Beyond the Bundles: Tachysystole Surveillance and Management during Oxytocin Administration
Version of Record online: 11 JUN 2013
© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2013 Convention Proceedings
Volume 42, Issue s1, page S18, June 2013
How to Cite
Martin, M., Holder, J. and Rios, E. (2013), Beyond the Bundles: Tachysystole Surveillance and Management during Oxytocin Administration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: S18. doi: 10.1111/1552-6909.12072
- Issue online: 11 JUN 2013
- Version of Record online: 11 JUN 2013
- Institute of Healthcare Improvement's bundle;
- hard stop
Purpose for the Program
Literature has shown that oxytocin, a potentially dangerous intrapartum drug for both mother and fetus, has been associated with as much as a 30% incidence of tachysystole during its administration. This risk has been partially alleviated by the use of the Institute of Healthcare Improvement's bundle methodology for safe initiation of oxytocin for labor induction and augmentation. However, the surveillance, documentation, and management of the tachysystole bundle component, after initiation, has been harder to effectively capture and needs additional exploration.
We began with a compliance rate of 25.9% in 2008 and improved to a compliance rate of 97.8% (p > .001) as a result of our current process and outcomes initiative: “all or none” oxytocin safety flow sheet bundles. As a result, a subsequent innovative approach to tachysystole management and documentation during oxytocin administration was instituted by using education of the bundle and reliability of the sciences. After a meticulous literature review and assurance of best practices, the oxytocin administration protocol and the tachysystole algorithm were revised, and healthcare provider education was revisited.
Implementation, Outcomes, and Evaluation
A mandatory standardized physician/nursing surveillance and systematic documentation process, which took place every 2 hours, was established with default goals, and hard stop implications should noncompliance occur. A change of culture over time was sought after for sustainability purposes. The overriding goals of both educational and bundle/reliability approaches included safer oxytocin initiation and administration, tachysystole detection and management, and improved neonatal outcomes. Since January 2012, compliance with the induction of the Beyond the Bundles methodology has been 91.3%, with documented or defined tachysystole occurring in only 10.83% of cases. By using tachysystole as the denominator, meaningful intervention was accomplished in 91.86% of cases and only 3.49% of neonates had adverse outcomes.
Implications for Nursing Practice
In summary, to further lower the rate of tachysystole-related adverse neonatal outcomes, the opportunity to further increase awareness and education for both physicians and nurses alike can be done by using an obligatory and comprehensive oxytocin safety flow sheet before and during oxytocin administration, along with a focused tachysystole management protocol. This will be a design worthy of consideration in reducing adverse effects from this high-risk medication.