Family Birth Center Performance & Quality Improvement: Labor Induction Process September 16, 2010

1. Family Birth Center Performance & Quality Improvement: Labor Induction Process September 16, 2010

2. PDSA Process Aim: Improve Induction Process based on the evidence and ACOG and AWHONN guidelines.

3. PDSA Process Plan

4. PDSA Process Plan

5. 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

6. 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.

7. 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.

8. Induction Checklist

9. Single Oxytocin Protocol

10. Documentation of Indication for Induction

11. 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

12. Consistent Patient Education • ACOG Patient Education Pamphlet on “Labor Induction” given to each patient prior to Induction of Labor.