Re: Amnioinfusion
From: Jamie (ajfields@pine-net.com)
Wed Nov 2 11:26:19 2005
I'm not defending the nurse's actions. They were counterproductive, and
her fears seem counterintuitive to me. The assessments I described are
standard care with any amnioinfusion. If I were concerned that a
specific method of infusion might increase IUP over another method, I
would monitor them more closely. My issue is with the few posters who
implied the nurse's job is only to follow orders, regardless of his/her
thoughts about their safety. Nurses are legally liable, even when
following orders. A physician can not completely remove responsibility
from the nurse.
Nurses are generally told in school and in CE the exact opposite
regarding policies and procedures, and in the last few years I've seen
some hospitals move to guidelines rather than P&P, allowing for some
legal flexibility. I'm going to research how that generally works out
in nursing malpractice cases-I have a feeling that plaintiff's attorneys
try to put all the responsibility on doctors when the doc is the
defendant but might change their angle when the nurse is in that chair.
And the situation may be entirely different when before the Board of
Nursing. Nurses can be disciplined for following order they should have
had the sense to refuse.
Nursing and medicine shouldn't be enemies. Why aren't policies
regarding patient care decided collaboratively? The risk is shared.
Would you have objected to the nurse stating her concerns and asking for
more information?
At Wed, 2 Nov 2005, Lynn D. Montgomery, M.D. wrote:
>
>First of all, based on several legal opinions I have gotten both locally and
>nationally during participation as an expert in cases, hospital policies and
>procedures are nursing guidelines and physicians can usurp these by simply
>writing an order. In doing so, they obviously assume the responsibility for
>same. Further, in our institution, the policies and procedures are written
>solely by the nursing staff and updated by same. Physician input is not
>engendered or accepted.
>
>Second, based a good study published by Wenstrom, et al in '95, encompassing
>644,000 deliveries and over 22,000 amnioinfusions, the protocol utilized for
>amnioinfusion made no difference in the incidence of any untoward outcomes.
>As such, statements regarding closely monitoring intrauterine pressure or
>weighing chucks to determine the efflux of infused fluid from the uterus are
>all futile measures that only serve to increase the anxiety level of the
>nursing staff and patients.
>
>The bottom line here is that without basis, a procedure that has been widely
>utilized and studied since 1985, was discontinued unilaterally by nursing
>staff - I wasn't notified prior to discontinuation. And worse, it was
>working and by stopping, placed the patient in the potential jeopardy of
>surgery.
>
>In follow-up, I have a new amnioinfusion protocol with supporting literature
>being disseminated to the department as we speak.
>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
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jamie
>Sent: Wednesday, November 02, 2005 9:54 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Amnioinfusion
>
>Quick intro first. I 'm a L&D nurse sidelined by latex allergy and general
>birth junkie. I get my fix by lurking here and debating birth on other
>boards. So you know my bias, 4 of my 5 children were born at home. I
>intend to remain mostly a lurker here.
>
>IRT the amnioinfusion disagreement, a clear and current policy would have
>protected the nurse. If the order was counter to the policy, she would be
>risking her own license and livelihood in following it. If the order was
>covered by the policy, she was clearly wrong and needs education. If there
>is no clear policy, once should be written to protect both the nurse and the
>physician. Nurses are in a difficult position as well. We can be held
>responsible for following orders that are unsafe or practicing
>inconsistently with hospital policy. At the same time, in many hospitals,
>policies are not kept current, placing us in the position of choosing
>between a policy that may not protect us b/c it is unsafe, and an order that
>goes counter to policy which leaves us equally unprotected. Reading this
>list over the past year has given me a much more sympathetic view of OBs in
>this litigious climate. I'm sure it is difficult when your own career is
>constantly at risk to remember that others may be in the same position. In
>the specific situation described, I would have left the infusion running,
>carefully observed IUPC pressures as well as the patient for symptoms of
>increased IUP, and if I was unsure of the safety of continuing contacted the
>physician to discuss the order. Especially given that the treatment
>improved the decels.
>
>At Tue, 1 Nov 2005, RModugno@aol.com wrote:
>>
>>In a message dated 10/31/2005 8:19:50 PM Eastern Standard Time,
>>forcep@intercom.net writes:
>>
>>Thats why obstetrical units need a Chairman of the Department who has
>>control of policy over physicians and nurses. And should be paid by
>>the monster, the Hospital,which should have the deep liabilty pocket.
>>
>>Exactly! This is a medical decision, not a nursing one!
>>
>>Robert Modugno MD MBA FACOG
>>Marietta, GA
>
>--
>Jamie
>
--
JFields, RN, BSN
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