Implementation of Nursing Protocol to Decrease Admission-to-Induction Timeline [A154

Abstract

INTRODUCTION: A quality initiative of nurse training in ultrasound and vaginal misoprostol placement was performed. The study objective was to determine if that initiative decreased admission to induction times for term inductions of labor. METHODS: Retrospective pre-intervention data was collected for 6 months. Following the intervention, there was a wash-out period and then 6 months of data was collected. Inclusion criteria were planned term inductions of labor. Clinical characteristics were collected. Univariable and graphical analyses were performed. RESULTS: A total of 368 pre-intervention and 430 post-intervention inductions were analyzed. The inductions did not differ in multiparity, gestational age, starting cervical dilation, induction medication, or cesarean delivery rate. The average time from admission to administration of induction medication did not differ from pre-intervention to post-intervention (90.8 min versus 87.3 min, P=.37). The post-intervention group had a nearly significant decreased time to delivery compared to pre-intervention (21.5 hours versus 22.7 hours, P=.07). The post-intervention group had fewer inductions that took>60 mins to start (67.2% versus 73.9%, P=.04). On graphical analysis, there appeared to be a trend toward decreased time from admission to induction as the months progressed after the intervention. CONCLUSION: While the intervention did not decrease the time from admission to induction, there was a trend toward decreasing times. There was a decrease in number of inductions that took greater than 60 minutes to begin. We believe the intervention to be a viable quality initiative; however, further work needs to be done on optimizing induction and admission processes.