Implementation, Outcomes, and Evaluation

Our hospital system participated in a perinatal risk

assessment with national consultants to identify

opportunities for improvement. Hospital leadership

was involved from the beginning of the project and

provided full support. This topic became the main

focus at our system Obstetric Collaborative, a group

of managers, educators, and physicians that meet

monthly. The oxytocin protocol was recommended

by our parent organization and studied and revised

by our Obstetric Collaborative. Education, including

National Institute of Child Health and Human Devel-

opment (NICHD) fetal monitoring nomenclature and

oxytocin protocol, was provided for all nurses and

physicians. Collaborative fetal monitoring strip re-

views are presented monthly on the labor & delivery

units. Chart audits have demonstrated documenta-

tion of early recognition and management of

tachysystole as well as compliance with maternal/fe-

tal assessments regarding oxytocin titration. The

medical record also demonstrated improved docu-

mentation using NICHD nomenclature.

Implications for Nursing Practice

As a high alert medication, increased scrutiny over

the use of oxytocin can be expected.Care providers

are held responsible when adverse drug events oc-

cur. Implementation of a standardized oxytocin

protocol provides the heightened surveillance nec-

essary to protect mothers and infants.

Evidence-Based Practice: I Know It’s the Best

Practice; Where on Earth Do I Start with the

Changes? (A look at how to implement changes to

decrease elective deliveries o39 weeks gestation.)

Poster PresentationPurpose for the Program

After multiple complaints from obstetricians/gy-

necologists (OB/GYNs) regarding scheduling

inductions, we revised our induction process at

which time we discovered challenges, especially

when working with over 40 private physicians,

administration, department leadership, and sta¡

nurses. The idea of practicing ‘‘as we’ve always

done it’’ was a huge hurdle for our team.

Proposed Change

Feedback from private OB/GYNs indicated lack of a

process for scheduling inductions for labor. Any

physician o⁄ce could schedule the induction with

any individual on the unit at any point during the pa-

tient’s pregnancy and for any gestational week.This

led to di⁄culty scheduling inductions for medical

concerns, which further led to chaos on the labor

and delivery unit.

Implementation, Outcomes, and Evaluation

A thorough literature review revealed that schedul-

ing elective deliveries less than 39 weeks might

cause an increased length of stay, an increased

chance for a Cesarean delivery and an increased

chance of neonatal intensive care unit (NICU)

admission. During implementation, the process

of scheduling inductions, induction standing or-

ders, and the induction policy were revised.

Various educational opportunities were provided

for physicians, physician o⁄ces, administration,

leadership, and sta¡ nurses. Medical records

of patients delivering less than 39 weeks were re-

viewed by both nursing sta¡ and the medical

sta¡ quality liaison. Although we had a physician

peer review committee, we strengthened that

committee with a subcommittee of physicians

to review medical records of patients delivering

less than 39 weeks gestation. Medical records

were assigned to physicians on the subcommit-

tee and only the records with a questionable

reason for induction were processed through to the

full physician peer review committee. Physicians

practicing outside the set standard were sent a let-

ter stating their chart was tagged and given the

option to further discuss with the chief of OB/GYN

services.

Implications for Nursing Practice

Our induction of labor for elective deliveries

less than 39 weeks gestation has decreased by

6%. Our health care system ended monthly meet-

ings for constructing a transitional care nursery

Keywordsoxytocintachysystole

Childbearing

Amanda French, RNC-OB,

MSN, CNS, Moses Cone

Health System, The Women’s

Hospital of Greensboro,

Greensboro, NC

Keywordsinduction of laborelective deliveryelective birth

Childbearing

JOGNN 2011; Vol. 40, Supplement 1 S21

French, A. I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention

since the well-baby nursery rarely has the

number of newborns needed to support a

‘‘step down’’ unit. This is not only a cost savings to

our health care system, but also less stress to those

parents.

Although deliveries less than 39 weeks gestation

continue for medical reasons, the dramatic de-

crease in elective deliveries has changed how our

health care system views evidence-based practice

and the process of making those changes.

Scratching the Surface: Bringing EBP to the Bedside

Poster Presentation

Purpose for the Program

To describe the evidence-based practice process

in a rural community hospital to address the pro-

blem of opioid-induced pruritis post-Cesarean.

Proposed Change

To change current ine¡ective practice for the

relief of opioid-induced pruritis to evidence-based

intervention.

Implementation, Outcomes, and Evaluation

A nursing team from the Birthplace utilized an evi-

dence-based practice model to identify the most

e¡ective intervention for opioid-induced pruritis

post-Cesarean. This was a unique practice project

since the goal was to change anesthesia’s practice.

After review, the physicians decided to change the

current orders for diphenhydramine to naloxone.

Current data on follow-up of naloxone usage in the

unit will be provided.

Implications for Nursing Practice

Evidence-based practice models are critical to im-

prove patient care outcomes. While typically

construed to address nursing practice, interdisci-

plinary communication can foster evidence-based

changes across practice disciplines.

Blood Conservation: An Innovative Program for the

Treatment of Prenatal Anemia

Poster Presentation

Purpose for the Program

Asmany as one third of pregnant patients su¡er

from anemia. Iron de¢ciency is responsible for

95% of anemia in pregnancy. The purpose of this

presentation is to demonstrate how the blood con-

servation program limits the patient’s exposure to

blood products by aggressively treating iron de¢-

ciency with the goal of raising hemoglobin and

hematocrit to a safe level before delivery.

Proposed Change

Prenatal patients have a complete blood count

checked at 28 weeks. If the patient is diagnosed with

anemia a consult to the blood conservation program

is initiated. An anemia diagnosis is made by hemoglo-

bin less than10 g/dl and hematocrit less than 30%.To

con¢rm iron de¢ciency a low ferritin, low serum iron,

and high iron binding capacity is seen.

Implementation, Outcomes, and Evaluation

Aprogram is outlined to assess for iron de¢ciencyand

implement a treatment plan. The initial treatment

o¡ered by the blood conservation program is to pro-

vide instructions on the best way to take oral iron to

increase absorption.Patients are asked to add ferrous

sulfate 325mg and vitamin c 250mg once a day to

already prescribed daily prenatal vitamins.

Implications for Nursing Practice

Through collaboration with the patient’s provider

the patient is aggressively treated. Patients with a

ferritin of less than 50 ng/ml are given intravenous

iron sucrose in divided doses over 3 weeks. They

continue to take oral iron, vitamin c, and prenatal vi-

tamins. A repeat check of blood count and iron

Anne Woods, PhD, MPH,

CNM, Department of Nursing,

Messiah College, Gettysburg,

PA

Jennifer M. Brewer, BSN, RN,

CNRN, Research, Holy Spirit

Hospital, Camp Hill, PA

Keywordsopioid-induced pruritisevidence based practicenaloxonediphenhydramine

Childbearing

Nancy Nuss, RN, CCRN,

Blood Conservation, Geisinger

Medical Center, Danville, PA

Keywordsiron deficiencyblood conservation programblood count

Childbearing

S22 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention