Objective: To standardize the use of a high alert medication, Oxytocin, supported by Evidence Based Best Practice in a community health labor and delivery unit.

Design: Tools, workflow, education and electronic documentation were based on the 2008 NICHD FHR Guidelines, AWHONN Guideline for Cervical Ripening & Induction & Augmentation of Labor (Simpson) and Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes (Clark et al).

Patients/Participants: Perinatal Practice Committee: Obstetricians, Perinatologist, Midwife, Maternal Child Educator, OB TraceVue System Administrator, Nursing Staff, Director of Maternal Child, Birthing Center Unit Coordinator, Risk Management and Health System Medical Director.

Methods: The project took place at Freeman Health System Birthing Center, which provides perinatal care to 2500+ deliveries/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 was mined into metrics reports to document progress of the program implementation.

Implementation Strategies: Creation of standardized Oxytocin tools for nursing and medical staff including Oxytocin Protocol Policy, Oxytocin Orders Revision, Induction/Augmentation of Labor Informed Consent, Pre-Delivery Evaluation, Pre-Oxytocin Checklist, In-Use Oxytocin Checklist and Tachysystole Algorithm. Education tools for patients and mandatory APS FM Education Module completion for all nursing and medical staff.  To support accurate data collection, the team created electronic documentation for Pre-Induction Checklist, Bishop Score and In-Use Checklist previously not available to the staff.

Results: 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, c-section rate of 9-12%, and a decrease from 9, down to 1 infant with a 5 minute APGAR <7.  The 2010 period demonstrated no admissions to NICU with an estimated cost saving of $200,000.  The incidence of tachysystole dropped from 52% to 21 % of all elective inductions.

Conclusion/Implications for nursing practice: Following the guidelines and protocols Freeman Health demonstrated no significant increase in C-section 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 team work, evidenced based protocols and electronic documentation can lead to safer patient care.

Keywords: Oxytocin, induction, tachysystole