BMI on admission _____ Gestational Age:____________ Weight gain in pregnancy___________ EFW:______________________ Diabetic Yes □ No□ Reason for admission: YES NO Bishops score / cervix on admit Previous cervical ripening Spontaneous labor SROM Medical induction reason Elective Induction AROM Other First Stage Recognition System Time labor Diagnosed___________ Cervical status_______________ Time of arrest of labor_____________ Time of oxytocin augmentation___________ Cervical status_______________ If patient receives oxytocin in 1st Stage, review oxytocin deep dive process questions. Explanations to support the process 1st Stage Oxytocin Specific Review Yes No questions Process Careful Monitoring- High risk- every 15 minutes during the active phase of the first stage of labor. Every 5 minutes during the 1. Appropriate level (high risk) based second stage of labor electronic fetal monitoring (or IA) for fetal heart rate and uterine activity while oxytocin administered.(Per Perinatal Guidelines) 2. Oxytocin initiated as intended no delay Was there a delay in initiation or during – in administration due to provider or nursing administration due to provider unavailability, response. nursing staffing, provider staffing issues?
BMI on admission _____ Gestational Age:____________ Weight gain in pregnancy___________ EFW:______________________ Diabetic Yes □ No□ Reason for admission: YES NO Bishops score / cervix on admit Previous cervical ripening Spontaneous labor SROM Medical induction reason Elective Induction AROM Other First Stage Recognition System Time labor Diagnosed___________ Cervical status_______________ Time of arrest of labor_____________ Time of oxytocin augmentation___________ Cervical status_______________ If patient receives oxytocin in 1st Stage, review oxytocin deep dive process questions. 1st Stage Oxytocin Specific Review Process Yes No Explanations to support the process questions Careful Monitoring- 1. Appropriate level (high risk) based electronic fetal monitoring (or IA) for fetal heart rate and uterine activity while oxytocin administered.(Per Perinatal Guidelines) High risk- every 15 minutes during the active phase of the first stage of labor. Every 5 minutes during the second stage of labor 2. Oxytocin initiated as intended – no delay in administration due to provider or nursing response. Was there a delay in initiation or during administration due to provider unavailability, nursing staffing, provider staffing issues?