SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE MATERNAL TRANSPORT TEAM EFFECTIVE DATE: REVISED DATE: STANDARD TYPE:, 4/95 1/18 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 7 STANDARD I - The transport team members will possess the combined expertise to effectively assess, plan, implement, and evaluate actual and potential problems of the mother during transport. 1. The transport team is composed of the following: maternal transport nurse, paramedic, and EMT or second paramedic. A perinatologist and /or neonatal transport nurse and respiratory therapist may accompany any transport as needed. Requirements to be a maternal transport nurse include the following: Attendance at 50% of scheduled transport meetings per year Attendance at the transport safety competency. Completion of a Neonatal Resuscitation Program with bi-annual recertification. RT and Maternal transport nurse: completion of Advanced Life Support Program with bi-annual recertification. The maternal transport RN will have a minimum of 4,000 hours RN experience, which includes 2,000 hours in the area of Labor and Delivery and care of the high risk ante-partum patient in a Level III facility. After above experience requirements met, nurse may submit a letter of intent and begin training to complete transport requirements. Attendance at in-service training on emergency delivery and demonstration of the skills necessary for a vertex delivery, with review every 2 years. Accompany a minimum of 2 maternal transports prior to staffing a transport as the only OB RN in attendance. The EMT on the transport team shall meet the requirements of 64J-1.008. The Paramedic on the transport team shall meet the requirements of 64J-1.009. 2. The primary team leader is the RN,( unless the perinatologist is present on Transport), and shall possess the clinical nursing, and leadership expertise necessary to direct the provision of safe and competent patient care.
2 of 7 3. The perinatologist/physician will be designated and available for consultation and medical control by phone and/or radio for all non-physician accompanied transports. 4. An objective evaluation of the team member's competence to perform his/her specific job responsibilities in the transport role is conducted at least annually by appropriate personnel. 5. The combined transport team members shall demonstrate competency in the following areas, but not limited to: 6.1. Advanced Cardiac Life Support and Neonatal Resuscitation Program certification 6.2. Assessment 6.3. Fluid and electrolyte therapy 6.4. Pharmacology 6.5. Anatomy, pathophysiology, assessment, and treatment for these categories: 6.5.1. Premature labor 6.5.2. Premature rupture of the membranes 6.5.3. Placenta previa 6.5.4. Placental abruption 6.5.5. Gestational hypertension/pre-eclampsia/eclampsia/hellp Syndrome 6.5.6 Chronic hypertension 6.5.7. Multiple gestation 6.5.8. Acute/chronic respiratory disease 6.5.9. Hematological disorders 6.5.10. Genetic/dysmorphology 6.6. Psychosocial/grief support and crisis intervention 6.7. Medico legal concerns 6.8. Transport policies and procedures 6.9. Performance improvement 6.10. Problem solving and priority setting 6.11. Transport equipment including back-up systems and troubleshooting 6.12. Mechanical ventilation techniques for transport 6. The transport team members shall possess the combined expertise and legal scope of practice to perform the following maternal procedures according to the procedures and policies of Sarasota Memorial Hospital. 7.1. Endotracheal intubation 7.2. Oxygen therapy 7.3. Mechanical ventilation 7.4. Intravenous access 7.5. Monitoring capability: Sa0 2, EKG, and B/P 7.6. Laboratory draws 7.7. Cardiopulmonary resuscitation 7.8. Medication administration 7.9 Assist mother with unanticipated vaginal delivery
3 of 7 STANDARD II - In all transport settings, the level of care provided by transport personnel shall reflect the mother's actual and potential problems. 1. The members of the transport team will accurately identify the patient to be transported. 1.1 When the transport is outbound, patient will have identification band checked and a time out will be performed prior to the transport process. 1.2 When the transport team arrives at the receiving facility, a time out and patient identification band check will be performed with the receiving RN. 1.3 When the transport is inbound, when the transport team arrives at the referral facility, patient will have identification band checked and a time out will be done prior to the transport process. 1.4 Prior to leaving the referral facility, an SMH ID band with admission number will be generated and placed on patient and correct patient identification made according to Policy 01.PAT.09. 2. For all transports, the transport nurse will verify that a Physician Certification for Transfer or other appropriate consent for transport has been properly filled out and signed by the patient and physician or the physician's medical support staff. 3. For outbound transports to an outpatient facility, the transport nurse will have patient sign an Authorization to Release Patient Information form and place in patients chart. 4. The transport nurse will have the patient sign an Inpatient/Outpatient General Consent and Financial Agreement. 5. The members of the transport team will obtain a systematic history that includes: maternal history, perinatal history, antepartum test results, previous delivery information, current medication therapy, pertinent lab results, and ultrasound results. 6. A complete physical exam will be performed to include current vital signs and assessment of the following systems: pulmonary, cardiovascular, neurologic, GI/GU, skin, and musculoskeletal. An assessment and documentation of existing intravenous site(s) to include date and time of placement, IV gauge, patency, absence of redness, pain or swelling, and verification of proper IV fluid, medication, and rate of infusion. Discontinue and restart IV if site does not comply with standards. 7. A clinical problem list will be formulated and actual or potential problems will be treated in order of priority. 7.1. Airway and vascular access will be assessed as top priority and steps will be taken to establish one or both depending on the mother s condition. 7.1.1 These conditions will be treated in accordance with direct orders from the transport physician or if there is no physician on transport, in accordance with written patient care guidelines and with phone consultation with the physician at the receiving hospital. 8. All indwelling lines, tubes, and catheters will be secured and in a documented acceptable position prior to leaving the referring hospital.
4 of 7 9. The transport nurse will notify the accepting perinatologist of the current condition of the patient and obtain any further orders for the stabilization prior to leaving the referral facility. 10. Maternal status will be monitored continuously with written documentation, including pain assessment according to Policy 00.PAT.44 Pain Management, a minimum of every thirty (30) minutes, or more frequently if the mother s condition warrants. 11. Documentation will reflect assessment, intervention, and evaluation. 12. A written, as well as, thorough verbal report will be given to the receiving facility. STANDARD III - The transport team will incorporate a family-centered care approach to promote optimal function of the family in time of crisis. 1. The family will be informed, as soon as possible, about the need to transfer the mother to another facility. 2. The transport team will establish communication with the family, as soon as possible, after arrival of the transport team at the referring facility once the mother s condition has been assessed and stabilized. A family member may ride in the front seat of the ambulance, with seat buckled at all times. When it is not possible for a family member to ride along during transport, the transport team will provide directions along with guidance and support for family members. 3. The transport team leader will provide/reinforce the following information to the family: 3.1. Reason for transport. 3.2. Mode of transport. 3.3. Destination and approximate length of time the transport will take. 3.4. Pertinent information regarding the mother s condition. 3.5. Anticipated care/types of procedures anticipated during transport. 3.6. Composition of the team accompanying the mother. 4. The transport team will give information regarding SMH (or other hospital as applicable) to the family before departure from the referring hospital. STANDARD IV - Appropriate communication will be initiated and maintained throughout the transport process.
5 of 7 1. Access of the maternal transport team at Sarasota Memorial Hospital will be available twenty-four hours a day through the Maternal-Fetal Medicine Department. 2. The transport team will serve as the liaison between the referring hospital and Sarasota Memorial Hospital. 3. While in the transport vehicle, there will be equipment to communicate within the vehicle itself, as well as, with the transporting facility, the physician responsible for the transport and the receiving hospital. 4. The transport team will maintain follow-up communication with the family and the referral center when appropriate. 5. Members of the transport team will participate in perinatal/neonatal outreach programs. STANDARD V - The transport process will have an ongoing process improvement program designed to systematically monitor and evaluate the quality and appropriateness of patient care, to pursue opportunities to improve patient care, and to resolve identified problems related to the transport process. 1. As part of the Process Improvement Program, the transport team will monitor the following: 1.1. Response time of the transport team. 1.2. Evaluation of the appropriateness of care. 1.3. Maternal and Neonatal transport team evaluations 1.4 Denied transports 2. Policies and procedures are available to all transport personnel and are reviewed annually for current accuracy. 3. Results of the Process Improvement Program are documented and reported to the director of Maternal-Fetal Medicine, the chief of the Obstetrics Department, the director of Women s and Children s Services, Respiratory Care Director, and to the department of Quality as required. 4. For all identified problems and opportunities to improve, a written action plan will be developed, implemented, and evaluated. STANDARD VI - The comprehensive program will be in existence to ensure safety throughout the transport process. 1. Once the team is in the ambulance and prior to departure, the Transport Safety Checklist will be completed and any issues addressed as necessary.
6 of 7 2. To ensure safety during the transport process, the mother will be properly secured on the transport stretcher, and transport personnel will utilize safety restraints. 3. All equipment will be appropriately secured. 4. In the event of inclement weather, the need for transport shall not outweigh safety consideration of the transport personnel and the mother. 5. The patient care area will be adequately lit. 6. All transport personnel will be familiar with all safety features of the vehicles and equipment. 7. All transport equipment will be checked for readiness on a daily basis. 8. It will be the decision of the registered nurse on board to initiate lights and sirens. Appropriate initiation may include sudden deterioration of the patient or some unforeseen emergency (Policy # 126.663/126.707 Mode of Response for Maternal and Neonatal Transport Vehicles ). References: 1. Rules of the Department of Health and Rehabilitative Services Florida Emergency Medical Services Act, Chapter 64J-1 Neonatal Interfacility Transfers Florida Administrative Code Emergency Medical Services January 2011 2. SMH Policies. (01.PAT.09) Patient Identification Inpatient/Outpatient. (01.PAT18) Correct Patient, Procedure and Site Verification. SMH: Author. 3. SMH Nursing Policy (126.663/126.707) Mode of Response for Maternal and Neonatal Transport Vehicles Reviewing Authors: Donetta Dangleis, RRT, Manager, Respiratory Services Heather Graber, BSN, RNC-NIC, Manager of NICU and Inter- Facility Transport Ann Dowd, BSN, RN-C, EFM, Clinical Coordinator, Labor & Delivery Susan Doyle, BSN, NICU Clinical Coordinator APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date
7 of 7 1/8/18 Pam Beitlich Director Women s and Children s Services 1/5/18 Mark Pellman Director, Respiratory Services Committee/Sections (if applicable): Clinical Practice Council 1/4/18 Administrative/Director (if applicable): Vice President/Administrative Director (if applicable): 1/8/18 Connie Andersen, Vice President, Chief Nursing Officer