The Effect of the Implementation of Institutional Checklist on Expert Opinion of Oxytocin Use in Labor

Abstract

Background: Oxytocin is a commonly used drug in the labor and delivery unit. Previous studies have shown the association between incautious use of oxytocin and adverse maternal and neonatal outcomes. The aim of this study was to assess whether the implementation of an oxytocin checklist in labor would affect expert opinion of oxytocin use in labor and delivery unit. Methods: This study was conducted in a single, university-affiliated medical center in two phases; before and after the implementation of an oxytocin checklist in the labor and delivery unit (2016-2017). Six experts reviewed cardiotocographs of deliveries performed in an urgent cesarean delivery due to non-reassuring fetal heart rate, after completing at least 4 hours of oxytocin infusion for induction or augmentation of labor. The experts included 3 obstetricians, a midwife, and 2 obstetrical expert nurses, who were tasked to conclude whether oxytocin was managed properly or not. Each case was reviewed by two reviewers separately. A total of 100 cases were reviewed; 50 before the oxytocin checklist implementation, and 50 after that implementation. Findings: We did not find a difference in the reviewers' assessment of oxytocin management before and after the institutional implementation of the checklist. Additionally, there were significant inconsistencies and inter-observer variations in their assessment before and after the checklist implementation. Interpretation: The implementation of an institutional oxytocin checklist did not affect expert assessment of the use of oxytocin in labor. Funding Statement: There was no funding of any kind. Declaration of Interests: All authors declare no conflict of interests or funding of any kind. Ethical Approval Statement: The study was approved by the Local Research Ethics Board at Sunnybrook Health Sciences Centre, Toronto, Canada.