1:1 patient). So how do you handle these patients and bed placement? We have an antepartum room on our floor that is basically a closet with no windows, it is okay for people here for observation, but terrible for anyone staying a while. We moved her into one of our LDR suites with a window, however because of patient census, she has had to be moved twice back and forth between the antepartum room and a labor room. As one of her primary nurses, I have really struggled with this. She feels (and I tend to agree) that the physicians are putting other patients ahead of her when they shuffle her around. It has made her already extremely stressful situation much more so. So many things are outside of her control and we are adding to that with moving her around so she cannot get settled in anywhere. The physicians and other powers that be will do anything to avoid sending other patients to other facilities, so as soon as we get full, she is the person who gets moved to accomodate the incoming labor patients. We are expecting an absolutely crazy December, so she is likely to have to keep moving. Do any of you have policies in place about these types of patients? I have gotten my manager involved, but I feel like I am swimming upstream, just about everyone, other nurses included, seems to think it is perfectly okay for her to just have to keep moving rooms. Thanks in advance for your input!

[Stacy in North Texas]

Interesting. When I worked in L&D we would keep people on Mag in one of the LDRs. It was policy to keep them in L&D for as long as they were on MAG, due to the frequent assessments necessary, even if it was for weeks. Only when they were off Mag, would they be moved to the antepartum/postpartum floor. We never moved the pt out of her LDR to accommodate other pts (too stressful!).

[Elvish, BSN, DNP, RN, NP]

If we have someone on continuous monitoring OR mag (either ante- or post-partum) they stay in L/D constantly. This may mean that inductions get pushed back but oh well. We have 10 L/D rooms plus 3 dedicated ORs plus triage, so this is not as big a deal as it would be if we had a smaller unit.

The situation you describe does not sound like an ideal situation and I agree that it is probably making things harder for your patient than they already are. Is there any way she can be moved to - say, a postpartum room with a dedicated L/D nurse and the EFM still hooked up to a central monitoring station (if you have that)?

[tewdles, RN]

Grrr

Okay. My personal/professional experience is in a regional hospital that had a dedicated high risk antepartum unit so...sort of an oranges and tangerines comparison. The bottom line is very much what Elvish has said...the hospital MUST give this woman the care and priority that she deserves. It is unacceptable to move this woman solely for the CONVENIENCE of the hospital. If the hospital cannot provide the safe and appropriate care for her without subjecting her to the disruption and disrespect of moving her everytime they see a billable case walk in the doors then they need to refer her to a facility that can.

[ldcmw1]

My question to you would be why is she on continious monitoring? Evidence based research doesn't seem to support this? I do feel sorry for her and she needs to be treated with respect and not be shuffled all over the place! At my facility once they get their second dose of steroids they are weaned off the Magnesium Sulfate given indocin for 48 hours and put on procardia.

[studentnurserachel]

I guess I could have been more specific, she has (had) mono-mono twins, I think the jury is out on monitoring protocols, but our MFMs tend to lean towards hyper-vigilance. Update: significant decels on tracing bought her a c-section at 28 6/7, so at least she doesn't have to move rooms anymore. Thanks for all the input, I'm going to keep being the squeaky wheel for cases like this.