title: Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hospital Corporation of America, Nashville, TN, USA. steven.clark@mountainstarhealth.org
authors.forename: Steven
authors.initials: S
authors.lastname: Clark
authors.forename: Michael
authors.initials: M
authors.lastname: Belfort
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Gary
authors.initials: G
authors.lastname: Hankins
authors.forename: Darla
authors.initials: D
authors.lastname: Miller
authors.forename: Donna
authors.initials: D
authors.lastname: Frye
authors.forename: Janet
authors.initials: J
authors.lastname: Meyers
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002985:Clinical Protocols; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007751:Labor, Induced; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D010120:Oxytocics; D010121:Oxytocin