Background: Labor inductions have become routine in modern society and are one of the most common procedures in obstetrics.  Women and babies undergoing induction of labor are at increased risk of cesarean delivery (Ehrenthal, Jiang & Strobino, 2010).  Additionally, a concerning number of elective labor inductions are performed at less than 39 weeks of gestation, often when the woman’s cervix is not yet ready.  Therefore the risks to the dyad include not only cesarean delivery, but morbidity from early delivery (The OPQC Writing Committee, 2010).   

Not only are there questions of "if and when" but "how" when it comes to induction.  Inappropriate use of oxytocin is one of the top five areas of preventable perinatal harm (Knox, Simpson & Townsend, 2003). The Institute for Healthcare Improvement (IHI) and Premier Perinatal Safety Initiative (PPSI) include the avoidance and proper management of uterine tachysystole as part of their evidence-based ‘bundles.’   Finally, elective induction and cervical favorability are becoming forefront issues.  Some facilities across the nation are disallowing cervical ripening for elective inductions and/or requiring a pre-specified Bishop score to proceed with elective induction (Fisch, English, Pedaline, Brooks & Simham, 2009;  Durham, et. al., 2008).   

Framework for the talk: As part of the PPSI, our level III perinatal center has addressed safety in obstetrics, particulary induction of labor.  The strategy was multifaceted but two issues are covered in this talk; elective induction of labor and induction medication safety.  In three years of projects to improve the quality of elective inductions, our facility was able to virtually eliminate < 39 weeks' inductions and maintain >90% compliance with tachysysyole recognition and treatment.  The next step will address the issue of cervical favorability.  Consistent with the literature, we have noted at our institution a significant difference in elective delivery outcomes in patients with favorable cervices when compared to unfavorable cervices.  Such differences include longer induction times, more cesareans, neonatal admissions to special care nursery and length of hospital stay. 

Implications for practice:  Induction Safety is of paramount importance to AWHONN nurses.  In sharing our story, I hope to ignite passion, renew commitment and promore professuional exceleence for the purpose of intrapartum safety./