Don't Get Lost in the Vacuum: Clarifying the Nurse's Role During Vacuum Assisted Deliveries

Purpose for the program:

After a vacuum assisted delivery in which the newborn subsequently suffered seizures, the delivery nurse wondered if she could have done something different to improve the outcome.  She informally surveyed her peers and found many variances in practice for nursing care during a vacuum assisted delivery.  There were inconsistencies regarding how total procedure time was defined and calculated.

These variances were brought to the unit’s shared governance practice and research council. In an effort to understand current standards of care a thorough literature review was conducted. A lack of consensus exists about number of pulls, number of pop-offs and procedure time.  The American College of Obstetricians Practice Bulletin #17, which was reaffirmed in 2009, offers no guidelines for number of pulls, pop-offs, procedure time or recommendations for documentation. Benchmarking revealed other hospitals had vague policies with no defined role for the bedside nurse.

Proposed change:

As a result of these inconsistencies a process improvement team was formed to develop practice guidelines.  Key elements of the practice guideline are:  staffing recommendations; definition of procedure time; use of the wall timer to calculate total procedure time; and recommended duration of procedure time.  Documentation was standardized by creating drop down boxes in the electronic medical record. With approval from the organization’s Office of the General Counsel the policy was revised.

Implementation, outcomes and evaluation:

Nurses were educated regarding the practice guidelines by reading a poster and completing a test.  The poster reviewed indications, contraindications, and complications of vacuum assisted deliveries. The poster also presented the new practice changes and examples of correct documentation. Every labor and delivery nurse scored 100% on the test.  Physicians were informed of the changes by their medical director at their department meetings.

Nurses eagerly implemented the new guidelines.  Nurse’s verbalized appreciation at having clearly defined guidelines regarding their role during a vacuum assisted delivery.  Chart audits reveal consistent and thorough documentation.  Physicians have provided positive feedback about the enhanced confidence of the bedside nurse and the heightened situational awareness due to improved communication.

Implications for nursing practice:

Resources need to be in place to support the bedside nurse when they recognize compromises to maternal-fetal safety.  Opportunities to improve patient care should always be encouraged.

Keywords:

Vacuum assisted deliveries

Role of the bedside nurse

Practice guidelines