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Keywords:

  • elective induction;
  • pre-oxytocin checklist;
  • 39 week pregnancy

Poster Presentation

  1. Top of page
  2. Poster Presentation

Purpose for the Program

The lenses of patient safety, evidence-based practice, and quality improvement have focused on inpatient obstetric (OB) care. We were struggling to comply with several recommended practice changes in the fall of 2008, when one of these converging forces, the elimination of elective inductions before 39 weeks gestation, became a priority for our 90 bed, inpatient, perinatal unit. Increasing delivery rates amplified the number of inductions and Cesarean births, and more, larger babies required admission to our neonatal intensive care unit (NICU).

Proposed Change

Members of our leadership team heard the presentation by Miller and Clark on their oxytocin protocol at the 2008 Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Annual Convention. This protocol adheres to American College of Obstetricians and Gynecologists (ACOG) guidelines on gestational dating for elective inductions. Miller and Clark described reduced numbers of inductions, Cesareans, and NICU admissions resulting from inductions. Additional emphasis from the March of Dimes 39 Weeks Campaign encouraged us to develop a plan to eliminate elective inductions before 39 weeks completed gestation.

Implementation, Outcomes, and Evaluation

Using an evidence-based practice model, a multiprofessional team reviewed available literature to determine options for best practice. Our medical director became our physician champion and drove the change after the Institute for Safe Medication Practices (ISMP) placed oxytocin on the high alert medication list. The new protocol, including consents and checklists, was presented and approved by the OB Department in October 2008.

Stakeholder education included nurses, physicians, pharmacy, and medical records, but key to our success was an informational session provided to the physician's office managers. We explained the rationale for this change, previewed the required documentation, and provided ordering information and individual packets with a checklist for forms required when admitting an elective induction. After publicizing our go live date of April 1, 2009, the nurse educator and clinical nurse specialist made frequent rounds, published clarifications when questions arose, and referred recalcitrant physicians to our Chief of OB and Medical Director. It was essential to minimize conflict over the new requirements when it arose between physicians and the surgery schedulers or labor nurses.

The outcome data validate our efforts. By delaying induction until 39 weeks gestation, more women went into labor spontaneously, a decrease of 17%; fewer women undergoing induction required a Cesarean, down 21%; and admissions of larger babies to the NICU decreased. A year later, elective inductions are not performed before 39 weeks gestation.

Implications for Nursing Practice

Our program will be of interest to hospitals seeking improved quality and safety when implementing the new core measure of The Joint Commission to eliminate elective deliveries before 39 weeks.