OB Rapid response team

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Specializes in nicu, L&D, Post Partum.

JACHO has recently recommended that hospitals incorporate an Ob response team for emergencies that come up in relation to pregnant women and postpartum women. Our facility has 4 LDRS with 1 triage room that holds two beds (very tightly). We are trying to put together a way to organize tasks for emergency cesareans. We are in the process of orienting L&D staff to circulate C/S after hours or on weekends. That is going great, but our biggest obstacle is having to be pulled to other units for coverage. This floating to other units, destroys the entire plan of being able to respond to an emergency within minutes. We all know that 30 min decision to incision is sufficient most of the time, but we also know that in a true emergency--14-17min is max before there is permanent damage to baby. How do your facilities handle staffing with a OB RRteam in place? I really appreciate any help you all can give. Our facility has a level one nursery, is a county hospital and does approx 700 deliveries a year. We are trying to get an Anesthesia team to be on call for OB, otherwise we do not have Anesthesia here on off hours. We need to call them from home. thanks again

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Specializes in Critical care.

Sounds like not having 24/7 anesthesia coverage is the first problem. Even if all the other team members are present for the emergency, it's not going to do any good unless someone can put the patient to sleep.

Second, why isn't the L&D/PP a closed unit? So L&D nurses are being pulled to places like med-surg? That seems to defeat the purpose of an "emergency L&D team" when that nurse has a team of patients she must leave behind.

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I work in a 5 bed LDR unit with 11 PP beds. We staff 2 RNs and 2 LVNs at night. That would be the emergency response team. No one else in the hospital wants to come near our floor. We are very good at working together in bad situations. We do not have anesthesia in house 24/7. For a true stat c/s we have to get the OR crew there, CRNA and MD in less than 30 mins....not easy.

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Specializes in L&D.

The #1 problem is no in-house anesthesia coverage 24/7. Until that can be addressed, you cannot adequately respond to true OB emergencies in a timely fashion.

The second problem is the pulling of nurses to other units. I understand the rationale: if L&D/PP is slow or empty, why staff it with nurses who could be working on other units that might be short staffed? The problem is: an OB patient can come in at any time, just like working in the ER. Thus, you would not pull an ER nurse to another unit, if the ER was empty? Would you? Why do that with OB? We need to run OB units like ERs, and staff them accordingly.

I used to work in a small community hospital with the same exact issues. We ended up closing OB, and I ended up taking a job at a much larger hospital with 24/7 in-house anesthesia and a level 3 NICU. We are MUCH better prepared for stat OB emergencies, and we are NEVER pulled to another unit if we are low census. I LOVE THAT!

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I agree that no 24/7 anesthesia coverage is a problem. Also the fact that you are floating! I work at a 10 bed LD unit with 28 or so PP rooms and we have the coverage and we never float to other units. We have implemented a rapid response team which really is people from ER who come when we call. It is usually patients who have problems with respiration. The ER team comes which is some ICU and ER RN's, an ER doc, and on call anesthesia. They pretty much handle everything and if the pt is stable OB wise they are transferred to a different unit and one of us LD RN's can go with to monitor baby. We also just started an OB Alert for hemorrhages. If we call one of those over the paging system an ER team comes with ER RN's (they are awesome at hanging blood!), ER doc in case we code or need an assist with emergency hysterectomy, lab staff to draw labs, Blood bank person will bring O- blood, OB call doc is paged automatically, and anesthesia is paged too. We also made little hemorrhage kits that we keep in the Pyxis refridgerator with meds: Methergine, Hemabate, Cytotec, and Pit. They are in a little tupperware kit that we just grab for hemorrhages or even just high risk pt's just in case. Since starting this we have had really great outcomes and it really works to have a team/system in place in case things happen. Unfortuanately, sometimes something terrible will have to happen before it is recognized as a problem. I know that is why JACHO has started this. There seems to be more and more complications before/after pregnancy lately. Sorry that was so long but its good to share what we are all doing to make things better and easier not just for us but for the safety of our patients.

:)

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Specializes in L&D.

I also work in a small rural hospital; we do about 1000 deliveries per year. No dedicated OB anesthesia. We have started doing our own C/S within the last year. I truly believe that God takes special care of the OB unit because of all the awful things that can happen, they seldom do. No, I would not try to use that as a defense in a legal case.

We have on rare occasions done sections under local; not pretty!! But if you get a good baby, it's worth it. I don't know if those moms have to deal with PTSD afterwards or not. When anesthesia is not in house or is tied up in the OR and the baby has to come out NOW, you do what you have to.

We are sometimes floated to other floors, but we do not ever take a team so we can return right away if necessary. We just help out where we can. And we don't take infected patients. And we always have 2 labor nurses in the unit even if there are no labor patients (we have a separate L&D and PP).

How many nurses do you usually have in the unit? Perhaps you could work something out with ER as other posters have mentioned. If you have 2 nurses in the unit, an ER nurse could perhaps take over the couplets until an on call person can come in to care for them while the 2 OB nurses set up and do the section. Who are you having scrub? We trained our OB techs to scrub. If you're planning to have an RN scrub, then you'll need 3 nurses: scrub, circulator and baby nurse. So that we have 2 NRP qualified people for the baby in a section, we have a Resp Tech at each of our sections along with the nurse for the baby. If we're expecting a problem, we'll call the Ped in from home, but in a true stat, they probably won't have time to get there first.

We have emergency on call required of all staff members to cover just for such situations. We have to be able to be here within in 30min, ready to go. Some of us live too far away to make in that fast, so we stay here when we're on call.

I used to work in a big city medical center and know what it is to have the baby delivered less than 10 min after the helicopter lands on the roof. Rural hospitals just don't have that luxury. Don't say we shouldn't do deliveries unless we can guarantee that 30 min decision to incision. We're out in the boonies and it's 3 hrs by fixed wing plane to the nearest place that can do that. That's assuming the weather is cooperating and the plane can get to us at all. That's why we don't do VBACs on purpose.

Good luck in your efforts, you're going to have to do some creative thinking and work with other departments to get the job done.

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