To standardize the use of a high alert medication, oxytocin, supported by evidence-based best practice in a community health labor and delivery unit.
Tools, workflow, education, and electronic documentation were based on the 2008 National Institute for Child Health & Human Development fetal heart rate guidelines, the Association for Women's Health, Obstetric, and Neonatal Nurses’ guideline for cervical ripening and induction and augmentation of labor, and implementation of a conservative checklist-based protocol for oxytocin administration.
Perinatal Practice Committee: obstetricians, perinatologist, midwife, maternal child educator, obstetric TraceVue system administrator, nursing staff, director of maternal child, birthing center unit coordinator, risk management, and health system medical director.
The project took place at Freeman Health System Birthing Center, which provides perinatal care for 2,500+ births/year. A multidisciplinary team reviewed the literature and determined needs for evidenced-based protocols, revision of guidelines, staff education, and performance metrics. Leveraging the Philips OB TraceVue documentation system, staff could electronically document the checklists, assessments, and care provided. Data were mined this doesn't really make sense, maybe she meant “combined” into metrics reports to document progress of the program implementation. Creation of standardized oxytocin tools for nursing and medical staff included the following: Oxytocin Protocol Policy, Oxytocin Orders Revision, Induction/Augmentation of Labor Informed Consent, predelivery evaluation, Pre-Oxytocin Checklist, In-Use Oxytocin Checklist, and Tachysystole Algorithm. Education tools were provided for patients, and all nursing and medical staff were required to complete the Education Module. To support accurate data collection, the team created electronic documentation for Pre-Induction Checklist, Bishop Score, and In-Use Checklist, which previously were not available to the staff.
Time periods (2009-2010) were similar with approximately 400 patients with gestational age greater than 39 weeks, average hours of infusion to delivery remained at 8 hours, cesarean rate of 9% to 12%, and a decrease from nine to one infant with a 5-minute Apgar score <7. The 2010 period had no admissions to the neonatal intensive care unit (NICU) with an estimated cost saving of $200,000. The incidence of tachysystole dropped from 52% to 21% for all elective inductions.
Conclusion/Implications for Nursing Practice
Following the guidelines and protocols Freeman Health demonstrated no significant increase in cesarean rate, a decrease in amount of oxytocin administration, and elimination of NICU admissions as a result of elective induction. Anecdotally, the team attributes the success to strong leadership, dedication, persistence, teamwork, a desire for learning, and the commitment of physician champions. The Freeman Health project demonstrates that using teamwork, evidence-based protocols, and electronic documentation can lead to safer patient care.