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Reduction of Elective Labor Inductions

Reduction of Elective Labor Inductions. Confidential: For Quality Improvement Purposes Only. Team Members. Dr Gianopoulos MD Christine Besler RN Maureen Davey RN Denise Goray RN Sandy Swanson RN MSOD AD Women’s & Children’s Health CCE. Confidential: For Quality Improvement Purposes Only.

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Reduction of Elective Labor Inductions

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  1. Reductionof Elective Labor Inductions Confidential: For Quality Improvement Purposes Only

  2. Team Members • Dr Gianopoulos MD • Christine Besler RN • Maureen Davey RN • Denise Goray RN • Sandy Swanson RN MSOD AD Women’s & Children’s Health • CCE Confidential: For Quality Improvement Purposes Only

  3. Opportunity for Improvement • Between 1990 and 2004, Induction of Labor was the most commonly performed obstetrical procedure in the U.S. (www.cdc.gov, Aug. 2007) • The frequency of Induction of Labor more than doubled rising from 9.5% to 21%. (www.cdc.gov, Aug. 2007) • Elective inductions are associated with increase instrumental deliveries, post-partum hemorrhage, longer labors and increase use of labor epidurals. (Grobman, W. Elective Induction: When? Ever? Clinical Obstetrics and Gynecology 2007 50(2): 537-546. Confidential: For Quality Improvement Purposes Only

  4. Project Aim Statement • The Labor & Delivery department evaluated the Induction of Labor rate and the reasons for induction according to the American College of Obstetricians & Gynecologists standards (ACOG). • Goal: To reduce the number of inductions that do not meet the ACOG criteria for induction. Confidential: For Quality Improvement Purposes Only

  5. Solutions Implemented ACOG criteria/standards for Induction of Labor were reviewed A new “Request for Induction of Labor Sheet” was implemented in Labor & Delivery. The ACOG guidelines were posted on the request sheet Confidential: For Quality Improvement Purposes Only

  6. Solutions Implemented • As requests for Induction of Labor were made the RN was asked to record the reason for induction and the number of weeks gestation. • Any request that did not meet ACOG criteria was referred to a Maternal Fetal Medicine (MFM) faculty member. • All Attending Obstetricians & resident staff were re-educated to the ACOG criteria. • NPIC (National Perinatal Information Center) data reviewed by key stakeholders. Confidential: For Quality Improvement Purposes Only

  7. Confidential: For Quality Improvement Purposes Only

  8. Analysis • This project was implemented in 2002. • Induction rates reduced from 25% (2002) to 2.9% (Q1- Q2 2007) an overall decrease of 88%. • The number of inductions have decreased from 435 (2002) to 170 (2006) an overall decrease of 61%. • A significant downward trend is noted. • Loyola remains below the trend hospitals average rate for 2006 and Q1 & Q2 2007. Confidential: For Quality Improvement Purposes Only

  9. Next Steps • Continue to assess the process by ongoing monitoring at the staff nurse level in Labor & Delivery. • Monitor NPIC data as it becomes available. • Share results with key stakeholders and post results for staff review. Confidential: For Quality Improvement Purposes Only

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