How often do you document fht's?

  1. I am curious to know what other hospitals are doing. According to AWHONN guidelines, a pt that is low risk should have fhr documented q30 min in active first stage of labor, however, it should be q15 min if high risk. Does having an epidural make a pt high risk? I can't seem to find anything that defines having an epidural as high risk, however, I have heard it through the grapevine. SO, any thoughts??
  2. Visit at your cervix profile page

    About at your cervix

    Joined: Dec '00; Posts: 291; Likes: 34
    Labor, Delivery, Post Partum and Newborn RN
    Specialty: 10 year(s) of experience in OB, Post Partum, Home Health


  3. by   mark_LD_RN
    no an epidural does not make them high risk, but we still use continuous fetal monitoring and document q30 but if on pit which most are we document q15
  4. by   anitame
    We have a list of things our unit has designated as high risk including use of Pitocin, epidural, NRHFR, no PNC and a multitude of others I can't seem to dig out of my head tonight. All of our epidural patients remain on continuous monitoring.
  5. by   SmilingBluEyes
    Read up on AWHONN standards to find out how often you do this. There are clear cut standards that say when , e.g, in active labor, early labor, under epidural anesthesia, pit drips, etc. That is your standard of care that you need to follow to know if you are doing right and is defensible in court. Your policies and protocols should at the VERY LEAST be meeting this standard; if not you could be in trouble later on. That is your best bet! Good luck!

    (addendum: duh am I STUPID, I re-read your post to see you HAD looked at AWHONN standards....sometimes I can be so stupid, I scare myself! soooo sorry. Anyhow, I will tuck my head down, pick up my sign and go. I have nothing at all to add here that was not already said. Again, I am so sorry! I must have lost my brain! Hope I find it by tomorrow when I go to work!) I am so embarassed!
    Last edit by SmilingBluEyes on Aug 22, '02
  6. by   Anaclaire
    Our L&D unit had their policies for FHR/strips documenting in place. Their policy said they should document every ____ minutes. (I don't know the details.) One super busy evening they happened to have a baby born who had evidently been in distress and was severly brain damaged as a result of lack of oxygen during the delivery. Until the delivery occurred, everything looked like a textbook vaginal delivery would be expected. The family took the hospital to court and won because the nurse didn't document the FHR/strips as their protocol instructed.

    After that law suit, the L&D unit changed their protocols. The new protocols are more "flexible" now while at the same time following AWHONN standards.

    I was working on the Mother-Baby unit when the child was born (I'm not an L&D nurse) and in the NICU when the case went to court a few years later.

    I agree with finding out the AWHONN standards. Also, be sure to know what YOUR facility's protocol states. In the case I mentioned above, the only thing that caused the nurse and hospital to loose was the hospital's protocol.

    By the way, the L&D nurse caring for that patient no longer works as a nurse. I don't know why, but I do know she quit nursing altogether. Very sad for the family as well as the nurse...
    Last edit by Anaclaire on Aug 24, '02
  7. by   shay
    #1, we document per AWHONN standards.
    #2, no an epidural does not equal "high risk."
    #3, I would leave nursing all together if I were sued too. Some days this job makes me wanna leave with all the people out there just waiting to sue you.
  8. by   mother/babyRN
    We also document on the strip q half an hour for low risk and q 15 for high risk. Yes, epidurals and pit, at least in our facility count as high risk. We document the fh, ltv or plain variability if there is an internal, iupc pressures and relationship to the baseline, whether or not the fetus is active and th uc pattern inclusive of duration, pain level of the pt ( on a scale of 1-10) and whatever else the nurse feels is pertinent...
  9. by   Stefdelrn
    I know that once active or on pit we're supposed to do it q15, but noone does. We just do q30 until complete then doc FHT's q5 unitl delivery.
  10. by   MKS8806
    Does anyone have a link to AWHONN's recommendations?? I've been googling, but can't find what I'm looking for....
  11. by   Alikatz
    There are recommendations in this link (towards the bottom on the 4th page):

    Hope that helps a little.
  12. by   Fyreflie
    We do q 30 in early labour, q15 in active and q5 in second stage. Q15 if there is an epidural or oxytocin. The facility in at now doesn't favor IA but my last hospital had the same guidelines for either IA or continuous. My last facility allowed for interruption of continuous if oxytocin was stable for up to 30 minutes (with IA at the 15 minute mark) to allow for walking and showering etc. The facility I'm at now certain docs don't mind but most want continuous all the time I think up here in Canada the policies pretty much say the same thing across the board but the interpretation varies. I always go by my policy--and what the situation is at the time I.e. if I have someone in early labour who seems to be picking up quickly I'll move right to q15.
  13. by   Michelle123
    Just curious, you are talking about continuous aren't you? Doesn't that cause issue with requiring the woman to lay in bed throught her labour? Or do you have portable monitors? Do you get many women that refuse? Or place their own restrictions? Say Doppler once an hour or something?
  14. by   Fyreflie
    My first two jobs we didn't have portable telemetry monitoring so if the woman needed to be continuously monitored we were limited to using the bed for positioning or the birthing ball/standing next to the bed. My current facility has telemetry that even works with our scalp clips so women can walk or be up even if they need to be on continuous. It's great and usually works fairly well!

    I have always preferred IA in any low risk situation but many OBs I have worked with are still very uncomfortable with it. My current hospital requires continuous monitoring during an epidural because one time a baxillion years ago a woman sat up for an epi and had a cord prolapse when her water broke and the outcome wasn't good. Stupid knee jerk reaction. A policy indicating IA in case of SRM would be just as safe and a lot easier IMO.