Inductions are the reality of labor and delivery units across the country. Concerns over the current induction process, available resources and patient, physician, nurse communication in a busy labor & 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.

Proposed change:

The LDR Process Improvement Team, a selected collaborative group of OB and anesthesia physicians, nurses, LDR management and hospital operational excellence personnel began bi-monthly 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, staggering patient arrival times between 1AM and 7:30AM, plus offer weekend induction opportunities and promote active labor management by ordering oxytocin initiation within 2 hours of patient admission or post cervical ripening.  Significant proposed changes consisted of eliminating elective cervical ripening and extend post dates, a medical diagnosis for induction, from 40 1/7 weeks currently used at our facility to 41 weeks. A unit specific scheduler with clinical knowledge to serve as a “gatekeeper” was the final key to successful initiation.

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 labor & delivery nurses were informed via a power-point presentation, staff meeting and bulletin board display. Members from the process improvement team were available resources during the start of the trial process.  The team had frequent “huddle” meetings to discuss and address plan problems.

Implications for nursing practice:

Preliminary data indicates 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 is being analyzed regarding an impact on C-section rates, scheduled and non-scheduled.  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.

Keywords:

Induction

Collaboration

Safety

Success