Ebola Planning Re: Labor and Delivery Patient and Neonate

EBOLA PLANNING RE: LABOR AND DELIVERY PATIENT AND NEONATE

MASSACHUSETTS GENERAL HOSPITAL

November 20, 2014

Overall goal: Avoid patient presentation of suspect or actual cases to Labor and Delivery Unit

1)OPD is asking screening questions about travel history

2)Patient Ambassadors/Police and Security dispatch will notify L&D Triage that patient is enroute. Any patient who is plausibly suspected of EVD would be sent to the ED.

Mitigate risk if patient presents to Labor and Delivery Unit:

1)L&D staff are asking all patients screening questions about travel history and case definition in Triage

2)Any patients with a positive screen will be placed in triage room isolated with mask. ED and ID will be called to direct next steps

Patient with a positive case definition and in labor:

1)Patient placed in room with mask, ED and ID called to verify positive case definition

2)L&D staff will follow guidance of ID and ED for next steps

3)If patient stable and can wait for MICU bed to become available, patient to go to MICU. MICU MD and RN in PPE will come to L&D to pick up patient for transport

4)If patient clinically unable to wait for MICU bed to become available, patient to go to ED until MICU bed is ready. ED MD and RN in PPE will come to L&D to pick patient up.

5) The obstetrical care will be guided by OB attending who has received PPE training as soon as available OR MFM offering consultation remotely outside of the isolationroom (if not PPE trained).

1. A trained OB MD and L&D RN would be called to come in if the on-site staff have not been trained in EVD PPE.

6)The decision about mode of delivery and other obstetric interventions will be made based on a number of issues to be determined on a case by case basis. Any interventions in those with suspected Ebola should be discussed and carefully considered before undertaken. In no case should any contact occur without recommended PPE regardless of the urgency of obstetrical circumstances.

1. The focus should be on stabilization of maternal status with fluid resuscitation and other supportive measures.
2. Consultation with MFM concerning the usual obstetric interventions (such as fetal monitoring, induction of labor, operative delivery) should occur prior to beginning any of these processes as they may not be appropriate in all circumstances.

Delivery of baby

In ED, an ED Attending will initially handle the delivery with a nurse from the involved area, supported by L&D MD and RN not in PPE but available for consult and guidance. L&D will call in staff whohave been trained in PPE to assist as soon as the patient is identified and in need of OB care. The patient will not go to the MICU without a physician and nurse trained in emergency delivery available who is trained and dressed in PPE.

1)Respiratory Therapy will be available to support the respiratory needs and care of the newborn

2)PICU MD and RN will be responsible for care of the baby. NICU staff will be available for consult outside of the isolation area.

Caregiver protection

1)Regardless of clinical situation that develops, no caregivers should engage in care of the patient without PPE. Clinical staff must be trained in PPE prior to caring for patient.

2)Staff who are pregnant or are trying to become pregnant should not care for these patients.