Question about xfer of pt from ldr to pp

NurseyNursey · Aug 25, 2002

We transferred patients to PP about 2 hours after delivery. If we didn't need the bed, they stayed longer. If we were getting desparate to avoid a hallway delivery, they went sooner. They usually had to pee before they could leave the Labor deck. Our PP was not really separate. Our patients had to walk. If they couldn't walk there, they stayed in their LDR unless it was really busy. It was all on the same hallway and PP was sometimes just the room next door.

When I delivered my first, I was transferred via WC to the separate PP, but I have no idea the time frame.

fergus51 · Aug 25, 2002

Minimum of 1 hour because we need to have 4 vs checks before they leave which we do q 15 after delivery. They also have to be walking, but we don't do the pee thing anymore because they just might not have to go for a few hours.

indynurse · Aug 25, 2002

Do you have to give report to the PP nurse prior to the transfer?

fergus51 · Aug 25, 2002

I usually walk the patient to her room and then give report at the nurses station, unless something was really unusual at delivery in which case I phone report before walking the patient over.

fergus51 · Aug 25, 2002

How do you do it? I mean, what was the problem you had with your procedure?

indynurse · Aug 25, 2002

Our standards of care for In House Transfers say that the L&D nurse calls report to the receiving unit prior to transfer. I was working PP and when the L&D nurse called to give report, I was with another patient and the Unit Sec told her I would call her back in a couple of minutes. On PP we usually have 8-10 pts plus admissions and getting report prior to transfer helps me to prioritize my workload for the time when the new pt arrives. Having worked both sides of the transfer, when I am on PP and not available to take report as soon as the L&D nurse calls, I ALWAYS call back as soon as I finish what I was doing at that time.

I called L&D back for report less than 5 minutes after the initial call and guess what, the patient was already on my unit and in bed. I went to the pt's room and found the pt., but could not find the L&D nurse to get report. I think it presents a poor image when I have to ask the patient things that I should already know. Also, this patient was left unattended and, if I were getting another pt out of bed for the first time after a c-section or helping with a breastfeeding, it could have been a very long time before I found out she was there. In my opinion, it is not my patient until I have report if the pt is transferred from one unit to another.

BTW, it was not like they were short on beds or staff in L&D that day. IMHO, it was just poor form on the part of the transferring nurse who, BTW, came back five minutes after I went into the pt room to give me report.

Prior to this job, I worked on a Med-Surg unit and always got report from PACU on a post-op pt prior to transfer to my floor. I have always thought of post-partum admissions as similar to a fresh post-op pt. For those first few hours, they are at increased risk for complications and bear closer observation. While most PP pts are stable from start to finish, I have seen enough patients "go South" unexpectedly after delivery to be extra vigilant about all of my new patients.

fergus51 · Aug 25, 2002

I agree with you the patient should not be left there without a nurse assigned to her. The nurse hould have waited for you at the nurses station. It would have even been better if she had interupted your time with the other patient so you would at least be aware of her stupidity. That said, do you have 8-10 moms and 8-10 babes at a time? That seems absolutely insane to me. Our pp is usually 5 mom and babe couplets max. How much monitoring can you give to 8 or 10 pp women?!

indynurse · Aug 25, 2002

Right now, we only have the moms. We will be switching to couplet care and I have been hearing them mention giving us 6 couplets plus an admit. With the amouint of staff we have and the number of inductions we do, it will be interesting to see how this is all going to work. Last week we had a day where we had 10 deliveries between 0800 and 1200. Some of my co-workers have worked couplet care and said it is great until you start getting a bunch of admits, then it can get very chaotic. We do have CNA's, but how much help they are depends on who it is. Some of our CNA's are excellent but a few of them are really scary and I can't trust them to notify me of something as simple as an abnormal temp.

I really like taking care of PP pts, but if things on this unit don't change for the better soon I think I will just transfer to L&D full-time or start looking into other hospitals around here. I like most of my co-workers on PP and would hate to leave, but a lot of changes that have been implemented lately are taking more time away from the RN providing pt care at the bedside.

Mimi2RN, ASN, RN · Aug 25, 2002

Six couplets equals twelve patients! That's not safe staffing. I now work ICN, have done couplet care, it can be hard teaching baby care, it goes in one ear and out the other. 3-4 couplets is much safer, you can spend time with the new moms, assist with breastfeeding etc etc, and be much more aware of problems. It may take a disaster on your unit to make any changes, though. Why do people always forget the baby when it comes to staffing?

Anaclaire · Aug 25, 2002

I worked on a Mother-Baby Unit in a 630 bed hospital in Georgia. Our L&D was separate from us too. When a Mom delivered lady partslly, she stayed in L&D for at least one hour to have vital signs, fundal, and lochia checks done. They also tried to keep them there until they got up for the first time and voided. If her baby was healthy it stayed with her for up to one hour to breasfeed/bond and then went to the Transition Nursery for the next 2-3 hours and would come to our Mother-Baby Nursery/Floor at about 4 hours of age. Our fresh c-sections came straight from the PACU.

In either case, a report was called and received by the transferring nurse before the patient was moved to our unit. That way we could prepare the room and tie up any loose ends with our other patients so we could be present when the new Mom arrived.

When the new Mom arrived, the L&D nurse or the PACU nurse and assistant would be sure the Mom was transferred to her new bed safely. We'd get a set of vital signs for the PACU nurse's paperwork. The L&D nurse and the Mother-Baby nurse would together check fundal height as a baseline paremeter for us and a transferring paremeter for their paperwork. If the fundus was high and off center, indicating a possible full bladder, we knew it right away and so did the L&D nurse. The L&D nurse would then tell us the patient hadn't voided yet, generally, and if she had been given any medication for that problem or if they had tried any nursing "tricks" to help her void. We also knew then to put a urine collector in the patient's toilet to be able to record their first voiding (and later voids until we were sure she was voiding adequately, etc.)

I worked on the night shift and we usually had between 4 and 6 couplets. Any more than 6 "easy" ones was way too much to be safe. Day shift would start with 6 and then discharge 2 or 3 of them and end up with an admission so by the end of their 12 hours they were back to 4 or 5 couplets. A c-section 24 hours.

In our state, if a nurse transfers a patient to another floor and leaves that patient without giving report to the patient's new nurse, that is considered "Patient Abandonment". In rare cases it happened to us, usually during shift change, where a patient was brought from L&D, placed in a bed, and no report was given... we found the patient either by the charge nurse simply peeking into each room routinely (to be sure all empty beds are made and rooms are ready for admissions, and to say hello to all the patients, etc.) or by us receiving report from the Transition Nursery when the baby has arrived in our Mother-Baby Nursery. I remember one case where we received a new baby and called L&D to find out how the Mom was doing (thinking she was having complications) and if she wanted us to bring the baby to her L&D room for a little visit. YIKES!!! They didn't have that patient in L&D and knew nothing about her!!! Sure enough, she was found, sound asleep in a room on our unit!!! Thank heaven she hadn't had complications, tried to get up to use the bathroom and faint, need pain medicine, or begun to hemorrhage!!! Incident reports were written and people were scolded for that one!!!

Our Mother-Baby Nurses did not "float" to L&D, but once in a while, when we were short and an L&D nurse wanted some extra money, they would come to our Mother-Baby Unit to work. We generally gave them our undelivered moms (we always had a couple on our unit who were too unstable for home but not critical enough to keep on L&D) and/or some normal lady partsl deliveries or close-to-discharge c-sections to care for. They felt most comfortable with the undelivered patients of course and seemed to really enjoy the family interaction of delivered moms and families.

By the way, we had an "X" hospital in out town too. It was a smaller hospital, private too. They were constantly applying for a CON (Certificate of Need) from our state so they could open up their own Delivery Unit. They hoped to lure all the private-pay patients there and leave us with all the Medicaid/Indigent patients. MONEY ISSUES AS ALWAYS!!! They still, after 8 years of trying, hadn't received the CON when I left (2 years ago) because of our NICU being a Level III NICU and responsible for patients from 13 surrounding counties. Our NICU always had at least 1 opening for RNs so that showed the state that there was not enough nurses to staff the "X" hospital... also there were MONEY issues concerning the expense and paperwork of transporting a baby from one hopsital that is less than 5 miles from the Regional Perinatal Center for High Risk Moms and Babies. It was a nightmare! The hospital "X" ended up focusing more on rehabilitative care for physical therapy-stroke-head injury type patients instead and have found their niche there. On the one hand, the "X" hospital wanting "Delivery" patients was a hassle and constant source of concern for our hospital, but at the same time, it was good for our hospital... competition is good!!! It caused our hospital to do more to make sure we stayed head-and-shoulders above the norm in our L&D, Mother-Baby, and NICU areas. As I said, we became a Regional Perinatal Center for High Risk Moms and Babies. We also were able to be a Children's Miracle Network Hospital, apply for and recieve state and government grants, etc. We even expanded our hospital to update and build a new L&D, new NICU, and update all the Mother-Baby rooms. They spent millions on that! Sorry, I digress...

I hope this information is helpful to you in some way. I know it's an "easy out" for your manager to compare you to the "X" hospital's way of doing things... There is, however, nothing wrong with encouraging all nurses to do their best for their patient's continuity of care. It only speaks well for the hospital and the patients tell their friends and family all about their birth experience and the ups and downs of their hospital experience. I know that the patient's felt more comfortable (because they said so) that the L&D nurse and the Mother-Baby nurse were together in the same room at transfer. It made the patient's feel that they could trust the new nurse (after having established a relationship with the L&D nurse) since the L&D nurse was present and introducing the patient to the new nurse. It's all part of that "contract" we make with our patients when we accept and end our care with them. I believe we learned about "patient contracts" in the first quarter of nursing classes in our school...

Again, good luck. Try to focus on the things that are going well, and document any problems with the date, time, patient ID number, and just the facts of what happened... no emotions. If what happens could end up going to court, write up an incident report form and send it to your Risk Management Department. I don't know what else to say other than that you seem to be doing the right thing by speaking to your manager about things. If you ever feel that you need to go "higher up" for resolution of a problem, be sure to follow the chain of command. All management stick together in this respect.

Good luck, and enjoy your patients! That's what its all about!!

fergus51 · Aug 25, 2002

Sounds like your hospital has some problems. I MUCH prefer couplet care and find that five couplets is busy, but manageable. I HATE having just moms without the babes because usually the mom wants to see her baby and it makes breastfeeding more difficult.....