The Effect of an Oxytocin Decision Support Checklist on Oxytocin Use and Maternal and Neonatal Outcomes: A Retrospective Cohort Study

Abstract

Objective To assess the association between use of an oxytocin decision support checklist with oxytocin usage and clinical outcomes.

Study Design We conducted a retrospective cohort study of patients with singleton gestations at 37^0/7 weeks or greater who received oxytocin during labor from October 2012 to February 2017 at an integrated community health care system during three exposure periods: (1) prechecklist; (2) after paper checklist implementation; and (3) after checklist integration into the electronic medical record (EMR). The checklist was a clinical decision support tool to standardize the dosing and management of oxytocin. Thus, our primary outcomes included oxytocin infusion rates and cumulative dose. Secondary outcomes included maternal and neonatal outcomes. We controlled for maternal risk factors with multivariable regression analysis and stratified by mode of delivery.

Results A total of 34,269 deliveries were included. Unadjusted analyses showed that compared with prechecklist, deliveries during the paper and EMR-integrated periods had a lower cumulative dose (4,670 ± 6,174 vs. 4,318 ± 5,719 and 4,286 ± 5,579 mU, p < 0.001 for both), lower maximal infusion rate (9.9 ± 6.8 vs. 8.7 ± 5.8 and 8.4 ± 5.6 mU/min, p < 0.001 for both), and longer duration of oxytocin use (576 ± 442 vs. 609 ± 476 and 627 ± 488 minutes, p < 0.001 and p = 0.01, respectively). The unadjusted rates of cesarean, 5-minute Apgar <7, mechanical ventilation, and neonatal hospital length of stay were similar between periods. The adjusted mean difference in time from admission to delivery was longer during the EMR-integrated period compared with prechecklist (3.0 [95% confidence interval: 2.7–3.3] hours, p < 0.001).

Conclusion Oxytocin checklist use was associated with decreased oxytocin use patterns at the expense of longer labor times. Findings were more pronounced with EMR integration.

Key Points

• An oxytocin decision support checklist is associated with reduced amounts of oxytocin used.

• However, checklists were associated with longer duration of oxytocin use and of labor.

• Results were more pronounced in the EMR-integrated checklist compared with paper checklist.

Keywords

oxytocin - decision support - checklist - maternal outcomes - neonatal outcomes

Note

This study was presented at the Society for Maternal Fetal Medicine 38th Annual Meeting 2018, Dallas, TX.

Authors' Contributions

All authors listed contributed to conception, planning, carrying out, analyzing, and writing up of the work.

^* Current affiliation: 49 Stevenson Street, Suite 1100, San Francisco, CA 94105

Publication History

Received: 18 March 2023

Accepted: 26 February 2024

Accepted Manuscript online:
29 February 2024

Article published online:
02 April 2024

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