Re: OB's and EBM--What do you do?
From: Barbara Nicol (blnicol@ix.netcom.com)
Sat Sep 2 11:31:07 2006
Our preprinted orders are strictly CDC, including what to do with GBS
unknown (risk factors)
- Barb Nicol, M.D.
>----- Original Message -----
From: "Anna Meenan, MD" <annam@uic.edu>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Saturday, September 02, 2006 8:09 AM
Subject: OB's and EBM--What do you do?
> It didn't take long at all after my return to L&D for deja vu to occur
> all over again.
>
> GBS unknown G4P3 in crashing good labor at term, presents 7cm, intact
> BOW, afebrile. Nurse orders penicillin herself (order is signed "V.O.
> Dr. Resident" and resident states he gave no such order)
>
> I complain to nurse manager and she sends nurse-who-writes-protocols to
> talk to me. Nurse-who-writes-protocols assures me that the new standing
> order sheets coming out next week will make this whole process easier
> because they will have a standing order for "GBS positive or unknown
> mom" (current standing order says "GBS positive mom") with boxes to
> check for the type of antibiotic you want given, and then all I or my
> resident will have to do is put a line through the order if we don't
> want it. I ask her why they would write standing orders that violate
> CDC guidelines, and why they continue to violate CDC guidelines IN SPITE
> of orders appropriately given or not given. Her answer was that I am
> the only one who declines to treat low-risk GBS unknown moms and
> therefore I am wrong and they are right. She says, "Why not treat?
> There's no harm in it." I ask her if she would like to testify for me
> someday after a mom has an anaphylactic reaction to pcn that was given
> in violation of CDC guidelines, or perhaps a case of pseudomembranous
> colitis after a dose of clindamycin.
>
> I ask nurse-who-writes-protocols what the nursing policy and procedure
> manual says on the subject and she says the head of the OB department
> will not allow her to write a nursing policy on the subject. I am
> guessing that his guys all decided it wouldn't be a good idea to put it
> in black and white somewhere that they routinely violate the guidelines.
>
> So, my question is: Do y'all treat low-risk GBS-unknown moms in labor,
> and if so, why?
>
> Anna Meenan, MD, FAAFP
>
