Labor epidural charting

[Harlean]

Hi - I am a clinical supervisor on a perinatal unit in downtown Los Angeles. We are currenting trying to determine the proper charting protocol when caring for a patient in labor with an epidural. Our general hospital policy for continuous administration of opioids requires monitoring of motor sensory function of lower extremeties using the CMS model - circulation, motor and sensation q 15 minutes x2 after initial dose and then every 4 hours. Implementing this in labor and delivery will be complicated. At this time we only chart the usual frequent vitals and amount of pain relief after placement and until the patient delivers.

My argument is that monitoring and charting the patient's motor sensory status comes under the responsibility of the Anesthesiologist who is technically in constant attendance (although in practice they are only on the floor when needed).

What are other units charting regarding this?

Thanks!

[kmchugh]

Just a couple of quick thoughts. As a CRNA, I pretty thoroughly chart my epidural placement, pain relief, etc when they are placed. I also chart 10 - 20 minutes of Q5 minute vitals after bolus doses. This is on the anesthesia record. So, that's covered, no need for the OB nurses to chart this stuff.

Generally here (I think) the OB nurses chart when anesthesia is called to place the epidural, when they arrive, and who places the epidural. Charting about the epidural and it's effects are properly the responsibility of the anesthesia provider. Certainly, I'd prefer to do my own charting.

Kevin McHugh, CRNA

[USA987, MSN, RN, NP]

Kevin,

Your thoughts are refreshing. Wish you worked at my facility! Our guys don't even stay around long enough to see if the patient has received adequate pain relief!

We chart vs q5min x 3, q15min x 1, then q30min until delivery. We don't really address sensory issues other than pain relief from the uc's unless there is an issue. We do chart using CMS prior to transfer to postpartum....they must have a 8 out of 10 for transfer....

[babyktchr, BSN, RN]

We recently "made over" our labor charting and one of the things we did include was sensory assessments. It had previously been yet on ONE more piece of paper to chart on. The only thing we did not do was allow for space to document frequent vitals (q5min). Something to do at our 6 month evals.

Our anesthesia docs don't say around either...just long enough to see if they are comfy and they are gone. They write down a few vitals and that is it...it is up to us.

Kevin...you sound like a cool one to work with.

[kmchugh]

Before you all get too down on your anesthesia providers, remember that I work at a relatively small hospital. We have a total of six anesthesia providers. One is assigned strictly to OB every day, so it's pretty easy for me to do all the follow up I want on my epidurals. Not everywhere has that luxury. As a rule, I put the epidural in, test dose it, then give a bolus dose. Usually, I stick around in the room after the bolus dose for about 10 to 15 minutes to be sure there isn't going to be a BP drop. During that time, I'll also set up and start the epidural infusion, and get my charting done. Then, about 30 - 45 minutes after the bolus dose, I'll stick my head back in the patient's room to be sure they are still comfy, answer any questions.

I'll also usually spend 15 minutes discussing the epidural with patients before placing it as well. Generally, I try to do this before hard labor has commenced, so that the patient can concentrate on what I am telling her, and can ask coherent questions about the procedure.

That's one of the reasons I like working at smaller hospitals. I have time to do these things.

Kevin McHugh

[SmilingBluEyes]

Our MDA's (we have no CRNA's) do like Kevin does. We only chart the vital signs and response (pain relieved etc) on our flow sheets. Our hospital is relatively small, too, doing only about 800 deliveries a year.

[babyktchr, BSN, RN]

Our MDA's (we have no CRNA's) do like Kevin does. We only chart the vital signs and response (pain relieved etc) on our flow sheets. Our hospital is relatively small, too, doing only about 800 deliveries a year.

We are small hospital too...and our CRNAs don't put in labor epidurals. We don't have an assigned MD either...I don't mean to sound critical at all..just they don't hang around...and especially at night. It bothers me, because sometimes they just don't work to the patients satisfaction and calling them back and getting them to come in just takes more time.