REVISION:
GUIDELINE APPROVAL: 06/07
TITLE: GUIDELINE FOR COMPLETION OF LABOR FLOW SHEET
INSTRUCTIONS:
I. Top Cover
1. Patient sticker
II. Inside Left Sheet
1. Patient sticker
2. Date of admission (mm/dd/yyyy)
3. Current date (mm/dd/yyyy)
4. Time of hospital admission
5. Blood Type
6. Patient’s age
7. G= number of times patient has been pregnant
8. T= number of pregnancies > 37 weeks
9. Pt= number of pregnancies < 37 weeks and > 20 weeks
10. A= number of pregnancies < 20 weeks
11. L= number of living children
12. EDD: Patient’s estimated date of delivery (due date)
13. LMP: Patient’s last menstrual period
14. State of membranes (Intact, Spontaneous Rupture of Membranes vs Artificial Rupture of Membranes, or Bulging bag of water)
15. Time (2400 clock)
16. Patient’s vital signs, including the (0-10) pain scale
17. Maternal assessments
18. Vaginal bleeding – see key for details
19. Uterine activity – see key for details
20. Fetal assessment – see key for details
21. Intake and Output
22. Medications on continuous drip
23. Initials of nurse doing assessment
24. Plan of Care – protocols
III. Inside Middle Assessment Record
1. Patient sticker
2. Current date of assessment
3. Patient’s allergies listed
4. Armband assessment
15 – 23 Assess according to previous guidelines
IV. Inside Right Assessment
1. Patient sticker
15 – 23 Assess according to previous guidelines
V. Nurses’ Narrative
1. Patient sticker
VI. Back Sheet
1. Patient sticker
2. Date (mm/dd/yyyy) and time (2400) IV fluids are started
3. Main solution of IV fluid
4. Amount (ml) in fluid bag
5. Specific medication and dose of medication added
6. Initials of the person who hung the fluid
7. Date (mm/dd/yyyy) and time (2400) fluid was completed or D/C
8. Total amount of ml infused
9. Intake and output totals
10. Date (mm/dd/yyyy) and time (2400) of vaginal examination
11. Amount of cervical dilation
12. Amount of cervical effacement
13. Station of fetal head
14. State of membranes
15. Name of person doing cervical exam
16. Title of person doing cervical exam
17. Date (mm/dd/yyyy) and time (2400) medication is given
18. The medication and actual dose given
19. Route of
medication (
20. Site of medication administration
21. Initials of person giving medication
22. Initials of person charting
23. Signature of person charting
RESOURCE PERSON(S): Tesa Ivey, RNC, MSN