mag sulfate bolusing

[Buggs]

I work on a Mother/Baby Unit. We do take care of many Mag sulfate pts--usually PP with PIH. Very rarely AP's on Mag. The Mag is USUALLY started in L&D. But at least 2-3x in the last year I have heard co-workers who have bolused the pts on the floor. The other day an AP PIH was bolused on our unit then transferred to another hospital where they would probably deliver her d/t the PIH. To the best of my knowledge we have not been trained to bolus the Mag--it was not in MY orientation. We carry at least 4 couplets, even if one of the moms is on Mag. Sometimes we have 5 couplets, and some of us have even experienced carrying 6 couplets. Anyway the nurse caring for the patient had 3 other couplets, had to do the bolus and transfer. I think that is too much. They are setting the stage for a mag sulfate scare at our hospital. Wondering if any of you bolus Mag on the M/B unit, what monitoring is done on mom and if AP what, if any fetal monitoring? After reading the sad story of the maternal demise from Mag, I have to wonder why there are not National Standards for Mag? Why do some hospitals provide 1:1 nursing and others carry Full assignments? Why is there no JACHO standards for Mag or AWHONN standards for Mag? When there is such a range of how to care for these pts shouldn't someone narrow the gap as to what is SAFEST, not what works best for the staffing of the unit? And, back to fetal monitoring, should that be done during a bolus? We aren't trained in fetal monitoring....ARGGGG Thanks for listening.

[AF-NRS]

oh, and of course-i forgot, we also do strict i&o, and although its not official policy, all the docs limit IV fluids to 100cc/hr while on mag.

we do 125ml/hr.....strict I&O's and DTR checks q1h.

[AF-NRS]

Same here, no Mag on AP or PP. We also do all the above, except that BP is q 15 just like for epidurals, and DTR's, lung sounds, recording vitals, and I/O's q hour. Everything double checked with another RN when beginning the bolus too. SG

what part of central america is your 'corazon' in?

[Buggs]

I'm in upstate NY. Worked in Delaware and NJ where the Mag seemed to more closely monitored. Thanks for the input. Creating change is not an easy task and I'm not really sure where to start. I just hate to not see it change til a bad outcome.