Unique Plan Description: OB Oxytocin Protocol EKM
Plan Selection Display: OB Oxytocin Protocol
PlanType: Medical                                 
Version: 5          
Begin Effective Date: 2020-04-21 13:08:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 10:23:51
Available at all facilities: No

OB Oxytocin Protocol EKM
IV Solutions
	Pitocin 30 units/lactated ringers 500 mL Premix IV
		30 units, EVERY BAG, 1 milliunits/min
		500 mL, IV, Routine, T;N
			Comment: (MJE/MWH) Start at 1milliunit/min and may increase by 1milliunit/min at a minimum interval of every 15 minutes
		30 units, EVERY BAG, 1 milliunits/min
		500 mL, IV, Routine, T;N
			Comment: (FH) Start at 1milliunit/min and may increase by 1milliunit/min at a minimum interval of every 30 minutes
Patient Care
	Oxytocin Protocol
		T;N
			Comment: 1. Titrate oxytocin according to maternal and fetal response, labor progress, and the "Oxytocin in Use" checklist. Components of the “Oxytocin In Use” Checklist include the following: 	• Fetal Assessment parameters		o At least one acceleration of 15 bpm x 15 seconds in 30 minutes or minimal to moderate variability for 10 of the previous 30 minutes.		o No more than one late deceleration occurred.		o No more than two variable decelerations exceeding 60 seconds in duration and decreasing greater than 60 bpm from the baseline within the previous 30 minutes. 		o Absence of prolonged decelerations(s).	• Uterine Contraction Assessment parameters		o No more than 5 uterine contractions in 10 minutes for any 30 minute interval.		o No more than one contraction lasting greater than 120 seconds duration.		o Uterus palpates soft between contractions. 		o If IUPC is in place, MVU must calculate less than 300 mm Hg and the baseline resting tone must be less than 25 mm Hg.2.  If adequate progress of labor cannot be determined by external monitors, notify healthcare provider for specific order for internal pressure catheter. 3.  If dilation is 5-6cm with adequate labor progress, oxytocin may be decreased in increments of 1 milliunit/minute. 4.  If the oxytocin infusion has been discontinued for less than 30 minutes and when fetal and uterine assessment parameters have been met, per the “Oxytocin In Use” Checklist components, oxytocin may be restarted at not more than one-half of the rate at which it was discontinued and then increased by 1 milliunit/minute at a minimum of every 15 minutes. 5.  If the oxytocin infusion has been discontinued for more than 30 minutes, and when fetal & uterine assessment parameters have been met, per the “Oxytocin In Use” Checklist components, oxytocin may be restarted at 1 milliunit/minute and then increased by 1 milliunit/minute at a minimum of every 15 minutes. 6.  Once oxytocin is at 20 milliunits/minute and contraction pattern fails to result in cervical effacement and dilation, a nurse should call the healthcare provider for specific orders for oxytocin.7.  When there is a Category II tracing, the following interventions may be considered: decrease or discontinue oxytocin, reposition patient, administer oxygen, assess hydration status, and consider IV bolus and notify the healthcare provider.  If no resolution and uterine tachysystole is present or the need to reduce uterine contraction activity is present, the RN will consider Terbutaline administration per order in the Oxytocin Power Plan. 8.  When there is a Category III tracing, the following interventions are recommended:  discontinue oxytocin, reposition patient, administer oxygen, consider IV bolus, and notify the healthcare provider for prompt evaluation / delivery.  If no resolution and if uterine tachysystole is present, the RN will consider Terbutaline administration per order in the Oxytocin Power Plan.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase