Running head: QI PROJECT 1

QI project

Michelle Arslan

Bon Secours Memorial College of Nursing

Quality and Safety in Nursing II

NUR 3207

Tomeka Dowling, DNP, MS, RN

July 22, 2016

On my honor, I have neither given nor received aid on this assignment or test, and I

pledge that I am in compliance with the BSMCON Honor System.

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QI project

I currently work at Mary Immaculate Hospital as a Labor and delivery nurse within the

Birthing Center and have noticed within my own professional practice the incidence to first time

mothers that are induced for labor just based on convenience alone hold the highest rate of C-

section. In fact the prevalence of cesarean section rates in the United States has dramatically

risen from twenty one percent to thirty three percent in just a thirteen year span (Yamasato,

Bartholomew, & Durbin, 2014). So the question was raised why the rush and also why are these

first time mothers being induced in the first place?

This issue is specific to my unit only. Mothers should only be induced for labor due to

medical necessity based on the national recommendation of The Association of Women's Health

Obstetric and Neonatal Nurses (AWOHNN). Per the AWOHNN guidelines it states that all first

time mothers should allow for labor to occur on its own unless medically recommended by an

obstetrician. In addition, the American Congress or Obstetrics and Gynecologists also known as

ACOG is the national body to which all evidence based practiced stems from, all hospitals and

obstetric physicians must adhere to the recommendations of ACOG. With the ACOG guidelines

that are reviewed on an annual basis ACOG states that elective inductions for multigravida

patients or for second time mothers who have had a successful vaginal delivery previously, and

have presented with a favorable cervix and who are least thirty-nine weeks gestation are now

allowed to be scheduled for an elective induction but no sooner for the sake of convince

(American Congress of Obstetricians and Gynecologists, 2013). ACOG goes further on to state

that within these guidelines of inducing only multigravida mothers or second time mothers for

elective inductions has decreased the national cesarean rates by half and has also decreased the
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neonatal intensive care NICU admission rate; there by also saving money to medical institutions

"American Congress of Obstetricians and Gynecologists, 2013).

Currently there has been a revision attempt on the policy that addresses inductions of

labor and the guidelines to qualify. Some for the guidelines per the new birthing center

guidelines states that a mother must be a second time mother, must be at least thirty nine weeks

gestation, and must be needed an induction for a medical obstetric necessity. A medical

induction of labor is an induction based on medical necessity, and benefits both mother and

baby. Some medical reasons for an induction of labor may be maternal hypertension, fetal

intrauterine growth restriction, poor placenta profusion, and even fetal macrosomia (Pillitteri,

2010). However within my nursing practice I have noticed first time mothers also known as

primigravidas who elect to be induced for labor at 39 weeks based on convenience alone often

end up having a C-section based on failure to progress. Often through my own work experiences

I have found that the elective induction process can take up to 72 hours just to make any labor

progress, and often times puts a patient at a greater risk for a cesarean delivery because we are

ensuing artificial hormones and not allowing this mother to go into labor on her own.

So the question was raised Whats the big deal of being induced if its my first baby?

The Association of Women's Health Obstetric and Neonatal Nurses (AWOHNN) who mission

statement is to promote the health of woman and newborns states that inducing labor without a

medical reason increased the risk for complications for both mother and baby, and should not be

done expect when medically necessary, and especially not for convenience (Association of

Womens Health Obstetric and Neonatal Nurses, 2014). Most people are unaware that giving

such medications without reason causes significant unnecessary complications both immediate

and possibly long term for both mother and baby. Some risk factors include maternal
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hemorrhage, fetal distress as well as fetal respiratory distress, the need for maternal blood

transfusion, maternal infection, major surgery, scar tissue, and disturbed body image, are just

some to name a few (Association of Womens Health Obstetric and Neonatal Nurses, 2014).

ACOG and AWHONN both recommend to all mothers to go the full forty weeks of pregnancy

unless medically not recommended.

The quality improvement that I suggest and the policy change that is underway within my

unit is to have every first time mother that would like to schedule for an induction of labor must

first be approved for her induction of labor by Maternal Fetal Medicine high risk obstetrics prior

to being scheduled. Getting prior approval from Maternal Fetal Medicine for induction of labor

will aide in sifting out elective inductions based on convenience and will allow for mothers who

have the need to be induced for labor that have a tangible reasons to be schedule instead. The

first time mother must first pass all qualify criteria. Reasons for first time mothers under the new

policy change would be gestational pregnancy age of 41 weeks placing the mother at post dates.

An additional reason a first to receive an elective induction of labor would be but not limited to

poor placenta cord insertion. All reasons to be induced must be medically necessary and

approved by maternal fetal medicine prior to the patient being scheduled for an induction of

labor. An additional aspect of this new policy change is to inform all mothers that want to be

scheduled for an induction of labor is education on the possible duration of the induction and the

emphasis that an induction may last for seventy two hours. All consents must also be signed and

explained by the physician not the nursing staff and the patient must sign for a vaginal consent as

well as C-section consent.

Another bonus to having all mothers screened for induction of labor is having only true

laboring mothers on the unit; having a free labor bed available in case of an emergency. Often on
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my unit I have witnessed labor induction patients that labored for days not making any progress

for up to 72 hours; while another mother presents to the unit complete in cervical dilation and

crowning, because there is no birthing rooms available this mother has to deliver in triage, with

no pain medication on board, with only a certain to separate her from the other patients. This

situation is unacceptable, because if a labor bed was free the mother that had a precipitous

delivery could have had a better experience in the most vulnerable experience of her life, and

patient satisfaction and patient engagement, and poor HCAHPS scores are sure to follow that

poor experience. By having these policy changes we can have a better approach on caring for our

patients and give patient care that is specific to every mother and infant. Our C-section rates

would drop, allowing for more vaginal births and less invasive deliveries. It is our job as nurses

to be adaptable, and educated. This policy change is a must and must be accepted and

implemented by all Mary Immaculate Birthing Center staff.

A dashboard report that I think would be very helpful is to take the micro-statistics of

Mary Immaculate Hospital, Birthing Center and see the vast improvement of the decrease of C-

section deliveries and the care delivered. This information can be collected by physicians while

conducted their morning rounds and input into an excel spread sheet then communicated to all

charge nurses, informing all staff of their quality performance and patient care evaluation.

In closing I am excited to see the vast changes that are occurring for the better at Mary

Immaculate hospital. We as nurses are dedicated to be lifelong learners while providing the most

up to date, excellent practice to our patient population (Amer, 2013).

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References

Amer, K. (2013). Quality and Safety for Transformational Nursing:Core Competencies. Upper

Saddle River, NJ: Pearson Education.

AWWHONN Recommends Reducing Preventable Harm to Moms and Babies by Eliminating

Overuse of Labor Inductions. (2014). Retrieved from

http://www.awhonn.org/news/news.asp?id=254629&hhSearchTerms=%22elective+and+i

nduction%22

Pillitteri, A. (2010). Maternal & Child Health Nursing, care of the childbearing and

childrearing family (6th ed.). Buffalo, NY: Lippincott Williams & Wilkins.

Restricting Elective Inductions Reduces Cesareans. (2013). Retrieved from

http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Restricting-

Elective-Inductions-Reduces-Cesareans

Yamasato, K., Bartholomew, M., & Durbin, M. (2014, October 2, 2014). Induction Rates and

Delivery Outcomes After a Policy Limiting Elective Inductions. Maternal & Child

Health Journal , 1115-1120. http://dx.doi.org/http://dx.doi.org/10.1007/s10995-014-

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