Perinatal Bundle - Elective Induction Bundle Composite

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Perinatal Bundle - Elective Induction Bundle Composite
Data Collection Tool
Elements:
□ Gestational Age 39 weeks or >. Documented prior to initiation of oxytocin. Per ACOG definition in ACOG Practice Bulletin
Number 10, 1999{Induction of Labor}.
Team Definition_______________________________________________________________________________
□ Normal Fetal Status: See NICHD September ’08 Tier Recommendations. Assessed and documented prior to initiation of oxytocin and during administration.
Team Definition________________________________________________________________________________
□ Pelvic Examination: This element includes documentation of a complete pelvic assessment with cervical examination (dilation,
effacement, station of the presenting part, cervical position and consistency; Bishop’s Score), clinical
pelvimetry (acceptable is “adequate pelvis”) and an assessment of the fetal presentation.
Team Definition_________________________________________________________________________________
□ Tachysystole: Recognized and management throughout the administration of oxytocin. NICHD September ’08 Definition- > 5 contractions in
1 0 minutes, averaged over a 3 0 minute window. If present, it is recognized and treated.
Team Definition: ________________________________________________________________________________
Instructions: Review 5 charts each week where oxytocin was used to electively induce labor.
N: Total number of individual components in place (5 charts X 4 elements= 20)
D: Total number of elective induction components possible in 5 charts reviewed(20).
Month ______________Week ____________________
Chart
Gestational
Normal Fetal Status
Pelvic Examination
Tachysystole
Total
Age
#1
#2
#3
#4
#5
When a rate of 95% or greater compliance is reached for at least ____________data points, move to the All or Nothing
Measure (Elective Induction Bundle).

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