Nurse ratios & comfort with high risk meds

[kathiecnm]

Last comment for the day. I was using the recommendations from AWHONN & the IOM report on magnesium sulfate to teach safest care of the mother on high risk medications in Professional Development Day (annual,reqired competency+ class) recently. "Best practice, safest practice, evidence base practiced be danged!" I got grief from both the L&D & PP nurses on hourly checks on respirations for women on magnesium sulfate & the concept that women on this medication are never truly "stable" or safe to ignore for hours.

They (including management) didn't even want me to use recommendations about staffing ratios for women at risk on AP/IP/PP. I can hardly wait until I start staff education on hanging IV Labedalol for hypertensive women on AP/IP/PP. Anyone out there running IV Labedalol (not IVp) without cardiac monitoring on L&D? Our Perinatologists & Pharmacist reassure me Labedalol is safer than magnesium sulfate & that we have women with healthy hearts on L&D. Any woman with heart disease would go to Telemetry for monitoring. Hoping to hear words of encouragement or advise on either topic. THANKS!

[SmilingBluEyes]

We don't hang IVPB labetalol where I work, so I can't comment there. BUT we DO do hourly vital signs on any patient on magnesium drips, period. We also do q 2 hourly reflex checks, and strict I/O----setting and resetting IV pumps hourly, as well. AP patients on mag are also on continuous fetal heart monitoring, in addition to the above. This is our written policy for all women on Mag.

[LizzyL&DRN]

I have hung IV Labetolol one time. The pt was on L&D floor and was a 1:1 ratio. I did vitals Q15min, but pt was not on a cardiac monitor. For our Mag pts they are on continuous SPO2/heart rate monitor and vitals are done at the very least every hour, but usually every 30min. We also do Q2 hour DTR checks and assess lung sounds.

[JAHJF]

We do Labetalol gtt on L&D, we have one special room w/cardiac monitor available and if by chance two pt's need a gtt we have another portable monitor. vs are q5min during bolus and q15min while gtt runs. We try our hardest for these pt's to be 1:1, for the simple fact they always see to have other things going on, but I also work at a large high risk ob/tertiary/teaching facility.

[Buggs]

On the PP unit we do hourly checks on our Mag pts including VS, DTR's, UO. They are not on any monitors. If they are an AP pt w/PTL on Mag vs PIH, on the PP unit, the MD's sometime order q4hr VS. Against my better judgement nurses w/ pts on Mag on the PP unit still carry full assignments of usually 4 couplets. In the good ol' days(80's) we did 1:1 or 1:2 when pts were on Mag. And remember, we do not have any ancillary help! The thought of a Labetalol drip scares me-that will be the next in the latest of scary practices on the PP unit. It used to be that Mag was started in L&D, now "they" have actually had us initiate Mag onthe floor with the loading dose-and remember, the nurse STILL has a 4 couplet assignment! Are there guidelines in existance from AWHONN for Mag pts? I would doubt they want us loading a Mag pt on the floor with no monitoring and full assignments. What info did you have to share at the class?

[babyktchr, BSN, RN]

OMG. The last time I ran a labetalol drip was when I worked in ICU. I can't even begin to imagine running it in OB and WITHOUT any monitoring. My institution does not allow it to be given without cardiac monitoring, so I don't have to worry about that.(although some docs try like heck to talk the newer nurses into it). I don't know that I agree with the "safer than mag on healthy hearts". Sometimes we don't know if we are working with healthy hearts. A lot of times cardiac problems manifest during pregnancy, and have an acute onset. One of the experiences I had with IV labetalol was a very labile BP in a craniotomy, and with the assistance of an A-line. That was with 1:1 care...and the assistance of another. I can't begin to imagine this drip in a PP area.

Mag...as SBE said.....q1 hour vitals...no questions asked. Strict I&O, q2 hour reflexes. Continuous monitor in antepartum...and we try to give that patient 1:1 care, but that doesn't always happen.