SOS, need Joint Commission advice

[ReadytoretireOBnurse]

At our recent JC visit we were cited because we had a delivery table that was prepared and stored in a supply room covered with a drape and transported to the patient room for delivery. The issue was a concern that someone could access it ( hit it and contaminate), however it is in a locked room with only staff access AND that it was being transferred to the patient room in a "dirty" hallway. It was covered at transfer. Does anyone have any suggestions that we could develop. Also, the reason that we currently do NOT leave them in the patient room is a concern family/children may disturb/contaminate the table and there is not a secure area to store in the patient room.

[Rose_Queen, BSN, MSN, RN]

I don't know about L&D guidelines, but the Association of periOperative Registered Nurses requires visual monitoring of all sterile fields/tables that are set up. Doesn't matter if they are covered or not- the only way to ensure that the sterility was not compromised is eyes on it. Also recommend that fields/tables are prepared as close to the time needed as possible- that setup and monitoring is for unanticipated delays only.

[klone, MSN, RN]

I don't know about L&D guidelines, but the Association of periOperative Registered Nurses requires visual monitoring of all sterile fields/tables that are set up. Doesn't matter if they are covered or not- the only way to ensure that the sterility was not compromised is eyes on it. Also recommend that fields/tables are prepared as close to the time needed as possible- that setup and monitoring is for unanticipated delays only.

A lady partsl delivery is not a sterile procedure, so while all the instruments are sterile and the table is set up in a sterile fashion, it doesn't have the same expectation that it must be visualized at all times. It's standard practice to set up a table, drape it, and then put it in an empty room (or the laboring patient's room). It's also standard practice to keep a minimum of one table set up for each laboring patient on the unit, +1 for spare in case you have a precip walking in. It's good practice to set up the table as soon as the woman is in active labor.

OP, it's my experience that if you have a written policy on the procedure for set-up and storage of lady partsl delivery tables, and you can speak to your rationale for your policy, that's good enough. Delivery tables are a VERY gray area. TJC does not provide a guideline or recommendation, they just say "Have a facility policy based on current infection prevention evidence, and then follow it."

[klone, MSN, RN]

Thinking more on this - TJC surveys are very subjective, depending upon the surveyor. Unless you get a surveyor who has a background in OB, they are not going to know any of the stuff I wrote above. They, like Rose Queen, will assume that it's a "sterile" table such as what you would find in the OR, and should be treated as such. I've found after doing numerous CMS and TJC surveys, that YOU need to be the expert. TJC is not the expert. If you can speak with authority about your practice, demonstrate that it's based on current evidence, assure them that it's standard practice everywhere, and have a policy that backs you up, they are usually content with that. There have been a few times where I have had to actually go to the TJC website, print out THEIR policy or position statement on something, and SHOW it to the surveyors to get them to back down on something. Don't fall into the trap of assuming that what the surveyor says is gospel. They're fallible too.

[Ilikeletters]

We have a policy that tables can be made for patients at 6cm and moved to their rooms. We always have at least one table set up in the OR hallway except for when JCO is around. They are fine with the 6cm in room policy.

[mortsg]

I can appreciate all of the above comments. Specifically in your case, maybe a locked cart containing the necessary items for a table to be set up that can be placed in the patient room and can be set up at the desired dilation and comfort level of that patient's nurse. " Sorry about being cited. After 29 years in L&D I can appreciate how "unrealistic" the entire Joint Commission process can be.