Transferring ob patients

[crazyinalabama]

Do patients being transferred to another hospital have to be accompanied by a RN? Who is liable for the patient until their arrival at the accepting hospital? The physician at the hospital I work at doesn't require a RN to accompany a patient on transfers, even if they are on MgSo4, which makes me nervous. The other hospitals where I have worked required a nurse to accompany the patient, no matter how far away, or how close.

[GilaRRT]

The answer to your question is multifactorial. This will depend on facility policy and the policy of the transport provider. EMS providers have their own certifying or licensing agency with state and local protocols and guidelines. Since, I do not know the level of provider you are talking about, the provider education, the provider qualification, and scope of practice, I am unable to make any informed statement regarding the team that transports OB patients from your facility.

Obviously, the transport team will be liable for the patient. However, the sending facility will still be responsible for the patient until care of the patient is transfered over to the receiving facility. The sending physician could have issues of liability if something goes wrong during the transport.

Why are you nervous about not having an RN accompany OB patients? A properly educated and experienced paramedic can safely and effectively care for an OB patient. Even OB patients on magnesium sulfate infusions. The key words are properly educated and experienced however. Obviously, high risk patients may need sub-specialty tams. This is where good physician judgment comes into play when looking for the most appropriate transport modality. Good judgment on behalf of the transport team is a must as well.

In fact, having an RN accompany the patient is adds additional liability. First, you take an RN out of their comfort zone and place them into a foreign environment with unfamiliar equipment, providers, and modalities. In addition, what if there is an accident? Now, we have an RN outside of their facility injured in another employers ambulance. Obviously, this complicates insurance and liability issues. Additionally, the RN will be working under the sending facilities guidelines, while the transport team will have their own guidelines and medical director. Obviously, this can create conflict and role confusion.

In fact, the ground transport environment is considered a critical care transport sub-specialty of nursing. This is validated by the fact that the ENA and ASTNA currently offer an exam that will result in board certification by the BCEN as a Certified Transport Registered Nurse (CTRN). Last I herd, the ENA was pushing to have the CTRN recognized by the ABNS.

So, the issue may be a little more complicated than simply having a RN ride along with the crew. Obviously, if policy/procedure, guidelines, and official agreements are in place, and providers are oriented and know their duties and responsibilities, having an RN accompany the patient is a possibility.

[Neveranurseagain, RN]

An RN may have to accompany the pt., depending on your county's or state's EMS policy's. Some areas only allow paramedics to transport pt. with drips that they are pre approved to administer and use out in the field. Check with the state and county to clarify.

I used to work as a paramedic, and was also an RN. When I worked as paramedic and had a pt. with a nitro drip or MgSo4, I would have to have an RN accompany me as these drugs did not fall under my scope of paramedic. If I was working and getting paid as a medic, then I could do only the scope of practice approved for a paramedic. To cross over and handle other meds would be working outside my paramedic license. And when I worked as an RN, I could only do procedures approved by the BON. The BON was so anal about me getting mixed up as to what I could do....

[crazyinalabama]

Thanks, it makes sense now. one night a paramedic had a fit that we were going to send a nurse because the patient had several complicated things going on with her. he said he'd need to call his supervisor, we were a liability, we wouldn't be able to touch the patient even if things went bad because we were not covered on their insurance.

[Neveranurseagain, RN]

As a medic, I would tell the hospital either send a RN with me or DC the drip during the transport as I would not work outside the scope of my license. It was up to the hospital and the ambulance company to work out a policy--preferably ahead of time. But most of the time they would DC the drip, depending on the transport time.

[GilaRRT]

They would discontinue a mag drip on an OB patient? Risky stuff IMHO.

[Neveranurseagain, RN]

If it was less than a 20 min transport--they would turn it off and have a RN meet us at the ER to turn it back on.

[HappyNurse2005, RN]

We are a receiving facility and many, many patients come without a RN. Some do, many don't. They come on mag, too. Most come by ambulance, some from close by (20 mins across town) some from more than an hour away. Occasionally they come by helicopter, though not too terribly often.

the transporters are liable, i suppose, until we recieve them. we can hardly be responsible for a patient that we have accepted, yet haven't even seen yet.