To Pit or Not To Pit?

The question to increase, maintain, or decrease Pitocin is a long-aged question, asked frequently by nurses working in labor and delivery areas.

Even though this very question has been asked countless times over a multitude of years, there is still no straightforward answer. Not having a clear answer is heavily related to the controversy surrounding Pitocin management practices between healthcare providers.

There are practice guidelines that help guide Pitocin management, but some assessments can come down to provider interpretation.

As the nurse, having all of your information is an invaluable resource to apply in your daily practice to help direct patient care.

Taking It All In

Upon first glance, you see an indication to evaluate your Pitocin infusion.

What is your next move? As nurses, we know that our assessment skills are the keys that we use to evaluate the need for additional assessments or set forth any corrective interventions.

To capture a complete clinical picture, we need to take it all in.

Of course, the decision to perform additional assessment can be altered if there is an emergent response required.

When there is not an emergent response required, we need to build up our clinical picture with an array of assessment information.

The medical equipment we use is depended upon to capture information for us, which is then used to piece together components of our clinical assessments.

We should always ask ourselves if we agree on the equipment information captured in comparison to any physical assessments performed. If there is any disagreeing data, we can start asking ourselves the following:

• Is there another piece of equipment that would capture more information that is conclusive?
• If we were using a Doppler, would an external ultrasound or toco give us more information?
• If we were using external monitoring, would internal monitoring with a fetal scalp electrode or intrauterine pressure catheter, give us more information?

Even with equipment availability, it is also important to ensure we are capturing correct information, so we may ask ourselves what we can do to verify our equipment readings.

• Can we palpate our patient?
• Can we auscultate our patient?
• What visual observations of our patient can we make?

We also rely on our communication skills to gather data from our patients and their family members to help direct our assessments. These verbal assessments can be used to identify changes from previous assessments or from our baseline assessment.

• Have we performed a complete pain assessment with our patient?

In addition, communication is frequently utilized throughout the healthcare team. Sometimes a set of new eyes brings in a completely new perspective.  More experienced co-workers may bring forth valuable knowledge and insight they have acquired.

Use these moments to initiate a huddle to walk through the gathered information; this can lead to solutions or alternative ideas that had not been considered previously.

Huddles can also provide an excellent opportunity for education among new staff members or solidify changes in evidence-based practice. Using our team members to help us connect patterns, rule out insufficiencies, or confirm any dots in this clinical picture we are building.

Considerations

Taking in all of the data allows us to build a complete clinical picture that will help guide us in our decision-making.

Imagine this scenario:

After glancing at our strip, we noted the possibility of tachysystole on the monitor; requiring us to create a complete further assessment.

Depending on the results of our complete clinical picture, we should start to consider several different options. This is where we begin to rely on our education and training in fetal monitoring and clinical interventions.

Considerations for in-utero fetal resuscitation measures include maternal positioning, supplemental oxygen, IV fluids, and of course our Pitocin management in conjunction with notifying the provider.

In order to prepare for safe and effective Pitocin management, you should always stay up to date on not only your facility's policies and procedures, but your fetal monitoring education as well. It will give you the best foundation in caring for your patients!

Going to Bat

Following the previous scenario, once the initial assessments are complete, the equipment has been checked, the communication avenues have been established, and other interventions are considered, this is when Pitocin would be administered.

However, because tachysytole is present on the monitor, the decision to not administer Pitocin was made.

And that's it!

We established a solid clinical picture and performed an intervention that you can back. Sometimes, this can be a difficult decision as a nurse, especially if it upsets anyone on the healthcare team.

Again, please revert to your facility's policies and procedures to help dictate best.

Remember being a patient advocate is also in the framework of your role.

Written by Hollie Dubroc, RN, BSN for Nursing CE Central