Re: Non-reassuring tracing in latent phase Family doc and Head nurse
From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)
Tue Apr 28 11:45:52 2009
At Tue, 28 Apr 2009, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
wrote:
>
>At Tue, 21 Apr 2009, Charlie Chambers wrote:
>>
>>Along those lines, how many of you practice in hospitals where
>>guidelines for consultation are explicitly spelled out, or for
>>comanagement or assumption of care? We currently do not have anything
>>that guides those situations and it scares the heck out of me when I
>>later find out about some of the things that mid level providers were
>>managing without me being in the loop.
>>
>>******************************************************************************
>>Charlie Chambers
>>Hood River, OR USA
>
>>--
>
>Charlie here is what we use for the Family Doc's, I think guidlines are
>reasonable, I don't think the transfer of care wording is helpfull, as
>far as I am concerned once I am consulted any concerns can be redirected
>to me I have no problem with that, I prefer that family doc's notify me
>if they are doing a vacum after I have been consulted, especially if my
>assesment showed the baby to be OP, some do not do the courtesy of
>calling to tell me they are attemping a vacum delievery. If I have not
>been consulted they can do what ever they want to do and I don't
>consider myself responsile for thier mangement untill consulted.
>
Sorry low risk are normal vaginal and vacum
>• Normal vaginal deliveries (cephalic presentation).
>• Vaginal deliveries requiring vacuum extraction.
>This process should be properly documented in a contemporaneous fashion
>in the patient’s chart. Nursing staff should be made aware by both
>Physicians of the patient’s status and be made aware of which Physician
>to address when concerns arise. Essentially a consultation does not
>imply a transfer of care.
>PROCEDURE
>Transferal of care can only occur once a discussion and consensus has
>been reached between the patient, the referring Family Physician and the
>consultant Obstetrician. This process should be properly documented in
>a contemporaneous fashion in the patient’s chart. Nursing staff should
>be made aware by both Physicians of the patient’s status and be made
>aware of which Physician to address when concerns arise. Essentially, a
>consultation does not imply a transfer of care. The term “courtesy
>catch” should not be used as it is not recognized by the billing
>authorities.
>Consultation with an Obstetrician/Gynecologist (OB/GYN) is required for
>moderate risk conditions. It is understood that if the consulting
>Obstetrician deems it appropriate, he/she can assume care of the
>patient, although the Family Physician can follow the case along.
>For high-risk cases, transfer of care to the Obstetrician is to take
>place, although the Family Physician can follow the case along.
>Although not meant to be limiting and all-inclusive, the following
>represent cases of moderate risk needing consultation:
>1. Insulin dependant diabetic pregnant patient.
>2. Mild to moderate pregnancy induced hypertension.
>3. Non reassuring fetal status.
>4. Induction of labour (any reason).
>5. Augmentation of labour with Oxytocin.
>6. Prolonged rupture of membranes greater than twelve (12) hours of
>labour is not established.
>7. Prolonged labour longer than eighteen (18) hours.
>8. Prolonged active phase of labour (less than ½ cm dilation per hour
>in a two (2) hour period when patient is in active labour).
>9. Prolonged pushing of second stage of labour unless delivery is
>imminent (Primipara two (2) hours or Multipara one (1) hour).
>10. Any births under thirty-five (35) weeks gestation.
>11. Retained placenta greater than thirty (30) minutes.
>CATEGORY: Policy and Procedure PAGE: 2 of 2
>Subject: CONSULTATIONS – FAMILY PHYSICIANS
>12. Repair of third of fourth degree perineal lacerations and/or major
>vaginal or cervical lacerations.
>13. Antepartum, intrapartum or serious postpartum infections.
>14. Preterm rupture of membranes.
>Although not meant to be limiting and all-inclusive, the following
>represent cases of high risk needing consultation:
>1. Abnormal presentations.
>2. Multiple gestation pregnancies.
>3. Major antepartum, intrapartum or postpartum hemorrhages.
>4. Severe pregnancy induced hypertension.
>5. HELLP syndrome.
>
>--
> Take care, John
>
--
Take care, John
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