Stamping out Tachysystole: Implementation of An Oxytocin Protocol to Improve Patient Safety

Purpose for the program: Oxytocin has been the subject of many recent patient safety initiatives.  The Institute of Safe Medication Practices (ISMP) added oxytocin to the list of high-alert medications in 2007.  Evidence suggests that high-alert medications warrant heightened surveillance.  Utilizing current evidence, our hospital system implemented a standardized oxytocin protocol to ensure early recognition and management of tachysystole. 

Proposed change: Our hospital system implemented standardized oxytocin dosing for labor induction and augmentation.  We adopted a process for heightened surveillance during oxytocin administration.  We also created a decision tree for oxytocin induced tachysystole which provides consistent management from clinician to clinician.

Implementation, outcomes and evaluation: Our hospital system participated in a perinatal risk assessment with national consultants to identify opportunities for improvement.  Hospital leadership was involved from the beginning of the project and provided full support.  This topic became the main focus at our system Obstetric Collaborative - a group of managers, educators, and physicians that meet monthly.  The oxytocin protocol was recommended by our parent organization and studied and revised by our Obstetric Collaborative group.  Education, including NICHD fetal monitoring nomenclature and oxytocin protocol, was provided for all nurses and physicians. Collaborative fetal monitoring strip reviews are presented monthly on the labor & delivery units.  Chart auidits have demonstrated documentation of early recognition and management of tachysystole, as well as compliance with maternal/fetal assessments regarding oxytocin titration.  The medical record also demonstrated improved documentation using NICHD nomenclature. 

Implications for nursing practice: As a high alert medication, increased scrutiny over the use of oxytocin can be expected.  Care providers are held responsible when adverse drug events occur.  Implementation of a standardized oxytocin protocol provides the heightened surveillance necessary to protect mothers and babies.

Keywords: oxytocin, tachysystole