Innovative Program Paper:  Poster                         

Submitted to AWHONN August 18, 2008 Title:  A Remarkable Induction Experience:  Improvements to the Process

Authors:  Conklin, Margaret C., RN, MPH; Mann, Diane Q., MS, Renegar, Lora, RN

The Sara Lee Center for Women’s Health, Forsyth Medical Center, Novant Health,

North Carolina.

Evidence from satisfaction surveys and internal monitoring processes revealed that our inductions were consistently delayed, patients were dissatisfied with the process, and nurses and physicians noted multiple inefficiencies across the continuum of care.       A multidisciplinary task force on inductions was convened to discover barriers to timely inductions and develop innovations after surveying member hospitals of the National Perinatal Information Center (NPIC).

The barriers included: (a) unpredictable timing in scheduling inductions, (b) supplies not readily available, and (c) the absence of physician orders upon patient arrival.  It was our standard operating procedure for a birthing suites nurse to call induction patients to come to the hospital when a room was available.  Times ranged from 7:00 a.m. to midnight.  Patients did not like the last minute scheduling, and staff found that patients often did not check in on time.  Staff also found it challenging to coordinate inductions with direct admissions.  In addition, physicians were not satisfied with unpredictable delivery times.

The task force operationalized a multi-solution approach to improve satisfaction with the induction process and maximize efficiency, which included:

·        Standardized induction times

·        Relocation of critical induction supplies

·        Order E-faxing

·        Physician scorecards

·        An induction nurse

·        Cervical ripening techniques.

To standardize induction times, six appointments were scheduled daily, beginning as early as 4:30 a.m.  Patients were instructed in a letter from their physician to arrive prior to their appointment to ensure that the induction began on time.  To improve supply availability, a par level of IV pumps and induction medications were stocked on the unit rather than in the pharmacy. 

To ensure that orders were present on admission, physicians began E-faxing their orders to an electronic scheduling program to coincide with the patient’s induction time.  To encourage physicians to continue to send orders early and to remind their patients to arrive on time, physicians were sent bi-weekly letters with specific data on their practice’s compliance compared to other practices (blinded).

To oversee the entire process, a dedicated Induction Nurse was added to the in-patient team.  In addition, nurses began administering cervical ripening agents to facilitate the progress of inductions. 

Efficiency outcomes with this multi-solution approach have significantly improved.  The percentage of patients arriving on time for their scheduled inductions has improved from 45% to 82%.  The average delay is currently only six minutes.  The percentage of orders received before the appointment has risen from 45% to 88%.  Anecdotal feedback suggests that patients, nurses, and physicians are satisfied with the new processes, allowing staff to focus on more value-added aspects of patient care.