What is your policy for scheduling inductions?

NPinWCH · Jan 24, 2004

I work in a small rural hospital with a level 1 nursery. We staff 2 RNs or 1 RN/1 LPN with a 3rd nurse on call (at night anyway). I WISH we had a policy similar to yours, but alas we don't :confused: .

Our docs, all of whom are family drs except 1, schedule inductions whenever it is convienent for them. I'm not kidding I've started pit on a 39 wk 3cm G1 at 2100 on Saturday night for no other reason than, and I quote, "Well, she says she's just too tired and miserable and she won't be happy until she has the baby."

I've even had to fight with docs because they wanted to do an induction of convienence when we only had 1 labor bed available. I would definitely NOT allow that one dr to do as he wishes or you may be back to square one with the others!

dnellnelson · Jan 24, 2004

Our unit has been trying to develop a protocol for all scheduled procedures. Currently we limit inductions to 6. There are 8 slots. 2 of each, MN, 5:30am, 730am,and 9:30am. When we have six slots filled we X out the other 2. This does not include c-sections, BTLs,cerclage, or occassionally infant eye laser procedures. That also does not include the add ons that occur all day long. By that I mean inductions and c-sections, not laboring patients. It is total chaos on some days. We are going to try to limit the total scheduled procedures and have a list of 4 levels of priority for scheduled procedures. This way hopefully we will have something in writing that allows a charge nurse to reschedule patients that are a lower risk. The trick will be to get the docs to play by the rules. I would like to limit total procedures to 8. That could be any combination of surgical and inductions. It is a matter of patient safety. You have to have some space left for patients that walk in the triage in labor. Yes spontaneous labor does occur. I have seen it on occassion! lol We do about 250 deliveries/month- level III center. We have 12 LDR and a 30 bed mother/baby unit. So we can get backed up fast. I am needing suggestions as well.

PegRNBSN · Jan 24, 2004

We have 9 LDRs and 2 c section rooms, but one anesthesiologist. We do about 3,000 deliveries a year.

We currently limit our scheduled procedures to 3 per am (surgicals and inductions) Cervidils count for the next day.

We are short on M/B beds and back up frequently, the reason for limiting it to three. We staff 8 nurses 07-23 and 7 23-07 ( Which includes staffing an eight bed antepartum unit) We are currently trying to get approval to increase our staffing numbers by one each shift. We usually have to postpone or cancel inductions about 3-4 times per month. The doctors of course want more spots. We also have an RN who starts at 0500 to help with am admits

dnellnelson · Jan 24, 2004

How many MB beds do you have? Do you have a triage, if so how many patients come through there per month? 8 nurses to take care of 9 LDRs, 8 antepartum , and surgical cases sounds very low. What is the RN/pt ratio in the antepartum area? :eek:

L&D_RN_OH · Jan 24, 2004

Originally posted by nellnell
8 nurses to take care of 9 LDRs, 8 antepartum , and surgical cases sounds very low. What is the RN/pt ratio in the antepartum area?

This is similar to our unit. We staff 4 L&D nurses for 7 LDRs, plus triage and RR. And 2-4 MB nurses for 9 MB couplets and/or GYNs.

We try to limit scheduled cases to 3 per AM. But we have had to reschedule when we are backed up.

rdhdnrs · Jan 24, 2004

We have six or seven RNs, depending on the day, one LPN, one triage nurse. This is for 11 LDR beds, two ORs. We cap scheduled procedures at four, because our clinic is so busy and we always have admissions during the day from them. We count cytotec inductions as the next day. We do have one doc who brings in pit inductions sometimes at 0200 or 0400. We count them as the date they come in. It works out pretty well, actually. We don't have scheduled procedures on weekends or holidays. Except, of course, NSTs from our antepartum service.

Dave ARNP · Jan 24, 2004

How do your doc's react when you tell them that they can't schedule a procedure?

At one of the largest heart hospitals in the state, nursing was turning down alot of the cardiac doc's procedures as they didn't have enough staff. Now a good portion of the cardiac nursing and Rad department is laid off, as their biggest group of cardiac docs pulled their privilages and went to another hospital.

We only have one Ob/Gyn group here in town now, which my wife is the director of. I can only imagine how she would react if she wanted to do a procedure and ANYONE told her that she couldn't.

Dave

dnellnelson · Jan 25, 2004

Refusing to admit truly elective procedure on a busy day should be carried out as a last resort. You have to maintain patient safety. I would hate to see someone throw a temper tantrum to get "one more" elective procedure added to an already chaotic, understaffed unit and then be documenting a sentinel event later. It is not always about convenience. I think mosts units bend over backwards to accomodate patients and physicians but there are days where you have to draw the line and say "STOP, we need to rethink our plan here". You have to prioritize on those days. Guidelines and common sense can be very helpful.

PegRNBSN · Jan 25, 2004

Our antepartum ratio is 4 to 1 unless high acuity. We sometimes have patients on our antepartum unit that are 1:1. Since it is the same staff as L&D and is connected to our labor unit we can keep patients on antepartum who need more intensive nursing care but don't need a LDR room.

Our docs grumble when we cancel inductions or won't schedule the fourth procedure, but because we truly only do it when it would be unsafe, they usually calm down quite quickly. The key is to point out what the consequences would be of admitting another elective patient, what it would do to patient care.

Now the patient and their families are another story. I have even had one dad demand that I "juice his wife up in a closet if I had to!" It really tries your patience some days.

We have three triage beds which we also staff, we don't do any testing though. We have 26 M/B beds. We usually have 180 outpatient visits per month.