I am trying to find references for guidelines on what the upper limit of pitocin is for both scarred and unscarred uterus's. It is not unusual to run pitocin at more than 50-60 milliunits even on VBACs and without IUPCs. This scares the hell out of many of us, but God forbid we don't increase it at the ordered intervals, turn it down or even off!! Despite what is going on with the strip, we can be (and have been) chewed out by a doctor for not turning the pitocin up on schedule. Notice it is "a" doctor.
I am trying to gather amunition to go to the nurse manager with so we can get administration's backing on putting a limit on how high we can run pitocin. I would really love it if I could get access to those references online, but any guidance would be greatly appreciated.
Scary to think that your manager is more interested in keeping people happy more than keeping patients safe. The use of pitocin that high is insane. As someone said earlier, if it isn't working at 20mu..then it certainly isn't gonna work at 50mu. The receptors are sooo saturated by that time, that all you are going to get is a hemmorhage afterwards.
There must be something on the ACOG site that has some sort of guidelines for pitocin practice. I haven't had the chance to go there and research it.
Gosh...I can't even begin to imagine pit running at 180cc/hr. Its a wonder your patients aren't insane from water intoxication. Its so frustrating, isn't it?
I wish you luck. I think one of the policies that every hospital should have is that MD's are NOT allowed to touch IV infusion pumps...not no how...no no where. (just my two cents)
If your manager is not receptive to information regarding the safe administration of Pitocin, perhaps your hospital's risk manager would be.
Another thought, what about contacting your state regulatory agency or JCAHO. They supposedly exist to protect patient safety.
Thanks for all the responses. I am going to be writing a memo to my manager today and give it to her tomorrow. I will also let her know that I was advised by an expert witness in perinatal cases that this is an undefendable practice, esp when everytime someone from our department attends a seminar and mentions this subject we all get the same reactions as everyone here has. I will also tell her that I have to bring this to the director of nursing's attention and the attention of the risk manager.
I discussed this issue with one of our more seasoned and politically astute (in the hospital, anyway) and she agrees that this is an insane practice, but that it will never change. I am on the policy and procedure committee at the hospital and will be bringing this to their attention as well. I have not had an induction with this amount of pitocin for a while, but it still happens and it needs to stop. I worked to hard for my license and care about my patients too much to lose it over something this crazy. I may end up losing my job over this.
Anyway, thanks for the advice, comments and links. I will post a reply and keep you informed of my progress. At this point, prayers would be appreciated.
Heather
Jolie, BSN
6,375 Posts
If your manager is not receptive to information regarding the safe administration of Pitocin, perhaps your hospital's risk manager would be.
Another thought, what about contacting your state regulatory agency or JCAHO. They supposedly exist to protect patient safety.
Good luck.