Purpose of the tool: This tool describes the key perinatal safety elements with examples for the safe administration of oxytocin during labor. The key elements are presented within the framework of the Comprehensive Unit-based Safety Program
(CUSP). Who should use this tool: Nurses, physicians, midwives, pharmacists, and other labor and delivery (L&D) unit staff involved in the preparation and administration of oxytocin during labor. How to use this tool: Review the key perinatal safety elements with L&D leadership and unit staff to determine how elements will be implemented on your L&D unit. Consider any existing facility policies or processes related to oxytocin use. Consider using
preprinted orders, standing orders, and staff training to support implementation. A sample of how some of these key perinatal safety elements can be incorporated into a unit approach to safe oxytocin administration is provided in the Appendix of this tool. A sample process and forms for a committee review are available at the Council on Patient Safety in Women’s Health Care, www.safehealthcareforeverywoman.org. In the context of oxytocin use, this includes staff alertness for early signs of fetal or maternal distress, and knowing the plan for a timely response to prevent
further deterioration. Every effort was made to ensure the accuracy and completeness of this resource. However, the U.S. Department of Health and Human Services makes no warranties regarding errors or omissions and
assumes no responsibility or liability for loss or damage resulting from the use of information contained within. Examples of gestational dating documentation include the following: Standing Orders for Response to Complications: For tachysystole, the following should be implemented as standing physician orders so that nurses can implement without delay: For Category I FHR pattern and tachysystole: Note: Consider any fluid restrictions the patient may have. If uterine activity does not return to normal after 10 minutes, decrease the oxytocin rate by at least half; if uterine activity has not returned to normal after 10 more minutes, discontinue the oxytocin until uterine activity is less than five contractions in 10 minutes. For Category II and III FHR and tachysystole: Note: Consider any fluid restrictions the patient may have. If no response, administer terbutaline 0.25 mg SC. Discontinue oxytocin infusion and notify provider for— For decreased urine output or maternal hypotension, administer 500 cc of LR by IV bolus, and notify provider of response to bolus. Resumption of oxytocin after discontinuation:
[Note: some facilities choose to require a provider order to restart oxytocin] If oxytocin has been discontinued for less than 30 minutes— Note: Do not start oxytocin on patients who are < 4 hours post-insertion of misoprostol. Note: Do not start oxytocin on patients who are < 4 hours post-insertion of misoprostol. Page last reviewed May 2017 Page originally created April 2017 Internet Citation: Safe Medication Administration: Oxytocin. Content last reviewed May 2017. Agency for Healthcare Research and Quality, Rockville, MD. How is oxytocin administered during labor?If oxytocin injection is given to induce labor or to increase contractions, it is usually given intravenously with medical supervision in a hospital. Your doctor may adjust your dose of oxytocin injection during your treatment, depending on your contraction pattern and on the side effects that you experience.
What is the best oxytocin administration protocol?The oxytocin should be administered using an infusion pump. Oxytocin in labour should be constituted by adding 10 IU oxytocin to 1 litre of 0.9% normal saline starting at an infusion rate of 1-5mU/min (6-30 ml per hour).
Which criteria must be in place before beginning an oxytocin induction?Oxytocin Infusion may be utilized when there is a favorable cervix and a Bishop score of six (6) or greater: a) If cervix is unfavorable/Bishop Score is less than six (6) see AHS Induction of Labour: Cervical Ripening Guideline.
When should I start taking oxytocin during labor?Start at 5 drops/minute, then increase by 5 drops/minute every 30 minutes, until contractions are effective (3 to 4 contractions of more than 40 seconds in 10 minutes). On average, 20 drops/minute results in satisfactory uterine contractions.
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