Performance Criteria Details RN Level III Obstetrics Performance Criteria 1. Assessment Perform a physical assessment of a patient receiving obstetric care per 2. Planning Initiate care plan/path per 3. Admission Admit a patient receiving obstetric care per 4. Patient Care Perform fetal/uterine monitoring per Criteria Details Pertinent assessment components Cervical Exam Knows that if applicable the FFN and/or Amnisure test should be preformed prior to SVE Membrane Status Vaginal discharge/bleeding Identify warning signs including symptoms of preeclampsia, placental abruption, breech presentation, cord prolapse, previous C-section, other complications/risk factors Reflexes/Clonus Screen for infectious/sexually transmitted diseases Screen for Drug/alcohol/tobacco use Screen for Domestic violence General Review of Systems/Head to Toe Assessment- heart, lung, skin, etc. Breast assessment Bladder/voiding (distention) Bowel function Fundus level Lochia Perineum/episiotomy/suture line Hemorrhoids Signs of DVT (Homan s sign, etc.) Hyperemesis Gravidarum Gestational Hypertension/Preeclampsia Preterm Labor/UTI Labor & Delivery Post Partum after vaginal delivery Post Partum after c-section delivery Well Newborn -Nsy I Premature/Sick Infant-Nsy II Infant-Hyperbilirubinemia Demonstrates good time management skills Demonstrates ability to prioritize tasks Demonstrates problem solving skills Completion of all portions of chart in EMR Classification of patient through Acuity Check Med Sheets Identify Baseline FHR Variability (Absent,Minimal, Moderate,Marked, Sinusoidal) Presence of acceleration 10x10 15x15 Prolonged Presence of Deceleration Performance Criteria Details RN Level III Obstetrics Feb2013 1
5. Patient Care Perform antepartum care for patient per 6. Patient Care Perform a vaginal examination per policy and physician order. 7. Patient Care Perform a Non- Stress Test (NST) for a patient receiving obstetric care per policy and physician order. 8. Patient Care - Perform a Oxytocin Challenge Test (OCT) for a patient receiving obstetric care per policy and physician order. 9. Patient Care Provide nursing care for the patient in labor per 10. Patient Care - Provide nursing care for the patient undergoing induction/augmentation per policy and physician order. 11. Patient Care Provide care for the patient during a vaginal delivery per Early Late Variable Prolonged Respond appropriately based on interpretation of EFM readings Identifies reassuring and non-reassuring FHR patterns Interpret contraction pattern Identify tachystystole and respond appropriately Set up for FSE application and use Set up for IUPC insertion and use (read MVUs) Document interpretation at appropriate intervals Utilizes standing orders Completes documentation on centricity Utilizes appropriate format when calling report to MD/CNM Knowledge of Stages of Labor Able to identify latent labor and provide appropriate care Able to identify precipitous labor and provide appropriate care Knowledge of position changes to facilitate fetal descent Knowledge of non-pharmacological methods of pain relief and ability to support patients desiring unmedicated birth Amnioinfusion Assembly of labor tub Able to assist with various cervical ripening procedures and care for pt per policy: Foley Bulb Cervidil Cytotec Able to care for a patient receiving Pitocin for induction/augmentation including: Understanding of Bishops score Documentation per policy Completion of Oxytocin safety module Assemble Necessary equipment Prep patient if physician desires Notifies proper personnel (Ped, RT, etc.) Prepare warmer for delivery Prepare meconium cart if necessary Performs sponge/needle count correctly Knowledge of nurse s role in assisting with shoulder dystocia Performance Criteria Details RN Level III Obstetrics Feb2013 2
12. Patient Care Provide care for the patient receiving epidural analgesia per policy and physician order. 13. Patient Care - Provide care for the patient delivering via cesarean section per policy and physician order. 14. Patient Care - Provide care for the patient during the postpartum period per policy and physician order. 15. Patient Care Provide care for the patients following fetal demise per 16. Discharge Follow discharge and/or transfer policy per physician order. Assists w/ and properly documents physician use of vacuum Knowledge of proper management of delivery unattended by Physician Completes necessary paper work and admission lab results prior to calling MD Educates patient including information regarding PCEA Assembles necessary equipment Documents per policy (time out, test dose, etc.) Monitors vital signs per policy Assesses for complications and acts accordingly Completes computer based education module Ability to properly remove epidural catheter observed Knowledge of sterility and proper OR attire Circulate Proper positioning on OR table; leg strap Assisting with spinal placement Equipment: electrocautery & pad, suction, OR transfer board Foley catheter protocol Knowledge of responsibilities of circulator Properly documents procedure in EMR Universal Protocol Performs time out Labeling of solutions and medications on the sterile field Abdominal/pubic skin prep Instrument/Sponge/Needle Counts Knowledge of responsibilities during emergency c-section Instrument set up OR table operation Application of Anesthesia monitors and oxygen Assisting with intubation Performs and documents surgical recovery according to policy Demonstrates ability to care for postpartum patient according to policy Able to teach proper perineal care Able to perform 8 point postpartum assessment Properly completes packet Bereavement pictures Release of body form Organ donation form Burial Transit Form completed by House Supervisor if body being carried across state lines Transfer body to morgue Utilizes other members of healthcare team to meet patient s needs Discharge Review physician order Inform patient of discharge and communicate physician orders Completes discharge paperwork Completes care plans (assesses outcomes) and Education Record Completes medication reconciliation and reviews with patient (inpatient) Coordinates follow up appointments as needed Transfer Contacts receiving facility/transport Locates and completes appropriate paperwork Performance Criteria Details RN Level III Obstetrics Feb2013 3
17. Equipment Demonstrate appropriate use and infection control procedures for obstetric equipment per manufacturer s guidelines and 18. Lab Values Demonstrate collection and analysis of laboratory specimens/values. 19. Medications Administer medications per physician order and Copies applicable portions of chart Verifies with house supervisor Assembles equipment necessary for transfer Cares for patient en route to receiving facility Labor Beds (Trendelenburg, stirrups, etc) Fetal Monitors Warmers Scales Isolette Datascope Massimo IV Pumps Halo System Photo Bilirubin lights OR table OR transfer board Epidural Pump PCA Pump IV Pump Labor and Anesthesia Carts Uses and restocks Keeps locked when not being used Hearing Screen Defibrillator Pulse Ox Lawson Point of Use Charge Capture system Breast Pump Ice Packs Sitz Bath Neopuff Obtain labs with IV Stick Properly labels tubes and apply bloodband Interpret labs Documents critical values according to policy Able to differentiate: Normal values Changes with PP Hem Changes with PIH/HELP Changes when infectious process present 24 hour urine collection Obtain FFN Obtain Amnisure Obtain and document BSGs Obtain PKU Obtain bilirubin and graph results Analyze blood gases Calculate dosages appropriately Document administration and results Administer Sub Q medications Performance Criteria Details RN Level III Obstetrics Feb2013 4
20. Newborn Admission Complete newborn admission per 21. Newborn Care Performs newborn assessment and care per Administer IM medications Administer IV medications Document site of injections Document PRN effectiveness Administer Oxytocin Administer Magnesium Sulfate Properly administer scheduled medications Assessment Hearing Link Acuity Orders Assembles chart Footprints Vital Signs Heart Rate (apically for 1 full minute) Respirations Temperature and respond accordingly Axillary Rectal Oxygen Saturation and interpret according to NRP guidelines Pre-ductal Post-ductal Blood Pressure Pulmonary Function Identify retractions including location and severity Evaluate quality of air entry on auscultation (equal, good, diminished, decreased on one side, moist) Identify presence of: Audible grunting Nasal flaring Apnea Cardiac Auscultate heart and identify abnormal heart sounds and rhythms Irregular heart rate and rhythm Murmurs Evaluate skin color Cyanosis Pale, white coloring Recognizes normal newborn accrocyanosis Evaluate capillary refill (applies pressure for 5 seconds) Assess peripheral pulses Brachial Femoral Utilizes cardiorespiratory monitor appropriately General Assessment Apgar scoring Weigh and measures newborn appropriately Assesses fontanels Classifies sutures appropriately Identifies caput, cephalahematoma, and subgaleal hemorrhage Performance Criteria Details RN Level III Obstetrics Feb2013 5
22. Newborn Care Provide nursing care for a newborn using Level II Nursery skills per Identifies signs and symptoms of hypoglycemia Obtains blood glucose via heel stick Responds to result according to policy Assesses newborns mouth and palette Assesses newborn s tone Assesses newborn s reflexes Suck Root Moro Assesses skin Documents skin integrity Initiates skin care protocol as needed Identifies jaundice Identifies skin markings (Mongolian spots, petechiae, birthmarks, other variations Assesses GI system Anus Bowel sounds Identifies distended/scophoid abdomen FLACC scale for pain assessment Newborn abstinence scoring LATCH scoring system Ongoing Newborn Care Document on infant flowsheet properly Hourly assessments Shift assessments Latch scoring Obtain and records vital signs according to policy IV Start infant IV 1 2 3 (date & MR#) Select appropriate equipment Calculate rates Manage IV Fluid administration including documentation Assess IV site Manage Saline Lock UAC/UVC Gathers equipment and sets up for insertion Assists MD with insertion Secures lines Assures proper placement Maintains catheter according to policy Assess and documents perfusion of lower extremities Assess patency Administers fluids/medications Draws blood specimens from line Removes catheter according to policy Chest Tube Identifies indication for chest tube Assembles necessary equipment Assists with insertion and set up Performance Criteria Details RN Level III Obstetrics Feb2013 6
23. Newborn Care - Follow discharge and/or transfer policy per physician order. 24. Readmission Performs a newborn/infant readmission per policy and physician order. Assesses system for patency and air leaks Assesses CT drainage Assists with needle thorocostomy NG/OG Assembles necessary equipment Inserts NG/OG properly Confirms placement Maintains patency and troubleshoots appropriately Demonstrates irrigation Demonstrates medication administration Demonstrates enteral feedings Intermittent Continuous Checks residuals Knowledge of proper use of HMF Monitors tolerance of feed ET tube Anticipates proper size of tube based on NRP guidelines Assists RT/MD with placement Assists with securing/taping of the ET tube Contacts receiving facility/transport Locates and completes appropriate paperwork Copies applicable portions of chart Verifies completion of transfer form with house supervisor Completes readmission packet Appropriately orients family Performance Criteria Details RN Level III Obstetrics Feb2013 7