How are pitocin orders written at your facility?

Elvish, BSN, DNP, RN, NP · Apr 20, 2011

I fixed the title for you. :)

NPinWCH · Apr 20, 2011

Not working in OB anymore, but will answer from past experience. When I first started OB, every doc wrote the orders differently. They were all over the place some were start at 3mu, increase by 3mu every 15 min until maxed out and some start at 1mu and double the mu every increase so 1, 2, 4, 8...blah, blah, hated this one by the way...our max was always 20mu and then with doc notification usually they'd tell you to go up to 30mu. The docs would scream if we used our judgment and didn't increase every 15min and trust me they knew where the pit was supposed to be, not that I cared I did what I thought was safe and usually moved slower.

THEN everything changed and we nurses were soooo happy, unfortunately it revolved around a bad outcome r/t uterine rupture. All docs were then required to write the same way: 10 units of pitocin in 500ml of NS or LR start at 1mu and increase by 1mu no sooner than every 30min until contractions every 2-3 min. Max dose of 20mu.

There were also rules about shutting the pit off. If it was off more than 30 min, it had to be restarted at 1mu. If it was off more than 15 min then we restarted it at half the dose it had been running prior to being stopped. The nurses had more leeway in stopping the infusion as well.

What we found out was that we had fewer emergency C/S and fewer failures to progress, though sometimes the labor did last longer.

Irishobrn · Apr 20, 2011

Again different providers write the orders differently, and some are more agressive than others with the use of pitocin. But generally they write start at 2mu and increase 1-2 every 20-30minutes until contractions two to three minutes apart or 200 mvu in 10 minutes, up to 30 mu/hr. After 30mu/hr we have to have the doctor write a separate order to go up past that. We have latitude in how we increase or stop infusions, we just have to document why we didn't increase or why we stopped the infusion. During the day there is no problem because providers are awake and around to work with you, at night it can get a bit tricky...when to wake the provider up and such. But all in all everyone is on the same page where I work. I do like that no one starts pit automatically...they will give the patient a few hours to see if they progress with out it first.

May2011Grad · Apr 20, 2011

I'm a still currently a student but I am precepting on a labor and delivery unit. The pitocin orders are to begin at 1mu and increase by 2mu every thirty minutes until contractions about 2-3 minutes apart. There is more autonomy in stopping and decreasing the pitocin (just document) and an order is required greater than 20mu.

winter_green · Apr 21, 2011

We have standing orders of physicians. When they give us the order either verbal or telephone, we look up their standing order (all in a binder) and check mark what they want on the printed sheet. Most start at 1, some start at 0.5... some are more aggressive than others. Then we fax in the checked mark order to pharmacy.

How do the rest of you guys do it? We do the same with intrapartum orders and post partum orders... look up in the binder of the providers, see what they want, and check mark the boxes and fax in the orders. Providers will either sign it at the time we fax in or sign it later.

socks341968 · Apr 22, 2011

Our orders are pretty lengthy, but basically they state : begin at 2milliunits per minute and increase by 1-2 milliunits every 15 to 30 minutes.

Starting in May, though, we will go to new orders that state : begin at 0.5 to 1 milliunit per minute and increase by .5 to 1 every 30-45 minutes. Which to me is awesome :) We are also stopping all elective inductions before 39 weeks. There must be a documented medical reason (not just subjective) to schedule.

lakec4me · Apr 24, 2011

we start pit at 1 mu and increase by 1-2 no more frequently than 30 minutes, depending on uterine activity.

as a previous poster stated, i have witnessed all types of pit orders over the years, but we now know that oxytocin is a high alert med and parameters should be followed.

FLOBRN · Apr 30, 2011

Our pitocin is the same a lakec4me at my current facility. Our max is 20 mU/min.

Previous job it was pretty much however the MD wanted to order it - 6x6 ( start at 6mU and increase by 6 every 15-30 min to a max of 42) 6x2 (same max) 2x2 (max of 20 interestingly).

The way I am doing it now works just as well as any high dose type protocol and is more physiological.

tablefor9, RN · May 4, 2011

Ours are much the same, start at 1-2 up by 1-2 q30 min to max of 20. We have alot of latitude with going up slower, or decreasing, or whatever. We do have an OB that occasionally will write 6x6 orders.

klone, MSN, RN · May 4, 2011

we start pit at 1 mu and increase by 1-2 no more frequently than 30 minutes, depending on uterine activity.
as a previous poster stated, i have witnessed all types of pit orders over the years, but we now know that oxytocin is a high alert med and parameters should be followed.

Ours are similar. The facility I used to work at believed "fast and hard" and wanted the RNs to go up by 2 every 20. Max was 36, and physicians expected the RNs to be at max within about 8-10 hours. The facility I work at now follows low-dose orders, and it's fairly common to keep it at 2-4mu. Max is 20.