Oxytocin augmentation during labor: how to implement medical guidelines into clinical practice.

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 1 year. 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 1 year. 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.