Nursing Care During Labor & Delivery

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 1 Labour and delivery section are designed and equipped to facilitate the safe and effective care of patients.
L&D 2 Each L&D is organized physically and functionally as a distinct entity within the hospital.
L&D 3 Sufficient floor space is allocated to each bed to accommodate the equipment and personnel necessary to meet the patient’s needs and any emergency situation.
L&D 4 Each labour & delivery ward provide appropriate space for the provision of services and the following:
Measurable Elements:
L&D 4.1 Single occupancy rooms and each room shall provide space for the mother, newborn and support person
L&D 4.2 A private toilet in each room
L&D 4.3 An appropriately designed and equipped distinct area within the room for newborn resuscitation and stabilization
L&D 4.4 L&D ward is appropriately ventilated area based on MOH specification
L&D 4.5 Accessible examination lights
L&D 5 The postpartum area provides semi private space for provision of service
Measurable Elements:
L&D 5.1 The postpartum area is properly equipped
L&D 5.2 The postpartum area is under the assignment of appropriately qualified and experienced staff

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 5.3 The postpartum area is equipped with a private bathroom
L&D 6 In the L&D ward, there is a properly equipped area to perform emergency surgical interventions and space for newborn resuscitation.
Measurable Elements:
L&D 6.1L&D should have the following:

(1) Heat source equipment;

(2) Oxygen, suction, and air outlets;

(3) Resuscitation equipment;

(4) Equipment necessary for physiologic monitoring;

(5) Transport conveyer system

L&D 7 For patients requiring isolation, an effective mean of isolation is provided for those patients suffering from communicable or infectious disease, until placement elsewhere becomes possible
L&D 8 Direct or indirect observation by L&D staff of all patients is possible
L&D 9 A direct intercommunication alarm system is provided between the nurses station and the patient’s bed with connections to treatment, work lounge or other areas from which additional personnel may be summoned
L&D 10 The unit is equipped with the necessary equipment and supplies suitable for the type and size of the patient’s load being handled by the unit .
L&D 11 An emergency cart within the unit contains appropriate drugs and equipment as determined by the medical staff

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 12 The emergency cart is checked at the beginning of each shift and after each use by the proper personnel for, quantity and quality
L&D 13 Emergency medications are available, monitored and safely stored.
L&D 14 All equipments within the L&D are maintained , tested and inspected ,periodically and dysfunctions are reported
L&D 15 Appropriate safety measures are implemented in the L&D.
L&D 16 Equipments that monitor the patient’s vital functions in the L&D area are operative at all times, has an alarm system and has battery backup system to operate in case of electrical failure
L&D 17 Each staff member responsibilities in L&D are defined in a current job description
L&D 18 L&D ward is properly directed and staffed according to the nature of special patient care needs anticipated and the scope of service offered
L&D 19 The obstetrical service has an appropriately qualified Ob/Gyn physician director
L&D 20 Those permitted to write patient’s orders write the order in the patient’s record in a uniform location.
L&D 21 All physicians in L&D ward are certified and well trained as appropriate to provide the care required
L&D 22 A sufficient number of permanently assigned qualified staff are on duty within L&D ward at all times.

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 23 Clinical privileges for midwives shall be those standards/usual and customary procedures appropriate to the diagnosis and management of uncomplicated obstetrical patients. They include the following:
Measurable Elements:
L&D 23.1 apply and remove fetal scalp electrode
L&D 23.2 assess and evaluate uncomplicated obstetrical patients for position
L&D 23.3 perform vaginal examination
L&D 24 Nursing activities are managed by Registered nurses who have experience in the particular area of practice.
L&D 25 All staff are appropriately trained on dealing with all equipments in the unit during the provision of care
L&D 26 A copy of the operating manual of each machine is available within L&D ward
L&D 27 The main instructions for operating each machine in the unit is posted nearby the machine.
L&D 28 All midwives have the proper qualification and experience
Measurable Elements:
L&D 28.1Midwives must have a midwife certificate from their country of origin in In addition to an approved RN education acceptable to ministry of health
L&D 28.3There is a formal documented clinical privilege in place for midwives which require renewal every 2 year

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 28.4Only RN midwives with current clinical privilege practice independently
L&D 29 Non-midwives obstetric RN have documented competence in :
Measurable Elements:
L&D 29.1 antenatal abdominal assessment / palpation
L&D 29.2 recognizing signs and symptoms of antenatal complication with subsequent intervention (e,g. pre-eclampsia, hemorrhages, fetal distress)
L&D 29.3 performing non-stress test for antenatal patients
L&D 29.4 assessing fetal heart
L&D 29.5 recognizing signs and symptoms for labour
L&D 29.6assisting at deliveries
L&D 30 Health care to labouring and delivery patient is provided independently only by privileged RN midwifes or physician.
L&D 31 The scope of practice for midwives is clearly delineated
L&D 32 There is 24-hour physician coverage for the unit.
L&D 33 An obstetrician and a pediatrician must always be readily available to attend in the obstetric care

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 34 RN and/or RN midwifes and Ob/GYN director collaboratively provide direction of care in in the obstetric area. Evidence of this

collaboration is documented

L&D 35 Patient’s privacy is ensured by individual rooms or proper partitions
L&D 36 The staff of the obstetrics area adheres follow specific and hospital-wide infection control measures.
L&D 37 Sterilization of all obstetrics equipments and instruments takes place in the CSSD
L&D 38 Obstetrics suites are organized to prevent movement of non-related

traffic.

L&D 39 All staff are appropriately trained on dealing with all equipments in the unit during the provision of care
L&D 40 Nursing staff is familiar with the admission and discharge criteria
L&D 41 Additional nursing personnel trained and experienced in special care units are available and assigned as needed
L&D 42 There are written guidelines which guide staff as to when to call a pediatrician to be present for delivery ( e.g. fetal distress , instrumental delivery , multiple births or premature )
L&D 43 There is evidence of continuous training and education for the nursing staff related to the care provided
L&D 44 There is a mechanism to summon help without leaving the patient’s bed side
L&D 45 Religious and cultural issues during provision of care are respected and supported
L&D 46 The patient’s right to treatment or service is respected and supported

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 47 Proper patient’s covering, and draping to ensure patients privacy
L&D 48 Obstetrical care area (labour and delivery ,postpartum, and nursery ) have unit specific specialty manuals with written policies and procedures that 1.define roles and responsibilities, 2. guide support , 3. assist all staff in the provision of nursing and midwifery practice
Measurable Elements:
L&D 48.1 Strict policy and procedures are written and enforced for the proper identification of babies
L&D 48.2 Written policies and procedures guide the provision of care in L&D ward
L&D 48.3 Policies and Procedures are written by the medical and nursing staff.
L&D 48.4 Prescribing, ordering and administering medications are guided by policies and procedures
L&D 48.5 Written policies and procedures guide the care of emergency patients
L&D 48.6 Written policies and procedures guide the use of resuscitation services
L&D 48.7 Written policies and procedures guide the handling, use and administration of blood and blood product

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 48.8 Written policies and procedures guide code blue teams
L&D 48.9 Written policies and procedures guide the care of patients on life support or who are comatose
L&D 48.10 Written policies and procedures are reviewed periodically as required by the medical staff and updated at least every two years.
L&D 48.11 Written policies and procedures are communicated and implemented effectively
L&D 49 Written guidelines/algorithms for the care of high risk patients in the labour room include:
Measurable Elements:
L&D 49.1 Pregnancy induced hypertension
L&D 49.2 Diabetes mellitus
L&D 49.3 Cardiac disease
L&D 49.4 premature labour
L&D 49.5 abnormal presentation
L&D 49.6 multiple births
L&D 49.7 fetal distress
L&D 49.8 chorioamnionitis
L&D 50 Appropriate documentation of all processes in the patient’s chart

CODE

STANDARDS

1

2

3

N/A

Explanation

Measurable Elements:
L&D.5.1 Appropriate documentation of all interventions
L&D 51 Each unit is directed and staffed according to the specific patient care needs and the scope of services provided.
Measurable Elements:
L&D 51.1 Units are managed by RNs and/or RN midwives who have experience in the particular area of practice
L&D 51.2 The obstetrical service has an ob/gyn physician director with recognized specialization in the care of obstetric patients.
L&D 51.3 RN’s and/or RN midwives and ob/gyn physician director collaboratively provide direction for care delivered in the obstetric areas. Evidence of this collaboration is documented.
L&D 52 A multidisciplinary committee, including the nurse manager and obstetrical director for the unit, oversee and guide the ongoing administrative and clinical functions of the area.
Measurable Elements:
L&D 52.1 The committee meets at least four times a year.
L&D 52.2 The committee assists in developing, reviewing, and revising policies and procedures for the provision of healthcare to obstetric patients and newborn infants.
L&D 52.3 The committee ensures enforcement of these policies.
L&D 52.4 The committee chairperson or obstetrical/gyn director of this committee signs off, in addition to nursing, on any policies and/or procedures that have any direct or indirect involvement on the physician role.

CODE

STANDARDS

1

2

3

N/A

Explanation

L&D 53 Physician standing orders are available for:
Measurable Elements:
L&D 53.1 Tocolytic administration (e.g. ritodrine, terbutaline and magnesium sulphate).
L&D 53.2 Pictocin stress test.
L&D 53.3 Routine orders for pitocin administration.
L&D 53.4 Routine labor patient orders.
L&D 53.5 Magnesium sulphate for pre-eclamptic toxemia (PET).
L&D 53.6 Routine delivery and recovery room orders.
L&D 53.7 Admission orders for all newborns.
L&D 53.8 Routine post partum orders.

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