Oxytocin augmentation during labor: How to implement medical guidelines into clinical practise

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 1year.

Study design

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 1year.

Main outcome measures

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.

Keywords: Oxytocin, Augmentation of labor, Barriers to change, Opinion leaders, Guideline implementation, Hyperstimulation