Before I get to the point: This is NOT a debate on whether circs are right or wrong, not an opinion debate. Don't want to get into it here. Anyone who's read any of my other posts on the subject knows how I feel about it. I am asking for help in streamlining a process that is not working at our facility. Also, I am not doctor-bashing, although it may seem that way.
Ok, now to the point...
Here's how we do it at our hospital: When mom comes to the hospital, the triage RN completes the pt profile and asks if mom would like her baby (if male) to be circed. She then puts a sheet in mom's chart for the OB doc to sign stating something like this: "I acknowledge that I have discussed circumcision with the male infant's mother, blah, blah, blah risks/benefits/alternative." Once doc has signed this, the charge nurse in NBN can then fill out the permit and take it to mom's room to have her sign the consent. Afterward, baby is put on the 'circ list' for circ in the AM.
Here are a few problems I have with this:
1) Docs are not signing the stupid risk/benefit/etc. sheet. So we in NBN while doing chart audits find that mom wants a circ & doc hasn't signed the sheet, so we take a sheet out & put it on mom's chart for doc to address on rounds in the AM.
2) Once docs do sign the sheets, the sheets have trouble finding their way back into the NBN. So often it's day of discharge and baby is circed 2 hours before walking out the door. (ok, being carried...)
3) When the docs DO sign the sheets (a lot of BS surrounding one stupid piece of paper!) they are just signing them. They do not actually discuss c Mom the risks/benefits etc. Before I have Mom sign the consent I ask her if the doc discussed any of this with her. Inevitably she says "No, s/he just asked me if I wanted him circumcised." This is NOT informed consent and I have a huge problem with having her sign it. I think if the MDs were more upfront with parents about this, there would be fewer circs. That's JMO.
4) Baby does not have to have been seen by peds before circ. Normally peds sees them before circ just by virtue of timing. But we had an OB wanting to circ a baby at 0600 that was born at 2214 the night before! Of course peds hasn't seen him! I felt that that was unsafe and the so did the couplet nurse, who refused to have mom sign the consent...so the NBN charge consented Mom herself. "OB wants to do it now" is NOT a reason to circ a baby that hasn't been seen by peds.:angryfire
5) Some of the OB residents want to circ babies at 0130 or some other ungodly hour of the night because they have 40+ patients to see the next day. It 'works better that way.' I understand that they are busy and all, but if you don't have anything else to do at 0130, for pete's sake GO TO SLEEP!
Personally, I don't care if no one ever got circed from now until eternity. But assuming that circ is not going to be outlawed here any time soon, I am looking for things that work for other places and just might work for us. How do things work where you are, and how do you feel it works for you and the patients?? Thanks for listening.
