Open Forum

Hi there,

There's a lot of talk about fetal NST's in the clinic setting. What about MONITORING the NST's? 

Questions for the group: 

Do Medical Assistants apply (ONLY apply) the nst monitors? 

Who monitors if once they are put on? 

If the RN monitors, are they continuously in the room? 

Does anyone have a policy or SOP regarding this practice that I could look at?

Thanks!

Kim 

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Kimberly Nelson MSN Ed RN RNC-OB
UT Southwestern Medical Center
Dallas TX
(214)836-1907
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Not sure if this will help as my clinic performed NSTs but SOP was not fully developed, it was all over the place. I, a RN, assisted with the NSTs at my clinic but at another site, same company, the MA placed the monitors. I did not have experience with NSTs or OB but was asked to assist as doctor wanted NSTs performed at my clinic. I placed the NST monitors and checked in on patient every 5 minutes and the NST was timed for 20 minutes. I only documented patients vitals than routed chart to provider who interpreted the NST than spoke with patient and did a US. I was to relay to provider if I had any concerns during the time patient was being monitored, for example if saw decels or abnormal fetal HR. I did some interventions if the strip was non reactive, ex: repositioned patient, moved monitor, provided snacks. I did discuss with RN manager who had experience in OB that this process needed much improvement. I had to complete a simple course to help understand NSTs but was not fully comfortable performing the NSTs. And as far as I know MAs at other sites were 'trained' by other MAs who worked in OB and did not have formal training. 

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Yolanda Mondragon
Nurse Manager
Legacy Community Health
Baytown TX
(409)549-9770
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Hello Kimberly, 

I too as you, have my OB in-patient certification; however, I am an intermediate and advanced fetal monitoring instructor for AWHONN. 

AWHONN is the only governing body for fetal monitoring and regardless where you are a RN need to apply the monitors and we aware of the basic knowledge of fetal monitoring due to if a monitor is placed and there is fetal bradycardia or something else immediately noted they are more skills at that assessment than a MA placing the monitor and later the nurse coming to evaluate. 

Years ago, in the 1990's an organization I used to work for allowed the L&D surgical techs to place the patients on monitors and the Standard of Practice then was changed shortly after I started due a sentinel event that occurred. From then on, here in Houston, Texas I have only seen RN's place the monitors. 

Hope this helps

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Tessia Winnfield, MSN, RNC-OB, AMB-BC
Nurse Manager
Harris Health
Houston, Texas
713-823-1645
Tessia.Winnfield@harrishealth.org
twinnfield@gmail.com
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