Purpose for the Program
Inductions are the reality of labor and delivery units across the country. Concerns over the current induction process, available resources, and the communication of patients, physicians, and nurses within a busy labor and delivery unit provided an opportunity to formulate ideas to improve safety, quality, and efficiency with patient care. One identified goal was to minimize day-to-day volume fluctuations in scheduled procedures. Any multifaceted, complex issue requires the oversight and guidance of a special committee to evaluate problems, create solutions, and implement successful change.
The labor and delivery room process improvement team, a selected collaborative group of obstetrician and anesthesia physicians, nurses, labor and delivery room management, and hospital operational excellence personnel began bimonthly meetings in November 2010. Identified concerns were compiled and prioritized. Potential solutions were discussed using evidenced-based criteria to formulate new induction guidelines. The proposed guidelines consisted of capping the number of daily scheduled inductions, unless a medical necessity occurred, and staggering patient arrival times between 1:00 and 7:30 a.m. Furthermore, the proposed guidelines offered weekend induction opportunities and promoted active labor management by ordering oxytocin initiation within 2 hours of patient admission or postcervical ripening. Significant proposed changes consisted of eliminating elective cervical ripening and extending post dates (a medical diagnosis for induction) from 40 1/7 weeks, currently used at our facility, to 41 weeks. The final key to successful initiation was the appointment of a gatekeeper, who was a unit-specific scheduler with clinical knowledge.
Implementation, Outcomes, and Evaluation
A 3-month pilot plan was designed with a “go live” date and established measurable goals. Prior to implementation, physicians and their office staff were educated on the impending changes. The nurses from the labor and delivery unit were informed via a slide presentation, staff meeting, and bulletin board display. Members from the labor and delivery room process improvement team were available resources during the start of the trial process. The team had frequent meetings to discuss and address procedural problems.
Implications for Nursing Practice
Preliminary data indicate patient volume is being spread more evenly throughout the week, with an increase in spontaneous labors and a decrease in the induction rate. Further data are being analyzed regarding an impact on scheduled and nonscheduled cesarean birth rates. Patient, physician, office staff, and nursing satisfaction are currently being assessed with positive feedback. Renewed commitment to delivering superior health care to women and newborns often requires change that can ignite passion to move forward on the path of continuous improvement.