King Faisal Specialist Hospital And Research Centre

Labour and Delivery

No. Of Beds:
5 Labor/Delivery
1 Surgical Suite
1 Recovery Room
1 Perinatal Lab

Nurse Patient Ratio: 1:1-2 (Days and Nights)

Scope of Service:
L&D Unit consists of 5 LDR's - 1 Surgical Suite - 1 Recovery Room - 1 Perinatal Lab. Average monthly deliveries are 115 per month, with a 65% high-risk patient population.

Frequent Procedures/Services/Function:

• External and internal fetal heart and maternal uterine contraction monitoring
• IV starts and maintenance
• Induction and augmentation of labor
• Tocolysis of premature labor and magnesium sulfate infusions
• Caesarean sections/scrubbing/circulating
• Recovery of patients undergoing surgery under General and Regional Anesthesia
• Pain Management including epidural and patient controlled analgesia administration and management
• Non-stress testing
• Removal of cerclage
• Caring for and resuscitation of the newborn at delivery
• Assistance in the perinatal lab with amniocentesis, intrauterine transfusions, and cordocentesis
• Patient/Family Education
• Maintenance of skin integrity
• Wound Care
• Hours of Operation
• 24 hours a day, 7 days a week

CRITERIA FOR ADMISSION TO SERVICE

Patients who are 20 weeks gestation and above, and who fit into those high risk categories as per following guidelines, are accepted for admission:

• Chronic pulmonary disease with decreased pulmonary function (excluding asthma not requiring steroids)
• Chronic liver disease undergoing treatment by Hepatology Service
• Epilepsy being treated pharmacologically (for fetal evaluation only)
• Infertility where the current pregnancy has resulted from treatment at KFSHRC, with other risk factors
• Previous 3 or more C-Sections or treatment for uterine anomaly at KFSHRC
• Multiple pregnancy
• Diabetes mellitus currently on insulin or oral hypoglycemic agent (impaired GIT is not included)
• Hypertension on medication treated at KRSHRC and previous complication treated at KFSHRC
• Severe cardiac disease (Class III or IV)
• Chronic renal disease under treatment at KFSHRC
• Previous history of or current Congenital/Chromosomal anomalies - Severe sickle cell anemia
• Rhesus Isoimmunization
• Recurrent abortions - 3 or more consecutive abortions presenting before 24 weeks prior to this pregnancy (excluding patients with subsequent successful pregnancy without any treatment)
• Prior fetal or neonatal death - Within 1 month after birth during the last pregnancy only
• All eligible employees/dependents
• Private patients

Hospital exceptions

High risk patients generally will not be admitted to the Service if they are greater than 36 week gestation.

Staffing plan

Number and Mix of Staff

• 18 SN-Is
• 2 WCs
• 1 PCA
• 1 Head Nurse (L&D, and A-1)
• 1 Clinical Instructor, shared with A--1

Staffing is calculated using 17.7 NHPPD. L&D has multinational nurses from USA, Canada, Britain, Australia, New Zealand, South Africa, India, Malaysia, Philippines, Jamaica, and Ireland. All staff are registered nurses and/or Registered Midwives who have had specialized training and experience in the nursing care of women and their newborns.

A charge nurse is designated for each shift. In the absence of the Head Nurse, she is responsible for unit supervision on a shift basis, for the quality of care delivered by nursing personnel.

The charge nurse is also required to provide care as needed to accommodate the fluctuating patient census and acuity.

Staffing assignments are made each shift by the charge nurse based on the following criteria:

• Acuity of patients' condition and required nursing care. Many patients require 1:1 care
• Degree of supervision required by each nursing staff member based on her previously assessed level of competence
• Type of technology employed in providing nursing care
• Availability of supervision appropriate to the assessed and current competence of nursing staff member
• Infection control and safety issues

Method of Adjusting to Staffing Variances

1. Back up systems include cross-trained staff from A-1

2. Additional staff are called in for periods of high acuity / census / short staffing

Labor & Delivery nurses generally float to the following units:

• A-1, Ante/Post Partum
• OB / Gyn Clinic
• D3-2, Gyne / Oncology

HOW ARE INSERVICES/CONTINUING EDUCATION PROGRAMS PROVIDED TO MAINTAIN

Staff Competency

Continuing education is offered through Nursing Development & Saudization (ND&S) and at the Unit level coordinated by the Head Nurse and Clinical Instructor. Education needs are identified through needs assessment tools, treatment protocols, performance improvement activities, regulatory agencies, new technology, new equipment, new products and individual input and surveys. Topics other than those which are based upon mandates and updated protocols, are also arranged. These may be issues of interest raised by the Unit staff, topics selected from the departments' needs assessment or information of interest or relevance from other departments.

Required Competencies

Annual review of education includes:

• Age Specific Care competency
• Performance Improvement
• Fire and Electrical Safety
• Infection Control and prevention online modules
• Skin Care and Pressure Ulcer Prevention online module
• Wound Care Online module
• Point of Care Testing (POCT)
• Medication Safety Online module

Method of Communication with other departments

Internal and External Methods of Communication:

Internally and externally, communication is accomplished via direct verbal communication, telephone, fax, intranet and written memos. Staff meetings are held on a monthly basis, or more frequently ifrequired. Collaborative practice meetings are scheduled on a quarterly basis or as required. Other meetings are scheduled as required.

Describe Collaborative Relationships With Other Departments:

The Head Nurse and staff participate on many multidisciplinary committees, as well as on Hospital wide performance improvement groups and committees. Representatives from other departments are invited to attend staff meetings when new programs are introduced or if complicated issues arise, to facilitate a mutually desirable resolution.

Plan to improve the quality of service

• Review & revise standards of patient care & clinical practice
• Ensure staff competency in required competency testing
• Offer educational programs to increase staff's knowledge and skills
• Review patient comments and follow-up as necessary
• Renovation of the unit in order to accommodate the present patient population
• Continue the Cross-training Program of A-1 staff to increase flexibility and provide continuity of care
• Staff participation in Hospital-wide and Unit-based performance improvement projects
• Expand patient teaching programs and materials