Re: Induction protocols
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Mar 3 13:47:40 2005
The pharmacy does a compounding procedure - dilutes the original
suppository into equally 2 or 3 mgs vaginal ovules.. (I don't know the
exact steps) but the amount is pretty much accurate..
The key for success for inductions as far as logistics goes- is
physician's cooperation - to stick to the rules - sometimes tricky when
there are some "wise guys" ...
Prepidil and cervidil are to expensive for our setting...
>At Thu, 3 Mar 2005, Seele, Mona wrote:
>
>I am surprised that you are using the prostin because pharmacy has to cut
>the suppository which means there is no guarantee of exact dose... we used
>to use that prior to prepidl and cervidil days, but once those products were
>available, we went to them. We also use cytotec, which is the cheapest, but
>not all md's are using; however most use either cervidil or cytotec, not
>much use of prepidil or laminaria.
>
>I work at the hospital that Dr. Chudacoff practices at and we do have an
>unusually high number of inductions...simply to be sure that we can
>accomodate all of our patients. We have guidelines for inductions and the
>doctors are great about following the rules. A labor patient or a medically
>indicated induction always takes precedence over an elective. We have a
>couple of evening slots for induction and then two more for the am (four
>induction slots total). We also have a slot for a 0730 and 1230 c/s that
>can be used for induction if not being used for c/s. There are times when
>we cannot accomodate that many inductions and then we prioritize according
>to need first and when they were scheduled next. Usually we can get all of
>them in and started sometime during the day they were scheduled, but if not,
>then we move them to another day or the doctor takes them to another
>hospital.
>
>We are so regimented because we have only 12 LDRP's + 3 triage beds and have
>30+ OB/GYN's wanting to use the unit. We can utilize beds in the adjacent
>unit for postpartum patients if we need to get a labor patient or medically
>necessary patient in. Because there is such demand, the physician's have
>been great about "the rules" and if someone violates they have also been
>great about handling it amongst themselves.
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
>eramirezt@coqui.net
>Sent: Thursday, March 03, 2005 1:35 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Induction protocols
>
>Cytotec was banned from our hospital - we are only using prostin
>suppositories - outpatient preinduction ripening is not allowed by our
>protocol.
>
>>At Thu, 03 Mar 2005, Andrew Folley wrote:
>>
>>Andrew responds:
>>Thanks for the fedback. It sounds lie we all are seeing and doing more
>>"elective" inductions. I do not think it is necessarily "bad medicine" but
>>that it causes some logisitic prolbems and it may drive up health care
>>costs. Many of our inductions come in the night before and are hospitalized
>>with cervidil placement until am. I think the cervidil costs the hospital
>>about $150 and the charge to patient and insurance is about $400 plus the
>>expense of the extra day in the hospital. Any other thoughts on how we are
>>doing inductions? Oral cytotec? vaginal cytotec? laminaria ripening?
>>prostaglandin gel as out patient etc? andrew
>>
>>>From: islesannie@yahoo.com (Joanne Bulley, MD)
>>>Reply-To: ob-gyn-l@obgyn.net
>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>Subject: Re: Induction protocols
>>>Date: Wed, 2 Mar 2005 21:55:12 -0600
>>>
>>>This sounds like something the chair of the dept would need to hold some
>>>pow wows on -- rather than declaring the plan. One there is a plan,
>>>however, then there has to be a dicision on implementation.
>>>
>>>In residency with a dept of about 30 OBs ... yes - al iinductions were
>>>booked with L&D and the log was kept with the reasons etc. We really
>>>didnt' have many that were the truly elective ones -- and if we got more
>>>than we were agreed to handle the least urgent w=ones were put off --
>>>and I would guess that if we had a new policiy that it would be the dept
>>>chair (or his / her designee) that would be called if some irate doc
>>>called up demanding that patient Ms Doe be put on and there was either
>>>no room -- or it was not indicated.
>>>
>>>Joanne
>>>
>>>At Wed, 02 Mar 2005, Andrew Folley wrote:
>>> >
>>> >Dan
>>> >How does your hospital enforce the policy? ie how far in advance does
>>>one
>>> >call to reserve a day for induction. Dioes L and D keep a log? do you
>>>have
>>> >strict criteria for inductions to be met? I think our induction rate
>>> >(medically indicated and "elective" is about 30% which is alarmingly
>>>high.
>>> >Andrew
>>> >
>>>
>>>--
>>>Joanne Bulley, MD
>>>Keene, NH, USA
>>
>>_________________________________________________________________
>>
>>_________________________________________________________________
>--
> I think I will do nothing for a long time but listen,
> And accrue what I hear into myself...and let sounds
> contribute toward me.
>
> ~walt whitman~
>
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I think I will do nothing for a long time but listen,
And accrue what I hear into myself...and let sounds
contribute toward me.
~walt whitman~
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