Title: Message

You all should push for a maternity module. They created one for the UK. They use a version of magic as well, so it would not be difficult for meditech to write.

 

Tara McNamara MT (ASCP)

Meditech Analyst

Rehabilitation Hospital of the Cape and Islands

Ph: 508-833-4025

Fx: 508-833-4056

[EMAIL PROTECTED]

 

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-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of June Emrick
Sent: Thursday, November 02, 2006 9:37 AM
To: 'Smith, Joan'; Jenifer Brewer; Elizabeth Kirksey; [email protected]
Subject: RE: [MEDITECH-L] APGAR scores

 

Jennifer & Joan:

 

Let's cut to the chase and address the real issue here: If Meditech had a Maternity module, we wouldn't need to have this conversation. I have been a Maternity nurse for more years that I wish to tell you and we have always done the Delivery Record on the Mother's account number, be it on paper or on line, and I have never seen a Delivery Record that didn't include Apgar scores. Jennifer apparently doesn't have a Delivery Record to pull from, possibly because her facility either uses an outside vendor for labor and delivery or they still document the Delivery Record on paper.

 

We do our Delivery Record on line in Meditech because we had once tried to document L & D in Meditech. That lasted less than a day (what a nightmare!). It was impossible to keep up with all the logging on and off every few minutes and it wasn't going to the monitor strip so they were still double entering everything. However, the nurses weren't opposed to entering the Delivery Record in Meditech and our UR people love it. So much so that when we purchased L&D software from an outside vendor, they insisted that we keep the Delivery Record in Meditech so that they could pull data from it rather than entering it in the new software from which data could not be extracted by them.

 

Jennifer's solution will depend on what her L&D or postpartum nurses do document in Meditech. At any rate, I have been able to successfully pull queries from the mother's admission assessment or delivery record to the newborn's admission assessment, but I have never been able to pull queries (specifically birth weight) back to the mother's delivery record.

 

I guess my question to Jennifer would be: Since the QM/RM is an internal tracking module that isn't looking at the broader picture as described by Joan, wouldn't you really be interested at looking at the infants, anyway? Or are you planning to use the information (APGARs, birth weight) to try to track how well the physicians' managed the antepartal or perinatal course? If the latter, APGAR scores are not as reliable of a predictor as tracking cord pHs, but your facility may not do these routinely. Low birth weight can be an indicator of many issues from the mother's diet and nutrition, to PIH, to drug usage or a host of placental problems or may simply be genetic. Certainly, low APGAR scores and low birth weight are indicators for increased risk of birth injury or potential lawsuits, but surely if you pull this information from the infant's abstracting, you'll be able to track which mother it was.

 

I hope this information is helpful.

 

June Emrick, RN
Patient Documentation Systems Nurse
Johnson Memorial Hospital
Franklin, Indiana

[EMAIL PROTECTED]
Phone: 317-738-7811
Pager: 317-301-9978

-----Original Message-----
From: Smith, Joan [mailto:[EMAIL PROTECTED]
Sent: Monday, October 30, 2006 9:54 AM
To: Jenifer Brewer; Elizabeth Kirksey; [email protected]
Subject: RE: [MEDITECH-L] APGAR scores

Yes, the greatest medical risk is to newborn.  However, the greatest emotional risk is to the family as a whole.  The goal is to keep the family a cohesive functioning unit. 

Many divorces have been triggered by the stress of a less than optimum birth outcome.   

Those families that do survive intact are at risk for financial ruin due to years of extensive care needs and medical costs incurred by the care of the child who may have residual deficits from a traumatic delivery.

Joan M. Smith, RN, MSN, BC

Clinical Project Leader

Doctors Community Hospital

8118 Good Luck Road

Lanham, Maryland  20706

301-552-8867

[EMAIL PROTECTED]

 

CONFIDENTIALITY STATEMENT:  This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you are hereby notified that any disclosure, use, copying, dissemination, distribution or taking of any action in reliance on the content of this information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return email and delete this communication and destroy all copies.  Thank you.

 


 

From: Jenifer Brewer [mailto:[EMAIL PROTECTED]
Sent: Monday, October 30, 2006 9:28 AM
To: Smith, Joan; Elizabeth Kirksey; [email protected]
Subject: RE: [MEDITECH-L] APGAR scores

And from a risk management/ quality management standpoint what would be the logic - I would assume the greatest risk is to the newborn?

Thanks,

Jen


From: Smith, Joan [mailto:[EMAIL PROTECTED]
Sent: Monday, October 30, 2006 7:33 AM
To: Elizabeth Kirksey; Jenifer Brewer; [email protected]
Subject: RE: [MEDITECH-L] APGAR scores

Why the Apgar score would be placed on the mother's record:

As you know Apgar scores are done on the baby as a quick assessment of the child's ability to survive without medical intervention.  The lower the Apgar score the more catastrophic the outcome of the childbirth to the baby, mother and family.  And the more technical the medical resources are required to save the child.  The lower the birth weight of previous pregnancies also indicates a history of pregnancy related issues.

Information is power. 

If a laboring woman has a known history of delivering children with low Apgar scores and/or low birth weights the appropriate planning can take place to ensure that the resources are available to provide a positive childbirth outcome for the baby, mother and family.  Is a C-Section warranted?  Is there a Neonatologist available to triage/treat the newborn in the delivery room?  Is there a neonatal intensive care unit (NICU) with ventilator support for the newborn who may have problems breathing?  If not, is there time to transfer the patient to a hospital that can provide all of the above?

If a laboring woman has a know history of delivering just one child with low Apgar scores and/or low birth weight that survived, this may indicate that the family is caring for a special needs child due to brain damage a birth from lack of oxygen.  Even if the current delivery is perceived not to present a similar problem, the hospital maybe sending the mom home to care for a newborn (which is stressful enough, especially with the possibility of postpartum depression) but also an older child with extensive physical care needs.  In this case planning to ensure that the mom and family have optimum support from community resources is important.

Joan M. Smith, RN, MSN, BC

Clinical Project Leader

Doctors Community Hospital

8118 Good Luck Road

Lanham, Maryland  20706

301-552-8867

[EMAIL PROTECTED]

CONFIDENTIALITY STATEMENT:  This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you are hereby notified that any disclosure, use, copying, dissemination, distribution or taking of any action in reliance on the content of this information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return email and delete this communication and destroy all copies.  Thank you.


From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Elizabeth Kirksey
Sent: Thursday, October 26, 2006 9:43 PM
To: 'Jenifer Brewer'; [email protected]
Subject: RE: [MEDITECH-L] APGAR scores

I'm not sure I understand why the apgar score would be placed on the mother. I do not use Meditech but we link our baby to the mother and this information is entered on the baby.


From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenifer Brewer
Sent: Wednesday, October 25, 2006 7:29 AM
To: [email protected]
Subject: [MEDITECH-L] APGAR scores

I have been asked to post the following question as we are in the middle of implementing the QM/RM module:

When setting up the Patient Reviews for OB cases we would like the APGAR score and the Birth Weight to come over from Abstracting.  The problem is that this information is Abstracted to the baby's record and not the mom's.  Does anyone know a way to have the baby's information come over to the Mom's review.

Thanks,

Jen

Beloit Memorial Hospital


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