First Stop: Pre-Admission for Your Delivery

Purpose for the program:

Leading and forging new directions in the care of scheduled inductions and cesarean sections, leads to increased compliance to safety initiatives, nurse satisfaction, physician satisfaction, patient satisfaction and safe, efficient, quality care.

A multidisciplinary team at Baylor University Medical Center identified the need to improve the admission process for scheduled inductions and cesarean sections.  This multidisciplinary team identified patient safety issues with the current admission process.   To improve patient safety, the following objectives were their main focus:  to improve the verification of patient information on admission, timely administration of medications and increased medication scanning compliance, access to lab results prior to surgery and reduction in stat lab orders, access to the most current prenatal history on admission, and timely implementation of physician orders. 

Proposed change:

In order to meet these objectives a comprehensive pre-admission process was implemented.

Implementation, outcomes and evaluation:

This process required that all physicians scheduling an induction or cesarean section submit orders and a current prenatal record for their scheduled patient within 2 to 14 days prior to admission.    Labor and Delivery secretaries would then create a pre-admission account for the patients and assemble the patient chart.  Physician orders would be faxed to the pharmacy the day before the scheduled case to ensure pharmacy verification of all medications, immediate availability of medications upon admission and thus increased scanning compliance to ensure safe and timely delivery of ordered medications.     In addition, any patient being admitted for a cesarean section would present 2-14 days prior to her scheduled date to have lab work completed to ensure results were known prior to surgery.    This lab initiative would also decrease the overuse of stat lab orders.    While obstacles were faced, many hospital departments came together to work through the process and make it successful.  A communication tool originally devised for pharmacy enabled us to track compliance for all components of the process.   Through implementation of this process we have improved nurse satisfaction, physician satisfaction and patient satisfaction as there are no delays in care.  We have seen increased scanning compliance for the safe delivery of medications and are able to verify all lab results prior to surgery. 

Implications for nursing practice:

The pre-admission process has created a checklist- type system that guarantees that all necessary components are met prior to the patient arriving for care, thus providing safe, efficient, quality care.

Keywords: Pre-Admission, Induction, Cesarean, Checklist, Scheduled