Best practice implementation strategy in the use of oxytocin during labour

Abstract

Globally there is a general lack of uniformity in Oxytocin (OT) concentrations, doses, rates, and duration of infusion for the induction (IOL) and augmentation (AOL) of labour. This project was set to analyse the local use of OT for IOL and AOL with the scope of developing a Best Practice Implementation Strategy for OT use during parturition. The study was divided into three main parts. During the first part of the study, a literature analysis was undertaken to identify a suitable quality metric for OT use. The second part consisted of application of the identified quality metric to undertake a local gap analysis. In the third part, data was collected retrospectively from the year 2022, using a purposefully developed data collection tool, from 355 patient cases who met the inclusion criteria, which included low-risk, cephalic pregnancies. The ‘Safe Administration of Oxytocin Implementation Toolkit’ developed by the Provincial Council for Maternal and Child Health1 (PCMCH) Ontario, Canada, was identified as being the most appropriate quality metric tool for gap finding. Out of a total of 27 criteria addressing 11 different best practice recommendations, 7 were unmet, 7 were partially met and 13 were met. The gap analysis exercise indicated that local practice fulfils most of the required clinical checks, however the recommendations that were unmet or partially met were mostly related to the documentation domain. The compiled retrospective data of the 355 participants was divided into 2 groups according to use of OT. This high alert drug was used in 63.9% (N=227) of the cases, 43.6% of which were inductions N=99. A higher use of OT was statistically significantly associated (p value <0.05) with greater gestational age, higher parity, increased frequency of uterine contractions, higher incidence of late decelerations or variable decelerations with concerning features, and higher use of epidural analgesia (EDA). The Best Practice Implementation Strategy developed for the delivery suite was evaluated for practicality and applicability by an expert panel consisting of four obstetricians, four senior midwives and two pharmacists. The Strategy developed focused on optimising practice through the development of checklists, adopted from the ‘PCMCH toolkit ́, to support documentation, better infusion labelling and independent verification checking procedures to reduce risk of errors. Subsequently, sessions were carried out with midwives working within obstetric wards to disseminate the Strategy by sensitising the safe use of OT and the implementation of the identified checklists. This study provided an insight into current practices of OT use including identification of further need of improvement in documentation systems. The developed Best Practice Implementation Strategy builds on the current good practice identified and provides measures to increase system robustness in ensuring standardised patient safety practices.