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Re: AmnioinfusionFrom: Henry Gregor (henrygregor@yahoo.com)Mon Oct 31 19:27:25 2005
Unbelievably difficult situation you describe and unfortunately, has all the earmarks of a "disruptive physician" slippery slope when you pursue it with hospital mnt and nursing service head. Hopefully, the hospital will see that its putting itself into a potential risk exposure situation. My cynical view of mgt...whether a hospital that's a member of a national chain, or local/regional independent...is that they will fight vigorously to support ancilliary staff over md staff. Unfortunately mgt can assign more woman/man hours to the analysis of this situation than you as a busy practiotioner would want to or could, and can probably run you into the ground with reviews, meeting, ad hoc committees, etc. Cynical I know, but just my view after a few years of observation. Proper documentation of all discussions, with chart entries, as well as filing risk review papers within the formal procedural process of the hospital should be pursued, along with a meeting of the director of nursing, birthing center and risk management officer for the hospital and chief of staff. Perhaps an overreaction, but just my two cents. Hank "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net> wrote: Listers, I eagerly await your collective comments on the following that occurred to me today. Had a patient in labor at 5 cm, who began to have fairly significant variable decels. An IUPC was placed and an amnioinfusion ordered. My practice has always been to hang room temperature normal saline and allow it to infuse via PASSIVE infusion (not on a pump) and have continuous infusion. I have done this in my current facility for 7 years and overall for 17 years. In this case, the amnioinfusion was started and the variables resolved. However, the new nursing director of Labor instructed the nurses to discontinue the amnioinfusion because the continuous infusion was dangerous and not covered by the hospital policy. The variables recurred shortly thereafter. I called her and asked her why she had given such instructions. She stated that she had been involved with amnioinfusions for years and never seen it provided as a continuous infusion and she considered it unsafe. I advised that with passive infusion, there was no way it increased risk and there was no data to support this. She replied by saying that she could understand why this wouldn't increase the risk, but she was still uncomfortable and would not allow "her nurses" to engage in this activity. Fortunately, during the exchange, the patient went to complete and delivered shortly thereafter. I have never felt quite so helpless in my career. 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
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