RN use of ultrasound in fetal demise cases

[April Tyler]

Are you as the RN and the Nurse in Charge that evening legally okay to use an ultrasound to reassure a patient that her baby's heart beat is no longer present? My Patient was not shown her demise at all on ultrasound and the doctor would not come in from home. The ultrasound tech at the hospital did not show her a picture of her baby either. They were still wanting me to give her the cytotec to induce labor; however the pt did not believe that her baby had passed without visual confirmation. No one would come a show her, therefor she thought htat she was terminating a wanted pregnancy. I put the ulrasound on her belly of 15 weeks and confirmed to her that her baby had passed. All the pt wanted was visual confirmation. I as a pt advocate did what I thought was correct and moral. The hospital suspeneded me for a week. Who is right ...the hospital or me for giving the patient and her family peace of mind and visual confirmation of no heartbeat? :confused:

Thanks,

April T.

[ijuanabhappy, ASN, RN]

Gosh, I do not know the legalities but I would feel so much better knowing that you put that poor woman's mind to rest so that it would not haunt her for the rest of her life. I would have done the same thing

[Jolie, BSN]

As a patient advocate, I would have supported her decision NOT to accept cytotec unless and until she had received the confirmation she desired that her baby's heartbeat had stopped.

I would have called the physician and reported that the patient would not consent to treatment until she had seen ultrasound results.

But unless you are specifically trained to perform an U/S and permitted to do so by your job description, I would not have done that.

My best to you, as I know that you intended nothing other than reasure a patient experiencing a terrible loss.

[Ericaj]

As someone who went through this myself, and a nursing student, you did the right thing absolutely. I did see the ultrasound in the doctors office, but still wanted to see the baby again "just to make sure" as crazy as it may sound.

You acted in the patients best interest and suspending you is absolutely ridiculous in this situation!

[wooh, BSN, RN]

Morally and ethically, I think you did the right thing. Unforunately, probably violated some rule and they're going to make an example of you so that none of you nurses will act up again and do something without being ordered to by a doctor. Because when the little nurses think they can do something without asking, then they might start questioning the powers that be! Hospital managment 101: Don't let the nurses find out they have brains that can actually think!

[klone, MSN, RN]

As a patient advocate, I would have supported her decision NOT to accept cytotec unless and until she had received the confirmation she desired that her baby's heartbeat had stopped.

I would have called the physician and reported that the patient would not consent to treatment until she had seen ultrasound results.

But unless you are specifically trained to perform an U/S and permitted to do so by your job description, I would not have done that.

This exactly.

I am not legally allowed to interpret U/S data or diagnose a fetal demise. I would have very quietly raised hell until that doctor came into the hospital to talk to the patient, or a radiologist officially read the U/S.

[LoveANurse09]

Just a thought, could you have used a doppler to let her hear there wasn't a heartbeat,since the baby wouldn't have been viable anyway? But thas awful that you couldn't get a doc to come in!

[PostOpPrincess, BSN, RN]

It is not in your scope of practice to interpret an ultrasound. That's a physician's call.

I hear where you are coming from though, and unfortunately for you, the outcome was not good.

I think you have the right to create an incident on the doc who refused to come in. There should be a reason you were "pushed" to the limit.

J

[bagladyrn, RN]

Unless you are properly trained and certified it is a liability for you to use the ultrasound. I would, however, have insisted that the physician come in or order a repeat ultrasound to be shown to the patient prior to administering the med. If the physician refuses, go up the chain of command until satisfied. (That doc would have gotten very little sleep until he/she cooperated!)

In the interim, you can continue to support the patient and reassure her that she is perfectly within her rights to request this.

[Zookeeper3]

A manager, or house supervisor or the medical director could have been brought in to facilitate an ultrasond being done by a trained person.

Nursing is gut wrenching, but it can't force your hand. The patient always has the right to refuse, and unless she was crashing from sepsis, it could have waited a few more hours until the ultrasound request could be done.

You practiced out of scope. Because your reasons were honorable does not change the scope of practice issues you are held to. I'm not intending to sound harsh... but others here whom think this was a good call are off the mark! You need to see that to aviod making a call like that again. It is a good learning experience because no one was hurt.

[Coffee Nurse, BSN, RN]

Is the problem in the use of the ultrasound equipment, or in the nurse making the "diagnosis" of IUFD? It seems to me that the diagnosis had pretty clearly already been made, if the doctor wanted to induce; the OP wasn't making a diagnosis herself.

Of course, if the actual use of the US machine is outside of the RN scope of practice (enough to warrant a suspension), then that's another kettle of fish.

Either way, my sympathies go out to you and that mom, April. Sounds like it was an awful situation, and your heart was clearly in the right place.

[PostOpPrincess, BSN, RN]

Is the problem in the use of the ultrasound equipment, or in the nurse making the "diagnosis" of IUFD? It seems to me that the diagnosis had pretty clearly already been made, if the doctor wanted to induce; the OP wasn't making a diagnosis herself.

Of course, if the actual use of the US machine is outside of the RN scope of practice (enough to warrant a suspension), then that's another kettle of fish.

Either way, my sympathies go out to you and that mom, April. Sounds like it was an awful situation, and your heart was clearly in the right place.

She was practicing out of her licensure limits.