Strategy of incorporating an estimated fetal weight restriction into implementation of an oxytocin policy at a major public healthcare network in New York City

Birth weight is one of the most important factors impacting perinatal morbidity and mortality. Oxytocin is listed by the Institute for Safe Medication Practices (ISMP) as a high-alert medication and is frequently associated with preventable adverse perinatal outcomes. The Institute for Healthcare Improvement (IHI) recommends obstetric units adopt a “bundle” for oxytocin, a small but critical set of processes that are evidence-based to: 1) reduce perinatal morbidity and mortality; 2) reduce unwanted cesarean sections; 3) reduce malpractice cost; and 4) ensure safe, highly reliable individual practice. We adopted and developed guidelines for a new oxytocin policy at North Bronx Healthcare Network after conducting a quality improvement study which 1) determined how accurate our estimated fetal weights were when compared with actual birth weight and 2) determined there was a pattern to our inaccuracy, particularly when considering infants with birth weights greater than 4000 grams. We retrospectively reviewed charts of deliveries that occurred at NBHN over a six month period in 2008. We included women between 15 and 45 years old who were in good health. We compared sonographic and clinical EFW within 7 days of delivery with actual birth weight. We found that in infants whose birthweight is greater than 4000 grams, provider EFW's were notoriously inaccurate; thus, predisposing to inappropriate labor and delivery management, and compounding potential morbidity from use of oxytocin. We conclude that by incorporating an estimated fetal weight restriction into our oxytocin bundle, and by using various strategies to ensure compliance with our oxytocin policy, we are incorporating a patient safety measure that will reduce obstetrical risk related to oxytocin induction/augmentation.