“Aye, Aye Captain!” Implementing an Induction Initiative to Improve Safety and Outcomes

Authors


Poster Presentation

Purpose for the Program

Labor inductions have become routine in modern society and are one of the most common procedures in obstetrics. Women undergoing induction of labor are at increased risk of cesarean birth. Additionally, a concerning number of elective labor inductions are performed earlier than 39 weeks gestation, often when the woman's cervix is not yet mature. Therefore, the risks to the dyad not only include cesarean birth, but also morbidity from premature delivery. When it comes to induction, there are questions of “if and when and how.” Inappropriate use of oxytocin is one of the top five areas of preventable perinatal harm. The Institute for Healthcare Improvement and Premier Perinatal Safety Initiative have addressed the avoidance and proper management of uterine tachysystole as part of their evidence-based bundles. Finally, elective induction and cervical favorability are becoming forefront issues. Some facilities across the nation are disallowing cervical ripening for elective inductions and/or requiring a prespecified Bishop score to proceed with elective induction.

Proposed Change

To ignite passion, renew commitment, and promote professional excellence to enhance intrapartum safety.

Implementation, Outcomes, and Evaluation

As part of the Premier Perinatal Safety Initiative, our level III perinatal center addressed safety in obstetrics, particularly induction of labor. The strategy was multifaceted, but two issues are covered in this talk: elective induction of labor and induction medication safety. After 3 years of developing projects to improve the quality of elective inductions, our facility was able to virtually eliminate inductions at less than 39 weeks gestation and maintain greater than 90% compliance with tachysystole recognition and treatment. The next step will be to address the issue of cervical favorability. Consistent with the literature, we have noted at our institution a significant difference in elective delivery outcomes in patients with favorable cervices when compared to unfavorable cervices. Such differences include longer induction times, more cesarean births, neonatal admissions to special care nursery, and length of hospital stay.

Implications for Practice

Induction safety is of paramount importance to Association of Women's Health, Obstetric and Neonatal Nurses.

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