OB Policy and Procedures " HELP PLEASE"

SmilingBluEyes · Feb 10, 2005

I can imagine how hard it is.......

By the time we would need to retrieve this pill, it would likely be dissolved or irretrievable. Esp in our bigger ladies, it would just about impossible..... I can see how it may be advantageous to have a pill TO retrieve, however. (versus PO route). But if that were in mind, maybe cervidil/tampon would be a better choice to begin with.....

(but expensive I know)

princess2 · Feb 11, 2005

Where there's a will, there's a way. I had a multip that responded too well fast and had to fish that thing out when FHTs were down, and low and behold, it doesn't dissolve that fast. She ended up down the hall anyway, because the physician wasn't going to try that again. Actually, I have had to remove a few times and was successful. They would not use Cervidil due to the expense and many would not use prostin either. Here, they prefer Prostin and pitocin and AROM and have much success with that. Thanks for responding.

RN4mommy's · Feb 12, 2005

There is an absolutely awesome website from the University of Texas that my manager shared with me. It was an awesome resource for guidelines and policies. They have all of their policies on line and available to the public for you to use as a resource in development of your own. It is a true godsend. I wish a book existed on sample OB policies or that more hospitals would have their policies on line to the public like University of Texas. Here it is:

http://www.utmb.edu/policy/nursing/nursing.htm

They have a whole section on OB and Newborn policies. Hope this helps :)

princess2 · Feb 16, 2005

Thank you so much!

princess2

NPinWCH · Feb 25, 2005

First let me state that we do not follow the recommendations of any professional body, we know it and we don't like it. We nurses have complained and yet the docs refuse to change the policy. I work in a small community hospital that is a level 1, all but one of our delivering docs are family practice docs and we have 1 OB.

For inductions we give 50 -100 mcg (almost always 100mcg) PO q 4 hrs x 6 doses or until the patient is having adequate contractions. Pitocin may be started 4 hours after the last dose. All patients must sign an informed consent that lists the risks of Cytotec and that also states Cytotec is not approved for use for labor induction. We do not do Vbacs, and we have used the cytotec even on grand multips.

Pt remains on the monitor from 30 min - 2hrs after each dose, then pt may ambulate. The monitor time depends on the doc, but the policy in place states at least 30 min. As stated previously, the Cytotec works really well or not at all.

I have had patients hyperstim 20 min after the first dose and I have had patients that required all 6 doses and then pit. We have been doing it this way for at least 2 years now and so far have not had a bad outcome (which if you ask me is only by the grace of God).

The docs basically have said - it works and until something bad happens and we can't use it anymore we are going to use it!

SmilingBluEyes · Feb 25, 2005

First let me state that we do not follow the recommendations of any professional body, we know it and we don't like it. We nurses have complained and yet the docs refuse to change the policy. I work in a small community hospital that is a level 1, all but one of our delivering docs are family practice docs and we have 1 OB.
For inductions we give 50 -100 mcg (almost always 100mcg) PO q 4 hrs x 6 doses or until the patient is having adequate contractions. Pitocin may be started 4 hours after the last dose. All patients must sign an informed consent that lists the risks of Cytotec and that also states Cytotec is not approved for use for labor induction. We do not do Vbacs, and we have used the cytotec even on grand multips.
Pt remains on the monitor from 30 min - 2hrs after each dose, then pt may ambulate. The monitor time depends on the doc, but the policy in place states at least 30 min. As stated previously, the Cytotec works really well or not at all.
I have had patients hyperstim 20 min after the first dose and I have had patients that required all 6 doses and then pit. We have been doing it this way for at least 2 years now and so far have not had a bad outcome (which if you ask me is only by the grace of God).
The docs basically have said - it works and until something bad happens and we can't use it anymore we are going to use it!

YOU GUYS USE A HECKUVA lot of CYTOTEC! It makes me shudder to think anyplace uses this much. Seems to me, if it takes that much, the induction is not meant to be done.

timewood · Feb 28, 2005

thought you all might find this helpful...I enjoy lurking and reading your posts. I am currently a student RN and plan on eventually becoming a CNM.

here tis: http://www.midwiferytoday.com/articles/cytotecwagner.asp