Anyone here work at a hospital that uses nitrous oxide in labor?

[klone, MSN, RN]

Posting this here for more traffic/feedback.

We're in the beginning stages of trying to add this service. One question that has come up that I don't really know how to address is concern about "diversion" of the N2O by partners/family members.

For those of you whose facilities offer this service (if there is anyone here whose facility DOES offer it, it's only in about 200 facilities nationwide), how is this addressed? Or is it addressed at all?

[RiskManager]

I am going to be interested to follow this. The last time I saw this used was on 'Call the Midwife' and I have not seen it used in real life in any of the facilities I have worked in. Only 200 places in the country use it. Interesting.

What would be the diversion concern? Someone else grabbing the mask while it is in use and taking a few breaths?

[klone, MSN, RN]

What would be the diversion concern? Someone else grabbing the mask while it is in use and taking a few breaths?

Yes, exactly that.

UCSF has been using N2O for over 30 years, and they were the only facility in the US until around 2011, where a delivery machine with a scavenging system was FDA approved, and slowly, facilities have been jumping on the bandwagon.

The process to get the service offered is a bit daunting.

[RiskManager]

The interesting thing is that I also do risk management for dentists, where nitrous oxide is ubiquitous. There is not this concern for diversion in dental, at least amongst patients/relatives while receiving treatment. Staff, maybe. I have never heard in dental, of someone else grabbing a mask or nose hood to divert nitrous oxide.

What does your facility risk manager say about this? When I think of all the other diversion possibilities in the typical facility for staff, patients, relatives or visitors, nitrous oxide diversion would rank pretty low on my list.

[klone, MSN, RN]

What does your facility risk manager say about this? When I think of all the other diversion possibilities in the typical facility for staff, patients, relatives or visitors, nitrous oxide diversion would rank pretty low on my list.

We haven't yet engaged RM in the process - I'm still trying to get the initial green light from OB and anesthesia to even move forward with the process. If they say no, it's dead in the water and there's no point in involving anyone else.

Interesting you think diversion is a non-issue. In dental offices, when a patient is using N2O, typically the provider is right there the whole time. In L&D that wouldn't be the case. There can be extended periods where it's just the mom and partner/family, with no staff in the room, much more time and opportunity for diversion to take place. Accessibility for diversion is much greater with this than something like a PO or IV narcotic, or PCA. So I find it interesting that you think the possibility of diversion is so low.

We also have a higher than average population of meth and heroin users in this community.

[RiskManager]

So at UCSF and other facilities with this service, is it par for the course that the patient is allowed to use nitrous oxide without any staff in the room or observing the patient? I am guessing that this is Nitronox, at fixed 50/50 nitrous oxide and oxygen.

[klone, MSN, RN]

So at UCSF and other facilities with this service, is it par for the course that the patient is allowed to use nitrous oxide without any staff in the room or observing the patient? I am guessing that this is Nitronox, at fixed 50/50 nitrous oxide and oxygen.

Yes, Nitronox.

I don't know what these other facilities have in place. Hence, my post. :)

I'm wondering how other facilities address this concern with stakeholders. I find it hard to believe that it hasn't been raised as a potential concern at other facilities.

[Pippynurseuk]

We use this in the uk, Entenox (air and nitrous oxide), I'm guessing this is the same thing. It's our main source of pain relief during labour. I would imagine it's fairly common for family members to have a cheeky little go on it, I've certainly seen it happen on our documentary "one born every minute," partner has a little go, maybe gets a bit giggly for a few seconds.......however I think the situation actually self regulates itself......you try wrestling that stuff away from a labouring woman!!

I don't work labour and delivery so I wouldn't know if there is an official policy on avoiding diversion. Different culture however and probably just more relaxed about it.

what I can tell you is that it does very little for the pain, just takes the edge off a bit. It does give you something to concentrate on though during contractions which is probably as effective as its pain relieving capabilities.

[klone, MSN, RN]

what I can tell you is that it does very little for the pain, just takes the edge off a bit. It does give you something to concentrate on though during contractions which is probably as effective as its pain relieving capabilities.

Yes, in my research, that is what I've found. It causes dissociation from the pain, rather than pain reduction. I think its main power is that it gives control over pain management in the woman's hands.

[nlb0101]

I recently used nitrous during my labor. I don't know the specific regulations at the facility as I wasn't an employee there. However, I know there was a nurse in the room at almost all times. The only time she left was to call my doctor.

[Lovekaylanicole]

So, we are in the process of starting Nitrous at our hospital. From all of the research we have done, most hospitals have a consent form to sign and in that it says that if anyone other than the patient is caught using it, it will be taken away immediatley and that person will be escorted out of the room. We will also exaggerate that upon initiation. Hope this helps.

[jennylee321]

It's used all across UK, Australia, NZ

So I'm guessing diversion isn't a huge issue