Category:OB & Newborn: Difference between revisions

From Guide to YKHC Medical Practices

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At this time, if a newborn is well, but has borderline or questionable screening labs that require 48 hours of antibiotics and observation, the infant will need to be transferred to NW or to ANMC.
At this time, if a newborn is well, but has borderline or questionable screening labs that require 48 hours of antibiotics and observation, the infant will need to be transferred to NW or to ANMC.
=[[OB Triage Patients]]=
=[[OB Triage Patients]]=
==OB Admissions==
OB patients are generally admitted only for when they are in active labor unless an OB Triage patient requires more than 24 hours of observation. Other OB admissions might be for a C-section post-op problem or a pregnant woman (>20 weeks gestation) but with a different primary diagnosis requiring admission…Although these technically would go to NW for admission they might be admitted to OB with permission from OB nursing staff.
*Complete a general admission H&P and include pregnancy problem list and prenatal labs.
*Complete the Medication Reconciliation
*Complete an E&M charge
*Update Diagnoses and Problem List
==OB Progress Labor Notes==
A note/update must be completed every four hours for any patient in active labor.

Revision as of 22:20, 26 May 2015

Unit Description (Facility)

The OB Unit consists of 6 LDRP (Labor-Delivery-Recovery-Postpartum) rooms with a bed total of 16 (8 mother and 8 newborn), one C-Section Delivery room, two OB Triage rooms, an infant treatment area, and a potential infant isolation area. Additionally, Room #1 can function as a negative air flow isolation room.

An average of 400 deliveries occur annually with the number increasing each year. The unit provides care to outpatient and inpatient obstetrical patients with a gestation of > 20 weeks gestation as well as newborns born in the unit. There is no nursery and babies room-in with the mothers unless they are being observed for a short while or are being stabilized for medevac.

Overview

The OB/NEWBORN scope of service includes routine vaginal births, external cephalic version, ante-partum testing, elective and emergency primary and repeat cesarean sections, pre-induction cervical ripening, labor induction/augmentation, low-risk VBAC (vaginal birth after C-section), stabilization of a sick neonate for transport and stabilization of the preterm or term patient for transport.

Family medicine hospitalists do all deliveries and take care of all mother baby pairs unless HROB (high risk OB) consultant assumes care of the mother (especially post-op) or pediatrics assumes care of an ill newborn. The average healthy mom/babe pair stays for 48 hours. This is because most of the patents will be returning to a remote village where access to care and travel back to Bethel may be difficult. Some exceptions are be made for Bethel patients who may leave as early as 36 hours. For billing purposes if a mother or baby is staying longer than 48 hours (or 2 hospital days) a justification for the increased length of stay must be given. If a patient delivers later in the evening, yet before midnight, consider discharging the mom and baby to pre-maternal home in the evening for travel home the next day.

There is on call pediatrician available for all newborn consulta¬tions. Pediatricians also attend all C-Sections and any deliveries on infants who are less than 36 weeks gestation or as requested. Note: We try to get moms to Anchorage if they are less than 36 weeks gestation. Some babies that are delivered close to 37 weeks, but many will have problems with feeding and maintaining temps. These babies will be need to be transferred to Anchorage when they are stable. Moms may travel with them if it is more than eight hours after delivery and they are stable post partum. Pediatricians also attend meconium deliveries and any other deliveries where there is evidence of significant fetal distress. Pediatricians are available to come to any delivery that a FM physician has concerns about the fetal/newborn status.

All sick newborns should be seen by the pedia¬trician to arrange or assist in arranging a transport via LifeMED with or without a NICU NP.

Because there is no nursery and limited nursing staff, all babies that need more than mother’s care must be transferred to Anchorage. Each delivery room is set up for meconium deliveries and any initial resus¬citation. If a baby requires ongoing resuscitation or intubation, they are moved into the procedure room. There are two neonatal crash carts, one in the procedure room and one on the unit across from the nurse’s station. The carts have all the needed resuscitation supplies and meds. On top of each cart are neonatal resuscitation worksheets with equipment sizes, medication doses, and fluids based on weight or estimated gestation age to guide resuscitation.

The goal of OB nursing and provider staff at YKHC is to ensure the safest delivery and the best care possible for our newborns as well as promoting good maternal-newborn bonding and avoiding separating moms and babies whenever possible.

Occasionally infants will be delivered that will need further evalu¬ation, observation, interventions and/or transport to a higher level of care. Because we do not have a nursery or the staffing level to care for sick infants we need to decide which baby’s will need to be transported out. We can do some limited observation and supportive care, but for all sick infants that require a higher level of care, providers will stabilize and transport the patient as quickly as possible.

If a newborn has a possibly transient condition (examples: TTN, low glucose, minor depression from precipitous delivery etc.) a baby may be evaluated and watched in the nursery for a limited length of time. If the newborn is not showing signs of improvement and it does not appear that they can be cared for as a rooming in patient with mom by 4-8 hours of life (depending on staffing and nursing comfort level), arrangements will be made to medevac the infant.

If a newborn is stable and shows no signs of illness or instability (i.e. can room in with mom), but needs labs and observation for 48 hours (ex: GBS exposure without appropriate maternal prophylax¬is or jaundice and phototherapy) the baby may stay with mom in OB with or without a heplock in place. Heplocks will be monitored per hospital policy.

At this time, if a newborn is well, but has borderline or questionable screening labs that require 48 hours of antibiotics and observation, the infant will need to be transferred to NW or to ANMC.

OB Triage Patients

OB Admissions

OB patients are generally admitted only for when they are in active labor unless an OB Triage patient requires more than 24 hours of observation. Other OB admissions might be for a C-section post-op problem or a pregnant woman (>20 weeks gestation) but with a different primary diagnosis requiring admission…Although these technically would go to NW for admission they might be admitted to OB with permission from OB nursing staff.

  • Complete a general admission H&P and include pregnancy problem list and prenatal labs.
  • Complete the Medication Reconciliation
  • Complete an E&M charge
  • Update Diagnoses and Problem List

OB Progress Labor Notes

A note/update must be completed every four hours for any patient in active labor.

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