Evaluation of oxytocin use during labour

Abstract

Introduction: Globally, there is a general lack of uniformity in oxytocin use with variation in the concent rations adopt ed, administration patterns (doses, rate, duration of infusion) for t he induction and augmentation of labour. This study aimed to develop a Best Practice Implementation Strategy for OT use during labour in a local hospital. Method: The study was carried out at t he Department of Obstetrics and Gynaecology, Mater Dei Hospital (MDH) and at the Directorate of Pharmacy, MDH in 2024. A suitable quality metric tool for the safe use of OT was ident ified to carry out a gap analysis exercise. A google search was undertaken to identify t ools t hat can be used in clinical practice. The keywords used were 'Oxytocin' and 'Toolkit'. Two relevant toolkits were found; 'Safe Medication Administration: Oxytocin' by the Agency for Healthcare Research and Quality Safety Program for Perinatal Care, 2017 and 'Safe Administration of Oxytocin Implementation Toolkit' Pharmacy Education 25(4) 1 - 121 Hospital pharmacy by the PCMCH, 2022. After carrying out the gap analysis, a Best Practice Strategy was developed and validated by an expert panel consisting of four obstet ricians, two senior midwives and two pharmacists. Results: The PCMCH toolkit was deemed the most suitable to use in performing the local gap analysis as it was developed in 2019, updated in January 2022 and evaluated in March 2023, making it the most recent. Risk minimisation strategies already in place pertaining to OT use were appraised. From the 27 criteria listed in the PCMCH toolkit, 5 were unmet, 8 were partially met and 14 were met. The strategy developed focused on optimising practice through the development of checklists to support documentation to reduce risk of errors particularly between shift changes. The expert panel confirmed the practicality and applicability of the proposed st rategy. Subsequently sessions were carried out with midwives working at labour ward to disseminate the strategy, create awareness on safe use of OT practices and faci litate the implementation of the identified checklists to enhance documentation practices. Conclusion: This study provided an evaluation of current practices of OT use in the labour ward with a focus on patient safety and risk minimisat ion. The developed Best Practice Implementation Strategy addresses the gaps identified and st rengthens good practices in ensuring standardised patient safety practices. The approach adopted in this study could be repeated in future practice research to evaluate practice and identify updates required in the strategy and health professionals re-training. Moreover the adoption of the use of Artificial intelligence could be considered in t he future to aid in predicting patients at risk for example of the occurrence of foetal hypoxia, so t hat prevent ive clinical decisions can be made to reduce risk for both mother and baby.