No Doppler in OR - Management NO help!

SouthernLPN2RN, MSN, RN, APRN, NP · Mar 9, 2006

I would be inclined to contact risk management on this one. If it got out that numbers were being made up, there'd be plenty of lawsuits.

beckinben, CNM · Mar 9, 2006

First of all, don't lie. Put your foot down on that one. Just don't do it. Put "FHM not available" or something to that effect.

Now, my opinion is, and I'd be happy to hear others, is that you probably don't need a doppler in the OR. Here's why. If you are doing a scheduled c/s and you get a reactive strip in pre-op or her labor room while you're getting mom ready for her section, that should be good enough. Remember, women walk around for their entire pregnancies without fetal monitors strapped to them, and the predictive value of a reactive NST is very good.

Second, if it's an emergent c/s for some reason, is the information from FHM in the OR going to change your management? If the strip you had prior to going to the OR looked good, and she's getting sectioned for something like FTP or oops, she's really breech, the chance of that baby crumping while mom's getting prepped for the section is pretty low. If the strip looked bad before you went to the OR, you're going to get that baby out as fast as you can anyway.

Now, I can totally see why you would want FHM equipment in the OR, especially from the medico-legal standpoint. We have it, although we don't always use it - it depends. We use it more if they have internals, because you can prep the abdomen. And if they have a bad strip, they probably have internals. But I can also see the viewpoint of it not being necessary.

Becki, SNM

babyktchr, BSN, RN · Mar 10, 2006

We take our own dopplers to the OR for c/s...routine or emergency and check a fetal heart tone prior to prep. We also have a monitor up there in case of a prolonged hold time in the pre-op area. Our policy in our institution requires a FHR documentation prior to incision.

ACOG guidelines dictate that continuous FM be documented for emergent c/s until incision time. If external monitoring was used, external is to be continued....if internal monitoring was used..the internal must be continued. I don't have the document at hand....but it is an ACOG directive. This does not apply to scheduled c/s. Now..in the real world, I don't know how many people do this...(I know we don't).

You are so correct in not falsifying the chart with a number for the FHR...as someone said..just chart not done, or equipment no available. Check you policy as to what you are supposed to do and then go to your risk management and get them involved. By the way..can you take your unit doppler to the OR??

SmilingBluEyes · Mar 10, 2006

How about having a monitor close by or in the ante room for csection? We do that.

JaneyW · Mar 10, 2006

I work with high risk moms that often hang out with us for weeks at a time prior to delivering. I have many times rushed one of these moms to the OR in anticipation of a 'crash' section only to have the heart rate recover and the decision made not to cut at that time. We will often do an u/s and then keep them in there for an hour or so under continuous EFM just to make sure. Our OR monitors are tied in to our central monitoring and electronically archived as well.

I like it because it can give some of these babies an extra week or two or even just an extra day inside to 'cook' a little longer. I've seen this at two different hospitals.

imenid37 · Mar 12, 2006

We have an u/s a physician's office was getting rid of and for a time had some dopplers that were hand me downs from doctors' offices. I would go to docs and ask them to talk to management about getting a doppler. If they ask for a doppler, it will have more impact and you may find someone who is willing to "donate" a doppler from their office.