Beyond the Bundles: Tachysystole Surveillance and Management during Oxytocin Administration

Abstract

Childbearing Poster Presentation Purpose for the Program Literature has shown that oxytocin, a potentially dangerous intrapartum drug for both mother and fetus, has been associated with as much as a 30% incidence of tachysystole during its administration. This risk has been partially alleviated by the use of the Institute of Healthcare Improvement's bundle methodology for safe initiation of oxytocin for labor induction and augmentation. However, the surveillance, documentation, and management of the tachysystole bundle component, after initiation, has been harder to effectively capture and needs additional exploration. Proposed Change We began with a compliance rate of 25.9% in 2008 and improved to a compliance rate of 97.8% ( p > .001) as a result of our current process and outcomes initiative: “all or none” oxytocin safety flow sheet bundles. As a result, a subsequent innovative approach to tachysystole management and documentation during oxytocin administration was instituted by using education of the bundle and reliability of the sciences. After a meticulous literature review and assurance of best practices, the oxytocin administration protocol and the tachysystole algorithm were revised, and healthcare provider education was revisited. Implementation, Outcomes, and Evaluation A mandatory standardized physician/nursing surveillance and systematic documentation process, which took place every 2 hours, was established with default goals, and hard stop implications should noncompliance occur. A change of culture over time was sought after for sustainability purposes. The overriding goals of both educational and bundle/reliability approaches included safer oxytocin initiation and administration, tachysystole detection and management, and improved neonatal outcomes. Since January 2012, compliance with the induction of the Beyond the Bundles methodology has been 91.3%, with documented or defined tachysystole occurring in only 10.83% of cases. By using tachysystole as the denominator, meaningful intervention was accomplished in 91.86% of cases and only 3.49% of neonates had adverse outcomes. Implications for Nursing Practice In summary, to further lower the rate of tachysystole‐related adverse neonatal outcomes, the opportunity to further increase awareness and education for both physicians and nurses alike can be done by using an obligatory and comprehensive oxytocin safety flow sheet before and during oxytocin administration, along with a focused tachysystole management protocol. This will be a design worthy of consideration in reducing adverse effects from this high‐risk medication.