Implementation experiences with improving safe medication practices for oxytocin and magnesium sulfate during labor and delivery

Abstract

Objectives. Oxytocin and magnesium sulfate are high-alert medications with risks for significant patient harm. This paper describes experiences of 25 Labor and Delivery (L&D) units which sought to apply safety science principles such as standardization, learning from defects, independent checks, teamwork and communication, and in situ simulation training for safe administration of oxytocin and magnesium sulfate. This effort was part of the Agency for Healthcare Research and Quality’s Safety Program for Perinatal Care. Methods. Use of safety science principles was monitored using a web-based reporting tool prior to program implementation, during, and 10 months after the start of implementation. Implementation experiences were assessed using semi-structured interviews and analyzed using qualitative thematic analysis techniques. Results. L&D units successfully applied safety science principles to medication administration. They achieved 100% standardization and made substantial progress in creating independent checks (82% for oxytocin and 78% for magnesium sulfate) and improving teamwork and communication (95% for oxytocin and 78% for magnesium sulfate). Learning from defects was maximized for oxytocin (91%) and less so for magnesium sulfate (67%). The least commonly applied principle was the use of in situ simulations, with only a third of participants utilizing such trainings for safe medication practices. Conclusions. Concurrent application of safety science principles to medication administration may offer a novel and effective approach to enhancing medication safety on L&D units.