The Clinical and Economic Impact of Nurse to Patient Staffing Ratios in Women Receiving Intrapartum Oxytocin

Abstract

Objective To examine the relationship between nurse-to-patient staffing ratios and perinatal outcomes in women receiving oxytocin during labor.

Study Design A retrospective analysis of perinatal outcomes in women receiving oxytocin for induction or augmentation of labor during 2010. Outcomes examined were fetal distress, birth asphyxia, primary cesarean delivery, chorioamnionitis, endomyometritis, and a composite of adverse events. Frequency of 1:1 nurse-to-patient staffing was determined for each hospital. Outcomes were compared between hospitals categorized into quartiles of staffing ratios.

Results In 208,033 women delivering during 2010, there was no relation between frequency of 1:1 nurse-to-patient staffing ratio and improved perinatal outcomes. Adoption of universal 1:1 staffing in the United States would result in the need for an additional 27,000 labor nurses and a cost of $1.6 billion.

Conclusion Available data do not support the imposition of mandatory 1:1 nurse-to-patient staffing ratios for women receiving oxytocin in all U.S. facilities.

Keywords

oxytocin - nurse staffing - patient safety

• References

• 1 Clark SL, Simpson KR, Knox GE, Garite TJ. Oxytocin: new perspectives on an old drug. Am J Obstet Gynecol 2009; 200: e1-e6
• 2 Freeman RK, Nageotte M. A protocol for use of oxytocin. Am J Obstet Gynecol 2007; 197: 445-446
• 3 Clark SL, Belfort MA, Saade GA , et al. Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes. Am J Obstet Gynecol 2007; 197: e1-e5
• 4 ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1) 386-397
• 5 Clark SL, Belfort MA, Byrum SL, Meyers JA, Perlin JB. Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety. Am J Obstet Gynecol 2008; 199: e1-e7
• 6 Clark SL, Meyers JA, Frye DK, Perlin JA. Patient safety in obstetrics: the Hospital Corporation of America experience. Am J. Obstet Gynecol 2011; 204: 283-287
• 7 Aiken LH, Sloane DM, Cimiotti JP , et al. Implications of the California nurse staffing mandate for other states. Health Serv Res 2010; 45: 904-921 . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20403061 . Accessed March 7, 2013.
• 8 Burnes Bolton L, Aydin CE, Donaldson N , et al. Mandated nurse staffing ratios in California: a comparison of staffing and nursing-sensitive outcomes pre- and postregulation. Policy Polit Nurs Pract 2007; 8: 238-250
• 9 Donaldson N, Bolton LB, Aydin C, Brown D, Elashoff JD, Sandhu M. Impact of California's licensed nurse-patient ratios on unit-level nurse staffing and patient outcomes. Policy Polit Nurs Pract 2005; 6: 198-210
• 10 Spetz J, Chapman S, Herrera C , et al. Assessing the impact of California's Nurse Staffing Ratios on Hospitals and Patient Care. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/A/PDF%20AssessingCANurseStaffingRatios.pdf . Accessed March 7, 2013
• 11 Clark SL, Belfort MA, Hankins GDV, Meyers JA, Houser FM. Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol 2007; 196: e1-e5
• 12 Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008; 199: e1-e5 , discussion 91–92, e7–e11
• 13 Healthdata Management. Change the zero-sum game in healthcare. Available at: http://www.healthdatamanagement.com/issues/20_9/data-analytics-ehr-electronic-health-record-44916-1.html Accessed March 7, 2013
• 14 Nelson B. Value based purchasing—raising the stakes. The Hospitalist. August 2012. Available at: http://www.the-hospitalist.org/details/article/1056049/Value-Based_Purchasing_Raises_the_Stakes.html Accessed March 7, 2013
• 15 American Association of Colleges of Nursing. Nursing Shortage. Available at: www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage . Accessed September 5, 2012
• 16 The American Nurses Association Nursing Shortage. Available at: www.nursingworld.org/nursingshortage . Accessed September 5, 2012
• 17 Romano PS, Yasmeen S, Schembri ME, Keyzer JM, Gilbert WM. Coding of perineal lacerations and other complications of obstetric care in hospital discharge data. Obstet Gynecol 2005; 106: 717-725
• 18 Bruce FC, Berg CJ, Hornbrook MC , et al. Maternal morbidity rates in a managed care population. Obstet Gynecol 2008; 111: 1089-1095
• 19 MacKAy AP, Berg CJ, Liu X, Duran C, Hoyert DL. Changes in pregnancy mortality ascertainment: United States, 1999–2005. Obstet Gynecol 2011; 118: 104-110
• 20 Hankins GDV, Koen S, Gei AF, Lopez SM, Van Hook JW, Anderson GD. Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy. Obstet Gynecol 2002; 99 (5 Pt 1) 688-691
• 21 Cooper GS, Chak A, Lloyd LE, Yurchick PJ, Harper DL, Rosenthal GE. The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage. Gastrointest Endosc 2000; 51 (4 Pt 1) 423-426
• 22 Austin PC, Daly PA, Tu JV. A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. Am Heart J 2002; 144: 290-296
• 23 Association of Womens Heath. Obstetric and Neonatal Nurses. Guidelines for Professional Registered Nurse Staffing for Perinatal Units. AWONN, Washington DC: , 2010