Nursing Care During Labor & Delivery

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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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