Re: Non-reassuring tracing in latent phase Family doc and Head nurse
From: Charlie Chambers (ricechaz@me.com)
Tue Apr 28 22:28:51 2009
Thanks John. Looks like a good starting point.
*************************************************************************
Charlie Chambers
Hood River, OR
cchamber@alumni.rice.edu
"No matter where you go...
there you are."
Dr. Buckaroo Banzai
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On Apr 28, 2009, at 9:35 AM, 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.
>
> • 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
