Who out there is doing standardized pitocin orders?

[ragingmomster, BSN, MSN, RN]

I have been working in a 3500 deliveries/year high risk LDR unit for more than 5 years. We are in the beginning stages of working on standardized pitocin orders based on EBP for all the practitioners to use. Because pitocin is a high alert medication and we want to be a highly reliable organization, there has been a large push from the RNs to standardize and use a checklist.

I would love to hear from anyone who has gone from MDs and CNMs writing their pit orders anyway they want to a standard order set across the institution.

Thanks

[BridgeRN79]

We don't have standard orders but almost all of our pit we start at 2 increase by 2 every 30 minutes, no more than 20 unless an IUPC is placed then we can go to 36 with an MD order.

[lovemyjoblandd]

We use standard orders. It has checkboxes and the physician can either choose to start at 1 or 2 and increase by 1 or 2 every 15 or 30 minutes with a max of 32

[klone, MSN, RN]

The hospital I just left also had standardized pit orders. The nurses were also required to do a "pit assessment" q15m to make sure she still met parameters to safely continue pitocin (category of strip, number of UCs per 10 minutes, etc).

[MKPRN]

My hospital has standardized Pit orders. We also have slow pit orders for cervical ripening. Pretty much the Pit is to turn in up 2mu q 30. If you aren't turning the pit up q 30 you need to document why. Turn the pit down 2mu once active labor is established. There are interventions that need to be done based on FHTs. Pit can not go above 20mu's without a doctors order and IUPC.

[babyktchr, BSN, RN]

Wow, you have to document why you DIDN'T turn up pitocin? Does your protocol/order set include parameters as to when it should or shouldn't be increased and is evidence based?

What a protocol should have is a statement that says the nurse has the ability to turn off pitocin at her discretion based on patient safety at the time of administration. Aside from obivious, this should also include the ablility (or inability for that matter) of monitoring contractions or a baby while pitocin (or cervidil) is being used. In this day when patients are getting fluffier and the guidelines for induction based on BMI are coming fast and furious, we need to figure out how we are going to monitor this mom's and baby's and sometimes for the long haul.

Are you all including where your provider must be in proximity to the patient when induction/pitocin is started? For those of you who don't have residents or in house hospitalists, what is your "rule" of the moment?

[allene24]

We start pit on almost every patient at 2 mU and increase by 2 every 15 minutes. Some girls get high dose, start at 6, go up by 6 every 20. We can go up to 40 before notifying MD. MD must be on the property (almost all of the MDs have offices/call rooms attached to the hospital) before starting pitocin. If MD leaves the property they cannot run the pit unless another MD agrees to watch it.

[allene24]

And those are standard order sets! :)

[winter_green]

Standard order, start at 1 mU then increase by 1 - 2 every 30 minutes to a maximum of 20 mU.

[lakec4me]

we have had standardized pit orders since 2010 - start at 1-2 and increase by 1-2 every 30 minutes. we must complete a checklist prior to initiation and complete a pit assessment every 15 minutes. maximum dose is 20, unless bedside assessment is completed.

[BellsRNBSN]

With our standard order set, there is a checklist that must be completed before the pitocin can be started (MD order in; gestation of at least 39 weeks, or documented reason for induction/augmentation if not; OB with surgical privileges on campus; the last 30 minutes of FHR monitoring must show moderate variability or at least one acceleration, no more than one late decel, no more than two variable decels that dip below 60 bpm from the baseline for 60 seconds or longer, no more than 5 contractions in a 10 minute period for two consecutive 10 minute periods, no more than one contraction lasting longer than 120 seconds in 30 minute period).

If that checklist is met, the pitocin may be started at 1-2 and increased by 1-2 every 30 minutes, as long as the FHR requirements I mentioned above are met. The max pitocin dose we may go to is 20, but we can surpass 20 with an MD order.