Liability of threatened AB on M/S unit?

[new_nurse_2006]

I'm a new LPN (8 months) on a med/surg floor and would love to hear from experienced nurses about this situation.

Management wanted to place a threatening abortion on our med/surg floor from ER. US showed viable intra-uterine pregnancy between 16-18 weeks; placenta intact. Minimal spotting and some cramping. L/D said they don't take

Supposed to be my admit, but I stated I was not comfortable taking this patient. I'm a new nurse, minimal L/D experience, no fetal or tele monitors on our floor. (Doesn't a mag drip need a tele monitor?)

The charge nurse had numerous conversations with the coordinator and unit manager, but the patient was brought to our unit. By then, the admit fell to the next shift. The patient ended up transferring to L/D on that next shift. I don't know the outcome of the baby, unfortunately.

Was I right to refuse the patient? All I could think of was losing the baby (or the mom!) because we didn't have the knowledge, skills or equipment to identify and prevent such a loss.

[cheshirecat]

Would not happen in the UK. She would be nursed either gynae ward or a midwifery ward depending on hospital policy.

You where, imo right to refuse to look after this lady/baby.

[psalm, RN]

You were wise to refuse. Was OB or ER gonna send up an emergency delivery set with the pt? Yes, I know, too early to "deliver" but what would be the liability if staff hadn't tried to "deliver" her if she was contracting?

Patient advocacy includes having staff that know what they're doing for the pt.

[ZippyGBR, BSN, RN]

Would not happen in the UK. She would be nursed either gynae ward or a midwifery ward depending on hospital policy.

You where, imo right to refuse to look after this lady/baby.

it happens routinely in the UK

a 16 week gestation patient whould be placed within the general bed base - generally on a gynae ward - however the impression i get is that due to the way hospitals work in the US there is less subspecialisation of none specialist clinicla areas - esp given the US is a lot more set up around single rooms rather thaan the UK model of 'wards'

med-surg = none specialist area ...

for the left pondians most Uk hospitals even new builds retain the 'ward' concept in terms of managing beds and staffing generally groups of 20 -35 beds with dedicated and to an extent subspecialised staffing - it's also due to the way in which Uk hospitals work with Physcians as hospital employees rather than peopel who bring work to the hospital

[rn/writer, RN]

In our hospital, such a patient would go to the antepartum unit.

I understand that L&D views a fetus

It also seems wrong to send a woman who might lose her pregnancy to a general med/surg unit where few people will have had experience in dealing with fetal demise. This is a pregnancy-related problem, not med/surg.

Not good for patient or staff. Thank you for advocating for this woman.

[Jolie, BSN]

Thank you for advocating for your patient and insisting that she receive care in an appropriate setting.

While she was under the 20-week "cutoff" of the OB unit, she was most definitely a pregnant patient who was being treated for an obstetrical complication. By placing the woman on MgSO4, there was a clear attempt being made to save the pregnancy. MgSO4 is a powerful drug with numerous, potentially serious side-effects, and she needed to be cared for by nurses with expertise in OB and MgSO4 management.

You did the right thing!

[tntrn, ASN, RN]

In our hospital, she would be admitted to the Birth Center as an antepartum patient. She would, as do all our patients (except triage) have a private room. She would be monitored for FHT's only with routine vital signs and not with continuous external fetal monitoring. She would not be placed on

MGSO4. In 30 years I've never seen a threatened AB placed on any kind of tocolytic drug. Also no tele required (or used where I work) when a patient is on MGSO4.

Was she or wasn't she on MGSO4? The OP implies that but doesn't specifically state that she was on that drug. Also 20 weekers and less are sent to us, only after they are triaged in ER and if it is decided there that their condition requires inpatient care for an obstetrical problem or if they are having surgery for an appy, gall bladder or whatever. We do not triage anyone under 20 weeks.

[XB9S, BSN, MSN, EdD, RN, APN]

it happens routinely in the UK

a 16 week gestation patient whould be placed within the general bed base - generally on a gynae ward - however the impression i get is that due to the way hospitals work in the US there is less subspecialisation of none specialist clinicla areas - esp given the US is a lot more set up around single rooms rather thaan the UK model of 'wards'

I have to agree with Cheshirecat here, I have worked in many hospitals in the UK and have never experienced a pregnant lady whose pregnancy is threatened to be bedded anywhere other than gynae or maternity. Where I work we have an early pregnancy unit that would have dealt with it.

To the OP in your position I would have done exactly the same, you have to practice within your capability and if you are unhappy with caring for a patient because you feel that you do not have the knowledge or skills then you are acting in the best interest of the patinet.

[TazziRN, RN]

In all my years in ER I have seen many many threatened AB's. I have never sent one less than 20 weeks to the L&D. In my first facility, where there is a gynie floor, I sent them there. In my last facility, where they had only laboring, delivery, and postpartum care until VERY recently, those pts were sent to medsurg. Not sure why this woman was on mag, I've never seen anyone on mag that was less than 20 weeks. I understand your concern about handling a mag drip, but as far as the pt herself, nothing other than emotional support would have been different in her care if she'd been 20 weeks and sent to OB.

[new_nurse_2006]

Sorry for the confusion . . . no, she was NOT on MGSO4. I was thinking that could be a possibility and knew it was a dangerous drug.

Thanks for the feedback - exactly what I need to know. So the situation wasn't quite as serious as I thought, but still not ideal.

If you don't use tocolytics at this stage, what can be done to prevent the miscarriage, besides bedrest?

[tntrn, ASN, RN]

Sorry for the confusion . . . no, she was NOT on MGSO4. I was thinking that could be a possibility and knew it was a dangerous drug.

Thanks for the feedback - exactly what I need to know. So the situation wasn't quite as serious as I thought, but still not ideal.

If you don't use tocolytics at this stage, what can be done to prevent the miscarriage, besides bedrest?

Nothing will prevent it at 16-18 weeks, which is why many times these patients are not sent to labor units, but gyn floors instead. Also why FHT's won't be monitored continually, if indeed that would even be possible.

[daisey_may]

I work on an m/s floor and have taken care of pregnant women. I have personally taken care of two and both were under 20 weeks along. One woman was in DKA and another was having seizures, which, yes, put the baby in jeopardy, but the mothers needed medical attention. But my scenerio is a little different in which the pregnancy was so much of the focus as was the mother's health for problems not necessarily associated with the pregnancy.