Creating a Comanaged Obstetric/Intensive Care Unit

Abstract

<h2>Women’s Health Poster Presentation</h2><h3>Purpose for the Program</h3> The critically ill pregnant woman presents a complex challenge to physicians and nurses in obstetric and critical care specialties. Statistics suggest the overall estimate of obstetric patients in the United States who require critical care services is 1% to 3% annually. A multidisciplinary approach was taken to review the literature and create an environment where the complicated obstetric patient can receive comanaged care in a large, university hospital birth center. The key focus was to recognize complications of pregnancy and the effect of preexisting disease on pregnancy to care for the critically ill patient who has the potential to develop a life-threatening condition. <h3>Proposed Change</h3> The literature shows that most intensive care admissions for obstetric patients are secondary to obstetric complications (e.g., hypertensive disorders or hemorrhage) along with complications related to preexisting conditions (e.g., respiratory failure or diabetes) warranting a higher level of care. A proposal was developed using a comanaged approach of obstetric and critical care specialties to care for critically ill obstetric patients within a six-bed licensed intensive care unit (ICU) located in the birth center. <h3>Implementation, Outcomes, and Evaluation</h3> A multidisciplinary team consisting of obstetric and critical care nursing; maternal–fetal medicine and critical care physicians; anesthesia, respiratory, pharmacy, and infection control was established to improve the assessment and management of the complicated obstetric patient. A change in culture and the need for additional education was identified within the birth center, and the facility recognized this unit as the place where the complicated obstetric patient would receive care. To implement the proposal, <i>OB Triggers</i> were developed to guide staff in identifying patients who would be transferred to the obstetric (OB)/ICU beds. A core team of nursing staff was established to take ownership of the unit and receive additional education on pregnancy complications and the effect of preexisting disease on pregnancy. Since the initiation of this project, an increase in the daily census of complicated patients per day in the six-bed OB/ICU unit has been demonstrated through cumulative statistics based on diagnosis coding. An increase in the amount of comanagement opportunities also has been demonstrated based on the admitting physician and consults. <h3>Implications for Nursing Practice</h3> The implementation of this project helped staff to recognize the importance of ongoing assessment of each patient by identifying complications of pregnancy that requires an increased level of care. In addition, the project has given all members of the health care team tools for recognizing the need for comanaged care and for implementing timely and well-coordinated interventions when faced with increasingly complicated patients at risk of life-threatening conditions.