Implementation of a Nitrous Oxide Program at a Small Community Hospital Is No ‘Laughing' Matter
Title: Implementation of a Nitrous Oxide Program at a Small Community Hospital Is No ‘Laughing' Matter
- Identify the challenges and opportunities in a small hospital birthing unit to provide the additional pain management option of nitrous oxide to laboring, and recovering women.
- Describe methods that were taken to educate patients and staff for the implementation of nitrous oxide.
- Identify the essential decision makers and their roles in the implementation of a nitrous oxide program.
It is a part of the mission of Monadnock Community Hospital’s Birthing Center to allow patients as much autonomy as possible in their birthing experience. We believe that providing patients with various pain management options and the education to empower them in their decision making is essential to satisfaction in their birth experience. Monadnock Community Hospital is one of the few hospitals in this country to launch minimally invasive, self-administered inhaled nitrous oxide for obstetrical analgesia.
Proposed change:
Nitrous oxide will be offered to all women that meet eligibility criteria as an option for pain management while in labor, or during the immediate postpartum recovery period. Unlike other organizations utilizing Nitrous oxide, Monadnock Community Hospital’s Nitrous program will be Nurse led, rather than being facilitated by the Anesthesia department.
Implementation, outcomes and evaluation:
Monadnock Community Hospital is a critical access hospital with 25 inpatient beds. The OB unit has 7 LDRP rooms. There is not 24/7 coverage in-house for either an obstetric or anesthesia provider. The initiation of the Nitrous program has made access to immediate pain relief a reality. A journal of the journey from concept to implementation has helped to capture the successes, and challenges of this project.
Implications for nursing practice:
A long-time labor nurse described nitrous as, “another quiver in the arrow” for helping women to manage their pain. Because of a national shortage, Monadnock Community Hospital has been unable to obtain Nubain, a popular IV/IM analgesic medication for obstetrics, leaving many women who choose a pharmacological approach for pain management to choose between Stadol, a sedative medication, and epidural anesthesia. Nurses note that they experience frustration at the lack of ‘better options’.
The nurse led approach to the nitrous program at Monadnock enables nurses to provide safe and quick pain relief to patients that was not available prior to the implementation of nitrous.
Night Nurses noted that they were hesitant to call the Anesthesia provider in the middle if the night, if there was a chance that the patient would deliver prior to the Physicians arrival. Nitrous helps bridge the gap of time that can seem endless while waiting for a provider to arrive.
Keywords: Nitrous, labor, analgesia, pain management option, patient satisfaction