Provider Orientation & Resources  

All Obstetrical Providers

 

Note: open ALL links and attachments that are applicable to your area(s) of practice.

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Clinical practice: Elective deliveries prior to 39 weeks
Establishes an expected clinical practice that elective singleton inductions or cesarean sections will only be performed on patients who are 39 weeks or greater gestation.


Clinical practice: Oxytocin administration for labor induction and augmentation
Establishes a standardized protocol for Oxytocin administration for induction/augmentation of labor including standard concentration and rate adjustment protocol (includes physician on-site assessment of the patient before exceeding dose of 24 mu/min).


Clinical practice: Enhanced labor progression
To enhance the progress of labor, a peanut-shaped exercise ball will be made available to every patient (with few exceptions) in active labor.


ED OB triage policy: Laboring and non laboring obstetrical patient triage assessment and disposition: Presenting to the Emergency department or OB triage.
Establishes guidance on triaging to most appropriate area (OB or ED) for pregnant patients over 20 weeks gestation presenting with potentially obestrical related complaints (mainly L&D), life threating conditions (mainly ED), and non-pregnancy related complaints (mainly ED). 


Clinical policy: WIS - Obstetrical department standing orders
To provide a set of Medical Staff approved Standing Orders that the Hospital Obstetrical Department Registered Nurse (RN) can initiate for patients presenting to the Obstetrical Department, including Obstetrical Triage Labor Evaluation, Preterm Labor, and Scheduled Cesarean Section standing orders.


Clinical practice: Indwelling urinary catheter use during labor
As routine placement is not recommended, this practice outlines the clinically necessary indications for placement of an indwelling urinary catheter in patients in labor.


Clinical practice: Postpartum hemorrhage: Early identification and management (adult).
This clinical practice outlines the expectation that all Obstetrical patients will be assessed for prevention, early identification and appropriately staged treatment of Postpartum Hemorrhage.


Clinical Practice: Management of Shoulder Dystocia
It is an expected clinical practice that all women in second stage of labor will be monitored for possible shoulder dystocia.  Upon identification, a defined timely sequence of interventions will be initiated, involving maneuvers to relieve the dystocia by manipulating the fetal position and maternal pelvis.


Clinical practice: Acute blood Loss Anemia Documentation (ABLA) in surgical patients
All surgical patients will be evaluated for acute post-operative blood loss anemia based on clinical indicators.  Accurate documentation of the clinical indicators used, the results of this assessment describing the extent of the acute blood loss anemia (ABLA), and any therapeutic treatment provided will be recorded in the medical record.  ABLA should only be documented when 1) blood loss of sufficient amount requires transfusion of blood products or 2) transfer to higher level of care (example – outpatient admitted after procedure or inpatient transferred to either a monitored bed or ICU).  ICD code assignment of ABLA will occur if documented as such by provider.


Clinical practice: Management of preterm labor
All patients with preterm labor between 24 0/7 and 34 0/7 weeks gestation will be evaluated using a standard process including cervical dilation, effacement, fetal fibronectin results and, when appropriate, cervical length.  Need for admission and treatment will be based on these findings following the preterm labor algorithm.


Clinical practice: Elective induction 39 weeks gestation or greater
It is an expected clinical practice that elective inductions will only occur in gravid patients at 39 weeks gestation or greater with a favorable cervix, defined by the Bishop score. This clinical practice has been defined but not yet fully implemented.


Clinical Policy: WIS: Perinatal prevention of early onset group B streptococcal infection
This clinical policy is utilized to identify and treat at risk mothers and screen at risk infants, in attempt to decrease the incidence of early onset group B streptococcal infection (GBS) including screening protocol, indication for intrapartum antibiotics and recommended requirements for intrapartum antibiotic prophylaxis.


Clinical practice: Chorioamnionitis management and the well term newborn
All infants born to obstetrical patients diagnosed with chorioamnionitis or suspected chorioamnionitis will have a neonatal chorioamnionitis management plan initiated within the first hour after birth. Once the diagnosis of chorioamnionitis or suspected chorioamnionitis is established the newborn infant will receive an evaluation and antibiotics administration.  All ill-appearing babies should receive the full sepsis evaluation and initiation of antibiotics soon after birth.  The approach to initiating antibiotics for well term/appearing infants will be as follows: a) blood culture to be drawn soon after birth, ideally within the first hour of life.  CBC can be drawn at the same time, or up to 6-12 hours of age; b) the first dose of antibiotics to be administered within three hours of birth.


Clinical Practice: Prevention of Pertussis – Use of Tdap Vaccine in ED and Obstetrical Patients
To improve immunity against pertussis, providers should not miss an opportunity to vaccinate people.  This expected clinical practice outlines that all obstetrical patients will receive a Tdap vaccine in their third trimester or postpartum if not vaccinated during their current pregnancy in accordance with ACOG guidelines.  This clinical practice has been defined but not yet implemented.


Additional items for obstetrical surgeons

Clinical practice: Adhesion barrier use in cesarean sections
Adhesion barrier products such as Seprafilm and Interceed should not be used in patients having a cesarean section at Banner Health.

Clinical Practice: Stat Cesarean Deliveries
It is an expected clinical practice that all pregnant women requiring a Stat cesarean delivery will receive timely life-saving obstetrical interventions to facilitate rapid delivery that would allow for resuscitation of mother and newborn.  This clinical practice outlines process components that should be utilized to ensure optional outcomes for mother and newborn in the event of a stat cesarean section.

Safe surgery policy
Standardizes safe practices to ensure correct patient, correct procedure, and the correct procedural site/side for procedures performed in the operating room. This includes appropriate marking by surgeon’s initials at surgical site if procedure involves laterality or multiples, a formal briefing in the OR prior to starting the case with all members of the surgical team in the room, a formal Time Out lead by the surgeon and involving all members of the team (an orange Time Out towel is used as a memory trigger), a formal counting process, and formal debriefing process at the end of the case led by the surgeon.

Counts: Sponge, sharp and instrument policy
Outlines the counting procedure used to account for items such as sponges, sharps, and instruments to prevent injury to patients as a result of a retained item.


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