The Safe Birth Journey...Beyond the "Bundles": Tachysystole Surveillance and Management During Oxytocin Administration

Purpose for the program:   Literature has shown that Oxytocin, a potentially dangerous intrapartum drug for both mother and fetus, has been associated with up to a 30% incidence of tachysystole during its administration.  This risk has been partially alleviated by utilizing the Institute of Healthcare Improvement’s “Bundle” methodology for safe initiation of oxytocin for labor induction and augmentation. However, the surveillance, documentation, and management of the tachysystole bundle component, after initiation, has been harder to effectively capture and needs additional exploration.  

Proposed change: Beginning at a compliance rate of 25.9% in 2008 to a greatly improved compliance rate of 97.8% (p>.001) is a result of our current process and outcomes initiative “all or none” Oxytocin Safety Flow Sheet Bundles, across approximately 19,000 obstetric deliveries.  As a result, a subsequent innovative approach to tachysystole management and documentation during oxytocin administration was instituted by utilizing education of the bundle and “reliability” of the sciences. After a meticulous literature review and assurance of Best Practices, the Oxytocin Administration Protocol and the Tachysystole Algorithm were revised and provider education revisited. 

Implementation, outcomes and evaluation: A mandatory standardized every two hour physician/nursing surveillance and systematic documentation process was established, with default goals, and “hard stop” implications should non-compliance occur. A change of culture over time was sought after for sustainability purposes.  The overriding goals of both educational and bundle/reliability approaches included safer Oxytocin initiation and administration, tachysytole detection and management, and improved neonatal outcomes.  Since January 2012, compliance with the Induction “Beyond the Bundles” methodology has been 91.3%, with documented or defined tachysystole occurring in only 10.83 % of cases.  Utilizing tachysystole as the denominator, meaningful intervention was accomplished in 91.86% of cases.  Finally, only 3.49% of neonates had adverse outcomes.

Implications for nursing practice:   In summary, the opportunity to further increase both awareness and education for both physicians and nurses alike in regards to tachysystole to further lower the rate of adverse neonatal outcomes can be done by utilizing an obligatory and comprehensive oxytocin safety flow sheet before and during oxytocin administration, along with a focused tachysystole management protocol.  This will be a design worthy of consideration in reducing adverse effects from this high risk medication.

Keywords: Tachysystole, Institute of Healthcare Improvement Bundle, Documentation, Hard Stop