title: Oxytocin augmentation during labor: how to implement medical guidelines into clinical practice.
abstract: OBJECTIVE
  To describe an extensive process to implement guidelines for oxytocin use during labor and to report its effects on compliance to clinical practice guidelines after 1 year.
  
  
  METHODS
  A multifaceted strategy was developed to involve all obstetric staff and identify possible local barriers to change in advance. The process lasted for more than 1 year.
  
  
  METHODS
  To describe the implementation of oxytocin use according to the new guidelines, and to compare management in clinical practice with guideline recommendations from audits performed before and after the project.
  
  
  RESULTS
  Identification of possible barriers to change, academic detailing, audits with feedback, and local opinion leaders were important factors for a successful process. Documentation of the indication for oxytocin use increased from 54% before, to 86% after the completion of the project (P<0.01). The percentage of incidents in which oxytocin augmentation was started before the diagnosis of labor dystocia was reduced from 40% to 11% (P<0.01). Improvement was found in the documentation of cardiotocography (from 5% to 58%, P<0.01) and contraction frequency at the start of the infusion (from 23% to 63%, P<0.01).
  
  
  CONCLUSIONS
  Our multifaceted strategy involved all obstetric staff, lasted for more than a year, and improved management of oxytocin use according to clinical guidelines. Established rules for documentation were used as a check list to monitor oxytocin use. However, audits with feedback need to continue for medical safety, and have been planned to take place every 6 months.
authors: Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
authors: Stina
authors: S
authors: Holmgren
authors: Kristina Gren
authors: KG
authors: Silfver
authors: Cecilia
authors: C
authors: Lind
authors: Lennart
authors: L
authors: Nordström
mesh_terms: D015148:Cardiotocography; D057189:Checklist; D004282:Documentation; D004420:Dystocia / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D007743:Labor, Obstetric; D007857:Leadership; D008485:Medical Audit; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D014590:Uterine Contraction
chemical_list: D010120:Oxytocics; D010121:Oxytocin