Time: in room to epidural?

BirthCenterRN · Nov 13, 2007

I work in a pretty busy birthcenter also. I would say 1/2 hour- 45 minutes. We do have to do all the paperwork too but I would have them sign the epidural consents first, get them on the monitor and start the auto vitals, get the IV started and start the bolus, check her cervix, page anesthesia (their eta is usually

I have to add that most of our admission paperwork is done prior to arrival *profile, birthplan, consents for baby, acog* Our doctors use the same computer system that we do so we just update any allergies and current meds if needed. Most of the time anesthesia asks these questions and I record at that time. The H&P is in the computer form their last OB visit which is typically within the last 7 days as our standing orders require. We have standing orders for admission from our OB doctors and we just page them to let them know that the patient is on the unit. We also have all of the supplies for epidural, delivery table, and baby warmer in every room prior to arrival. These items are in a locked closet in between 2 LDRP rooms.

If I had a patient who was new to our system and did not have anything done prior and nothing in the computer, it would take alot longer. But we do have orders for nubain IV and I would get the that because it last 1-2 hours and takes the edge off while they wait.

Hope this helps.

CoffeeRTC, BSN, RN · Nov 13, 2007

Well...I'm told, much quicker than my timing. LOl.

Went to triage at 12 in active labor with #4 baby. By the time I got to the LD rooms, it was 3 hrs later...another 2 hr wait (waiting on labs to r/o assess Pre E/ HTN issues) then it was almost an other 1.5 hrs due to a back up with emergency C sections.

This was in a major womens hospital. LOL. I remember just thinking in horror that I would need to go it all natural.

Can't wait to hear all the responses.

bagladyrn, RN · Nov 13, 2007

In bigger facilities I have worked contracts in, I'd say it is possible that she might get her epidural within an hour if (big if) anesthesia is in house and not tied up in the OR. In a small facilitiy where the anesthesia and OB providers are at home at night, I'd say not less than 1 1/2 - 2 hours, depending upon how far out the providers are. Of course, if it seemed prudent, we would call the anesthesia provider right after assessing/checking the patient and get the IV going and the paperwork done while they are enroute.

I've also seen patients very upset when they didn't get their epidurals as fast as they thought appropriate, including one multip (G4) who drove past her local (reservation) hospital where epidurals were unavailable to our hospital, arriving at 100%/8/+2/ bulging bag saying she really wanted an epidural with this birth. After an immediate SVE, I was paging the OB at home and explaining that the CRNA would be paged but was unlikely to arrive from home before her delivery when she ruptured her bag of water and immediately delivered into my hands (I said, here it comes and hung up on the doc). Even after the delivery, holding the baby in her arms, she kept looking at me and repeating in a plaintive voice: "But I really wanted an epidural"! Luckily, a few hours later she was able to laugh at herself!

I do think docs and anesthesia need to make the time frames, required test and IV boluses as well as possible delays if anesthesia at home or in OR clear to the patients long before they come in to the hospital.

nurseynightnight · Nov 16, 2007

It usually takes us at least an hour. By the time someone comes in, assess dilation, call Dr. or MW for admit orders, start IV/bolus, wait on lab results then call anesthesia. I work night shift and they are not in house 24/7 at our smaller hospital. So they have to wake up, get dressed,etc... It usually takes 20 minutes just for them to show up since it isn't an emergency.

I do think most mom's assume it can be done as soon as they walk in the door. They don't realize what we have to do before hand.

waterfall99 · Nov 16, 2007

I feel pretty lucky, the last 2 places I've worked, we could probably get them comfortable in

Both places require only an IV, as long as no hx or sx of pih. I get the important questions, and do all the rest later. The only consents they sign are for a c-section.

Anesthesia can generally be in the room in 5 minutes, unless they're tied up somewhere else.

If a patient comes in super active, usually other nurses will help, and we can have an IV, delivery set up, etc pretty darn quick.

eden · Nov 16, 2007

It depends. We don't need to do labs or any consents, the anesthesiologist does the consent when he come in the room and unless the patient is high risk we don't need to do labs. All we do is start the IV before we call but wait times depend on if they are busy or not. We do close to 6000 deliveries/year so you can get one right away if there's no sections (like within 10 minutes) or the worst I've heard of is 7 hours due to several crash sections in a row. Average wait is about an hour though. An epidural is a part of our standing orders so when the doctor sings the orders the patient can get an epidural without us having to chase down an OB.

mitchsmom · Nov 17, 2007

I'd say between 1-1.5 hrs., usually. Our anesthesiologists require 2 liters bolus... so that takes time. I think it's ridiculous, since it seems like no one else uses this much. I'd be curious to see if there is any evidence for it.

Occasionally someone will get lucky and anesthesia will go ahead and do it before 2L if they are on the unit already anyway. I try to give all my patients the spiel when they come in, so that they can sort of know what to expect & plan. I tell them about the bolus and that it takes a while, etc. The good thing (I guess) is that they will do it all the way up to the end as long as mom passes the sheet test (no baby falling out when you check under sheet :).

We also have to order our infusion from the pharmacy each time and it has to be hand carried up, but really that doesn't matter because we're waiting on the bolus anyway.

I get my consent signed when patient presents - it's for anesthesia of any kind so it would apply for cesarean or epidural. I get consents done before patient is dying in pain anyway when possible so they can think straight. :)