Standard of Care/preterm labor check

  1. In what time frame should a patient be seen by a physician or midwife who presents at 30 weeks with complaints of leaking fluid and contractions? Of course I know it is less than the 5 hours I waited for a physician to come in. The patient's mother was beside herself with frustration which generated a complaint against .........who else ? The nurse. The patient is a teenager who comes in at least 2-3 times a week to be checked, she did not have one contraction in 5 hours but that is beside the point. What if she had been ruptured with an unknown GBS status at 30 weeks and we are shipping her from our small hospital 5 hours later ??? Lord help me hang on. Now I have to defend myself against such nonsensical complaints as I wiped the ultrasound gel off her tummy with the sheet. Yes, she was going home and the sheet is softer than the paper towels. Everything I said and did is being scrutinized but nothing is being said about the fact she was not seen for 5 hours by her doc !!!!!!!!!!!!!!!!
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    About magz53

    Joined: Jul '06; Posts: 155; Likes: 84


  3. by   SmilingBluEyes
    I would be writing this up---if the standard is to be seen by physician and there is a time frame in your P/P and it's violated, write it up. In the chart, you can state times when you called the MD and received no orders. But as far as the dr violating any policies about when a patient is seen by him/her, write it up in an incident report. Also you might want to speak to the manager about this.

    Don't you love stuff like this???? UGH.
  4. by   htrn
    Aren't frequent fliers fun!!!

    If you documented when you called the MD and what you told him, the onus is on him/her for not showing up. I would have monitored the patient for contractions, FHTs and continued leakeage. I would have nitrozined her panties/pad or labia and then reported this to the MD when I called. If the nitrozine was negative, no contractions, no leakage of fluid or blood with a reactive NST, then I wouldn't worry about it too much. The MD is probably very familiar with this patient and knew she was looking for attention and reassurance, but that she and the baby were fine.

    If, on the other hand, the patient was contracting, the NST was not reactive or there was either nitrozine positive or continued leakage of blood or fluid, I would have been on the phone every 15-20 minutes until he walked into the door - and I've been known to do it.

    Bottom line, MD didn't show up because she was really fine. Pts mom is pissed at having to sit in the hospital for so long, but maybe next time she will call the on call doc before she shows up and avoid a hospital visit all together.

    Good luck.
  5. by   babyktchr
    All you can do is document it...making sure (as everyone else has said) that you include how many times you spoke with the MD and what was said (no orders blah blah blah). I also let the patient know that they can certainly call their physician and speak to them about their practices if they have concerns, or transfer their care to another MD. It isn't YOUR fault that the MD isn't showing up.

    We have a doc who notoriously does this, and once he let a pretermer lay around till I called him and told him to get over here to deliver the baby. The incident report didn't look kindly on him. Since then he has endured peer review after peer review, and has had his priviledeges threatened if he didn't shape up.

    What needs to be done....and it needs to be standardized nationally...globally, a policy that dictates an exact time frame in which patients are to be seen. Especially when it comes to pre term patients. I am tired of policy being written to ensure MD convenience, and not protect the patient (or the nurse for that matter). It just isn't good medicine to leave a patient waiting all night...bogus or not.

    I am sure if it were a physicians wifey on that stretcher, he would've materialized toot sweeeeeet.:roll
    Last edit by babyktchr on Feb 1, '07 : Reason: forgot something
  6. by   magz53
    Thanks for your support, my hospital goes ballistic over patient/family complaints. I will be writing up an incident report. I do see the situation more clearly after a couple of days. This mother has 2 teenagers pregnant at the same time, a full time job at night etc. etc. She has very little control over things that are happening in her life. She herself is desperate for someone to care for her........which frankly, I was too busy to meet those needs having other labor checks etc. If I were in management, my concern would be preventing another occurence. That prevention would not lie in making the nurse jump higher, faster and with a wider smile. We could prevent patient complaints by seeing them in a timely/safe fashion. Unfortunately, management in my facility is scrutinizing my every move.......I didn't plug her back into the EFM for 10 minutes after she went to the bathroom, used the sheet to wipe off the gel off her tummy, yadda, yadda How do you defend yourself against such crap ?????? Sad thing is, she and her sister are pregnant and we have months more of them coming in for no reason. It's almost like a Munchausen's syndrome kind of a thing....I am so tired of it all. Used to be the good experiences outweighed the bad and if management stands behind their nurses it is a beautiful thing..........don't see that too often any more either. Everyone is too busy polishing their halo. Thanks again for the moral support.
  7. by   SmilingBluEyes
    I am so sorry. I understand completely. This customer service aspect to what we do can make things so hard. Take care and good luck.
  8. by   Jolie
    When I was pregnant with my oldest, I started contracting at about 24 weeks. I called my doctor's office first thing on Friday morning to report that I'd had contractions during the night, expecting to be told to come in immediately. Instead, I was told that I was probably having Braxton-Hicks, and to stay off my feet all weekend and notify the office if anything changed. I KNEW better, but was told what I wanted to hear, so I listened.

    When I called out sick for the weekend, my boss had a fit that I was not being seen. By Monday, I was contracting again, so the doc could no longer ignore me. You guessed it...I was effaced and dilated and got my first taste of MgSO4. Probably would have been a whole lot easier to control my labor if it had been treated promptly.

    4 weeks later, home on meds and monitors, I had an impressive run of contractions that was reported to the same doc by my home health nurse. Doc failed to return phone calls for several hours, at which time the home care nurse finally paged another doc in the practice. I was admitted, and had advanced from 1cm to 4cm with a +2 station. I am convinced that I would have delivered that night had the nurse not contacted another doc.

    I would document phone contact every 1/2 hour, go up the chain of command thru the nursing supervisor and medical staff, and encourage the patient/family to contact the physician as well.

    The potential risks to a preemie posed by a physician who is unwilling to evaluate his/her own patient are enormous. It is necessary to place that responsibility squarely in the physician's lap. If he doesn't want to be bothered by inconvenient calls, he can always take up dermatology.