dnellnelson

Our perinatologist has instituted a new pp pit protocal over the the last year or so. 40 units of pitocin in 500 cc D5LR to run in wide open after a c-section. 30 units in 500 cc D5LR over 30 minutes for SVD. It seems we have seen an increase in our use of misoprostil, hemabate, methergine for PPH. One article I read implied it was not the overall dosage of the pitocin but the length of time it is infused that helps control the bleeding. I have not done an official evidence based lit search but we really have increased our bleeding, I believe by running in more over less time. We'll see.

EMAR is a decent application in world where most of the meds are scheduled and non emergent. It also helps to have a pharmacy staff adequate enough to meet the demands EMAR puts on that department. I work in L and D and in our OB ER. Our patients fly in there so fast and need even scheduled meds started right away that we basically override the entire safety mechanism of EMAR and then each individual gets "dinged" if you you couldnt wait for pharmacy to reconcile the meds you gave emergently. I used to really worry about bypassing this system AND then getting my percentages posted on the breakroom door. Now I just do the best I can do and if that means having to order and enter all my meds myself because I cant wait on pharmacy then so be it. I really don't understand why in an emergent type environment this is practical. If you are giving the meds anyway without reconciliation and then going back after the fact to scan them, isnt that just a waste of nursing time? Again, non emergent schedule meds this is fine. Sorry, this is really just a thorn in my side at work.

I think the process of maintaining the certification with CEUs helps a professional nurse keep current in her profession. The certification is not a way of saying you are smarter than anyone else but that you, by experience and knowledge obtained along the way have credentials to put behind that process and that you are dedicated to the pursuit of ongoing eduation and professionalism. Certification is not for everyone. It was just something that I wanted to do for myself.

I obtained my OB certification this spring. I did it for self fullfillment. Our hospital paid for the exam and gave us a 500.00 bonus. Now our facility is launching a professional ladder that includes a 2500.00 bonus but you must be have your RNC before applying for the ladder. Glad I did it now for sure. I have 20 years L and D experience and was nervous about taking the exam but it really was not that difficult. I say do it, you will not regret it.

Refusing to admit truly elective procedure on a busy day should be carried out as a last resort. You have to maintain patient safety. I would hate to see someone throw a temper tantrum to get "one more" elective procedure added to an already chaotic, understaffed unit and then be documenting a sentinel event later. It is not always about convenience. I think mosts units bend over backwards to accomodate patients and physicians but there are days where you have to draw the line and say "STOP, we need to rethink our plan here". You have to prioritize on those days. Guidelines and common sense can be very helpful.

How many MB beds do you have? Do you have a triage, if so how many patients come through there per month? 8 nurses to take care of 9 LDRs, 8 antepartum , and surgical cases sounds very low. What is the RN/pt ratio in the antepartum area?

Our unit has been trying to develop a protocol for all scheduled procedures. Currently we limit inductions to 6. There are 8 slots. 2 of each, MN, 5:30am, 730am,and 9:30am. When we have six slots filled we X out the other 2. This does not include c-sections, BTLs,cerclage, or occassionally infant eye laser procedures. That also does not include the add ons that occur all day long. By that I mean inductions and c-sections, not laboring patients. It is total chaos on some days. We are going to try to limit the total scheduled procedures and have a list of 4 levels of priority for scheduled procedures. This way hopefully we will have something in writing that allows a charge nurse to reschedule patients that are a lower risk. The trick will be to get the docs to play by the rules. I would like to limit total procedures to 8. That could be any combination of surgical and inductions. It is a matter of patient safety. You have to have some space left for patients that walk in the triage in labor. Yes spontaneous labor does occur. I have seen it on occassion! lol We do about 250 deliveries/month- level III center. We have 12 LDR and a 30 bed mother/baby unit. So we can get backed up fast. I am needing suggestions as well.

I need input on how to limit or not limit scheduled procedures. These include inductions, c-sections, BTLs, and cerclages. We even occassionally schedule Baby Eye laser procedures. We deliver about 250/month. We have 12 LDRs, 3 ORs, and a 30 bed postpartum unit(it is staffed separately) We currently have 8 timeslots for inductions(12 MN,5:30a,7:30a, 9:30a) However, we limit the total inductions to 6. Surgeries are not limited in number. Some docs want to schedule every thing in 2 days (usually Thur and Fri). We are then busting at the seams and then if Postpartum gets backed up we have to hang on to our delivered patients and have no LDRs for new admits. It really is mass chaos. I just wanted to know what other similar facilities do.