Family Birth Center
Performance & Quality Improvement:
Labor Induction Process
September 16, 2010
PDSA Process
Aim: Improve Induction Process based on the evidence and ACOG and
AWHONN guidelines.
Describe your first (or next) test of change:
Person
When to be
responsible done
Where to be
done
Revise “Oxytocin Guidelines for Induction of
Labor” Policy and Procedure.
Jamie
Vincent
JMH
November
2009
PDSA Process
Plan
List the tasks needed to set up this test of
change
• Literature Review
• Identify Physician champion.
• Identify Stakeholders
• Discussion on criteria for elective induction
• Make proposed changes to P&P
• Create Induction Checklist
• Present P&P revisions to OB Quality committee
for input and approval.
• Present P&P to OB/GYN committee for approval
• Educate nurses and physicians regarding
changes in P&P
• Research Patient education on inductions
• Utilize ACOG Pamphlet on Inductions for
consistent patient education
• Resources for staff nurses
• Plan roll out
Person
When to
responsible
be done
Jamie Vincent
Team
Team
Team
Jamie Vincent
Pavna Sloan
Team
Team
Jamie and
Pavna
Jamie
Team
Team
Team
Team
Where to
be done
PDSA Process
Plan
Predict what will happen when the Measures to determine if prediction
test is carried out
succeeds
• Resistance from staff and
physicians
•Lack of documentation, delayed initiation
of pitocin
• Lack of follow through
• Inconsistency in following policy
•Utilizing old policies and practices
•Lack of documentation, delayed initiation
of pitocin
•Improved process and improved
outcomes
• Policy and checklist followed as
educated
PDSA Process
Do
Describe what actually happened when you ran the test
• Physician and Staff Nurse education on new induction policy and checklist
through email communication, staff meetings, in-services, one-on-one
communication, OB Quality and OB/GYN Department Meetings.
• Resource RN position added.
• Resource/Staff nurses obtained necessary documentation utilizing checklist 24
hours prior to scheduled induction.
• MD offices faxed in required documentation.
• Induction not initiated until required documentation in chart.
• Oxytocin administered per new protocol.
• ACOG pamphlet provided to all patients scheduled for induction of labor.
• Track elective inductions less than 39 weeks resulting in NICU admission.
• Present data to OB Quality.
• Continued physician and nursing education
PDSA Process
Study
Describe the measured results and how they compared to the
predictions
• 2010 YTD: Only one elective induction less than 39 weeks resulted in
NICU admission
• 100% of elective inductions had appropriate documentation prior to
initiation of pitocin.
• Admission to initiation of pitocin within 30 minutes as planned.
PDSA Process
Act
Describe what modifications to the plan will be made for the next
cycle from what you learned
• Physician buy-in for changing criteria to a firm 39 weeks for elective
induction as recommended by ACOG.
• Consider adding Informed Consent for Induction of labor.
Induction Checklist
Single Oxytocin Protocol
Reference / Regulations:
ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists #107, August 2009 Induction
of Labor
ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists #49 December 2003 Dystocia
and the Augmentation of Labor.
ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists, #106, July 2009 Intrapartum
Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles
Documentation of
Indication for Induction
Oxytocin IV bags
• Oxytocin Infusion bags
are Pre-mixed in the
Pharmacy to ensure
consistency and safety
• 20 units Oxytocin in
1000 ml Lactated
Ringers
Consistent Patient
Education
• ACOG Patient Education
Pamphlet on “Labor
Induction” given to each
patient prior to Induction
of Labor.