Obstetric patients requiring hospitalizations for non-obstetric diagnoses have increased over the past few years.  Common diagnoses of trauma, acute appendicitis, and pneumonia lead to admission to a general Medical or Surgical unit.  A few pregnancy specific illnesses such as eclampsia, hemorrhage, HELLP syndrome, and tocolytic induced pulmonary edema may lead to an ICU admission. 

Medical-Surgical nurses in our 1,000 bed tertiary care hospital raised concerns about maternal-fetal safety during those non-OB admissions. Our institution did not have a process in place for notification/consultation with an obstetrician to determine the appropriate OB monitoring when the pregnant patient was admitted to a non-OB unit.

Representatives from Women’s Health and Medical-Surgical Nursing collaborated to research current standards of care and evidenced-based practices.  Since both nursing and medicine were key players, a general house policy was developed. 

The policy states if the patient’s gestational age is 20 weeks or greater, the Acute Medicine and/or Surgery services will collaborate with Obstetrics to determine appropriate OB monitoring and care for a pregnant patient.  At this gestational age the fetus is not viable, but interventions can be helpful if the mother is contracting.  The Labor and Delivery/High Risk Antepartum nurses provide maternal fetal monitoring on the non-OB unit.  
This poster outlines the process of policy development, approval by the obstetric, medical-surgical and critical care continuous process improvement teams, approval by the medical departments, and policy implementation.