Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes - 22/08/11
, Michael Belfort, MD, PhD a, George Saade, MD b, Gary Hankins, MD b, Darla Miller, RN a, Donna Frye, RN a, Janet Meyers, RN a
Address correspondence to: Steven L. Clark, MD, Medical Director, Women and Newborns Clinical Program, Hospital Corporation of America, St Mark’s Hospital, Women’s Pavilion 1140 E 3900 S, Salt Lake City, UT 84124Résumé |
Objective |
The purpose of this study was to examine the effects of a conservative and specific checklist-based protocol for oxytocin administration on maternal and newborn outcome. The protocol was based on maternal and fetal response to oxytocin rather than infusion rate.
Study Design |
This was a retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol and the first 100 patients receiving oxytocin after protocol implementation.
Results |
The 2 groups were demographically similar. For the pre- and postprotocol groups, the mean time of infusion to delivery was 8.5 ± 5.3 hours versus 8.2 ± 4.5 hours (NS), the maximum oxytocin infusion rate was 13.8 ± 6.3 mU/min versus 11.4 ± 6.1 mU/min (P = .003) and the cesarean delivery rate was 15% versus 13% (NS). Every index of newborn outcome was improved in the post-protocol group, but these differences did not individually reach statistical significance. However, newborns with any index of adverse outcome were significantly fewer in the post protocol group (31 vs 18, P = .049). System wide implementation of this program was associated with a decline in the rate of primary cesarean delivery from 23.6% in 2005 to 21.0% in 2006.
Conclusion |
Implementation of a specific and conservative checklist-based protocol for oxytocin infusion based on maternal and fetal response results in a significant reduction in maximum infusion rates of oxytocin without lengthening labor or increasing operative intervention. Cesarean delivery rate declined system-wide following implementation of this protocol. Newborn outcome also appears to be improved.
Le texte complet de cet article est disponible en PDF.Key words : cesarean delivery, medication safety, oxytocin
Plan
| Cite this article as: Clark S, Belfort M, Saade G, et al. Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes. Am J Obstet Gynecol 2007;197:480.e1-480.e5. Reprints not available from authors. |
Vol 197 - N° 5
P. 480.e1-480.e5 - novembre 2007 Retour au numéro
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