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Re: AmnioinfusionFrom: ainsron (ainsron@sbcglobal.net)Mon Oct 31 18:07:03 2005
Like others have said, you need to be sure the unit policies and procedures address this in the way the medical staff want it to. The unit director should not have the ability to veto a physician's order, even if it is not addressed in the units policies and procedures. It is always appropriate for a nurse to question the orders she sees as being at risk for patients she cares for. However, when push comes to shove, the physician should have the final say, not the nurse. T Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn D. Montgomery, M.D. Sent: Monday, October 31, 2005 3:27 PM To: Multiple recipients of list OB-GYN-L Subject: Amnioinfusion Listers, I eagerly await your collective comments on the following that occurred to me today. Had a patient in labor at 5 cm, who began to have fairly significant variable decels. An IUPC was placed and an amnioinfusion ordered. My practice has always been to hang room temperature normal saline and allow it to infuse via PASSIVE infusion (not on a pump) and have continuous infusion. I have done this in my current facility for 7 years and overall for 17 years. In this case, the amnioinfusion was started and the variables resolved. However, the new nursing director of Labor instructed the nurses to discontinue the amnioinfusion because the continuous infusion was dangerous and not covered by the hospital policy. The variables recurred shortly thereafter. I called her and asked her why she had given such instructions. She stated that she had been involved with amnioinfusions for years and never seen it provided as a continuous infusion and she considered it unsafe. I advised that with passive infusion, there was no way it increased risk and there was no data to support this. She replied by saying that she could understand why this wouldn't increase the risk, but she was still uncomfortable and would not allow "her nurses" to engage in this activity. Fortunately, during the exchange, the patient went to complete and delivered shortly thereafter. I have never felt quite so helpless in my career. Lynn Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net
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