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: Elective deliveries prior to 39 weeks (loaded 10/11)
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
- Clinical practice: Enhanced labor progression (loaded 10/11)
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).
- Emergency department OB triage policy #12898 (loaded 07/12)
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 policy: WIS - Obstetrical department standing orders (loaded 010/12)
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: Postpartum hemorrhage: Early identification and management (adult) (loaded 03/12)
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: Management of preterm labor (loaded 07/12)
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.
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: Adhesion barrier use in cesarean sections (loaded 10/11)
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.
- Counts: Sponge, sharp and instrument policy #12688 (loaded 07/12)