Edorium Journal of

Gynecology and Obstetrics

 
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Original Article
 
Managing high dose oxytocin via a standardized protocol: An institutional experience
Robert Shapiro1, Sandra Dayaratna1, Melanie Clemmer1, Leo Brancazio1
1West Virginia University School of Medicine, Department of Obstetrics and Gynecology, West Virginia University Hospital, Morgantown, WV, United States.

Article ID: 100011G06RS2016
doi:10.5348/G06-2016-11-OA-5

Address correspondence to:
Robert Shapiro
MD, West Virginia University School of Medicine
Department of Obstetrics and Gynecology, 1 Medical Center Drive
PO Box 9186, Morgantown
WV 26506

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How to cite this article
Shapiro R, Dayaratna S, Clemmer M, Brancazio L. Managing high dose oxytocin via a standardized protocol: An institutional experience. Edorium J Gynecol Obstet 2016;2:28–33.


Abstract
Aims: Oxytocin has been on the Institute for Safe Medication Practices (ISMP) high alert medication list since 2007. This raises concern over the safety of oxytocin, especially in higher dose regimens. However, expediting delivery using high dose oxytocin would facilitate care for more patients by decreasing length of hospitalization. Drawing off the experience from the aviation industry, standardized protocols have been shown to increase both safety and efficiency. A high dose, standardized oxytocin protocol may expedite labor without sacrificing patient safety. We evaluated the impact of a high dose oxytocin protocol for labor induction with a hypothesis that length of hospitalization would decrease without adverse obstetrical or maternal outcomes. We further hypothesized that education regarding the use of high dose oxytocin would increase nursing compliance with the protocol.
Methods: A retrospective cohort study involving 277 obstetric patients >35 weeks gestation who received oxytocin before protocol and 109 patients after protocol for induction / augmentation of labor. Oxytocin orders were standardized into a "low" and "high" dose protocol. Educational sessions were held to explain the safety and efficacy of these regimens. Obstetric interventions, outcomes, and nursing compliance with oxytocin orders were evaluated before and after standardization.
Results: A comparison of intra-partum interventions and outcomes at the time of delivery showed no difference in the rate of occurrence in the before or after protocol implementation (p >0.05). While the overall percentage of patients receiving the high dose oxytocin protocol as ordered improved from 52.8% before protocol implementation to 66.7% after implantation, this difference was not significant (p >0.05). The high dose protocol (6x6) was the only treatment where the patients did not always get oxytocin administered as ordered. The rate of maternal infectious morbidity was reduced almost by half after protocol standardization (5.8% before versus 2.8% after). However, this was not statistically significant (p = 0.21). A significant barrier to implementation of the high dose protocol was nursing compliance with the standard orders (47% before protocol/33% after protocol). Upon further questioning, it was identified this was due to nursing concerns about possible adverse side effects in high risks obstetrical patients.
Conclusion: We found no significant difference between the low and high dose protocols as far as the outcome/intervention parameters studied. Nursing compliance proved to be a barrier to implementation of the high dose protocol.

Keywords: High dose oxytocin, Protocol


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Author Contributions:
Robert Shapiro – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sandra Dayaratna – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Melanie Clemmer – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Leo Brancazio – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Robert Shapiro et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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