As an adjunct to inductions, a number of procedures to ripen the cervix are employed. One of these methods is the vaginal administration of preparations using prostaglandins. Before administering this medication, the nurse should be aware that this class of drug is an appropriate choice for women who have had a prior cesarean birth. Purpose of the tool: This tool describes the key perinatal safety elements with examples for the safe administration of oxytocin during labor. The key elements are presented within the framework of the Comprehensive Unit-based Safety Program (CUSP). Show Who should use this tool: Nurses, physicians, midwives, pharmacists, and other labor and delivery (L&D) unit staff involved in the preparation and administration of oxytocin during labor. How to use this tool: Review the key perinatal safety elements with L&D leadership and unit staff to determine how elements will be implemented on your L&D unit. Consider any existing facility policies or processes related to oxytocin use. Consider using preprinted orders, standing orders, and staff training to support implementation. A sample of how some of these key perinatal safety elements can be incorporated into a unit approach to safe oxytocin administration is provided in the Appendix of this tool. Key Perinatal Safety ElementsStandardize When Possible (CUSP Science of Safety)Key Perinatal Safety ElementsExamplesStandard criteria established for oxytocin use.
A sample process and forms for a committee review are available at the Council on Patient Safety in Women’s Health Care, www.safehealthcareforeverywoman.org. Select "Get SMM Forms."Share outcomes or process improvements from the informal (debriefing) and formal analysis with staff to achieve transparency and organizational learningSites can decide how often this information will be shared, how much information will be shared, and with whom, and whether this is specified in a unit policy or is handled more informally.Simulation (Safety Program for Perinatal Care Signature Element)Sample scenario:
In the context of oxytocin use, this includes staff alertness for early signs of fetal or maternal distress, and knowing the plan for a timely response to prevent further deterioration. Use SBAR (Situation, Background, Assessment, and Recommendation), callouts, huddles, and closed-loop communication techniques.Use SBAR, callouts, huddles, and closed-loop communication among team members. In the context of oxytocin use, these techniques are particularly useful—
References
AppendixEvery effort was made to ensure the accuracy and completeness of this resource. However, the U.S. Department of Health and Human Services makes no warranties regarding errors or omissions and assumes no responsibility or liability for loss or damage resulting from the use of information contained within. SAMPLE Safe Medication Administration for Labor Induction or Augmentation with OxytocinCategoryProcedure1. Verifying and documenting indications for use
0–302–4 40–501–2 60–70<1 >80Station-3-2-1 or 0+1 or +2ConsistencyFirmMediumSoft-PositionPosteriorMidpositionAnterior-2. AssessmentFetal assessment
Standing Orders for Response to Complications: For tachysystole, the following should be implemented as standing physician orders so that nurses can implement without delay: For Category I FHR pattern and tachysystole:
Note: Consider any fluid restrictions the patient may have. If uterine activity does not return to normal after 10 minutes, decrease the oxytocin rate by at least half; if uterine activity has not returned to normal after 10 more minutes, discontinue the oxytocin until uterine activity is less than five contractions in 10 minutes. For Category II and III FHR and tachysystole:
Note: Consider any fluid restrictions the patient may have.
If no response, administer terbutaline 0.25 mg SC. Discontinue oxytocin infusion and notify provider for—
For decreased urine output or maternal hypotension, administer 500 cc of LR by IV bolus, and notify provider of response to bolus. What are nursing considerations for oxytocin?The main adverse effects of oxytocin are related to uterine hyperstimulation, where there's too much contraction. This could cause painful contractions, and lead to uterine rupture and hemorrhage. It could even restrict placental blood flow, resulting in abnormal fetal heart rate patterns.
What should be the priority nursing care at this phase of labor?Here are nursing responsibilities in this phase: Inform patient on progress of her labor. Assist patient with pant-blow breathing. Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or depending on the doctor's order.
What is the priority nursing intervention following an amniotomy?After the procedure, she assesses the maternal temperature every two hours and watches out for any signs of infection. The nurse also monitors the fetal heart rate via continuous electronic fetal monitoring and communicates the findings to the provider.
What are some common nursing interventions for a patient being admitted for labor?Nurses in the Delivery Room. Monitor and time contractions during labor and delivery;. Administer epidurals (pain management) and other medications;. Assist the doctor in inducing labor by administering Pitocin or Cytotec;. Monitor the vital signs of the mother and the heart rate of the baby;. |