1. No category

STAT PHARMACY
ORDER
(Place X in Box)
Do Not Use Abbreviations: U, IU, Q.D., Q.O.D., Trailing zero (X.0 mg), Lack of leading zero (.X mg), MS, MSO4 and MgS04
DATE
TIME
OXYTOCIN (PITOCIN) INDUCTION AND AUGMENTATION ORDERS Use black ball point pen. RM#
Reminder: Date, time all orders. Print name & ID # under signature.
1. Start Oxytocin (Pitocin) for
£ Induction
2. Indications for Induction: £ Medical
£ Augmentation
£ Favorable Cervix
Bishop Score:____________
3. If for Augmentation: Reason: ____________________________________________________________
4. If fetal heart rate (FHR) pattern is not a Category I:
• Review FHR pattern with physician prior to starting Pitocin
• Document FHR pattern and physician approval
5.
Obtain premixed intrapartum Pitocin concentration: Pitocin 30 units in 0.9 % sodium chloride 500 mL
(0.06 units/mL = 60 milliunits/mL).
• Connect to lowest port on mainline IV tubing.
• Label tubing with Pitocin label.
6. Complete pre-procedure checklist and perform second RN verification prior to initiation/restart of medication.
7. Initiate Pitocin infusion at £ 1 milliunit/min (1 mL/hour) OR £ 2 milliunits/min (2 mL/hour).
8.
9.
Titrate Pitocin infusion by £ 1 milliunit/min (1 mL/hour) OR £ 2 milliunits/min (2 mL/hour) every 30 minutes
until adequate contraction pattern established (1 contraction every 2 - 3 minutes).
Avoid:
• More than 5 contractions in 10 minutes
• Two contractions lasting greater than 120 seconds in duration
• Baseline resting tone greater than 25 mmHg as measured by Intrauterine pressure Catheter (IUPC)
Pitocin infusion not to exceed 20 milliunits/minute without an additional order from physician/Certified
Nurse Midwife (CNM).
10. Notify physician promptly if unable to start Pitocin or if stopped due to FHR or uterine activity pattern.
11. Discontinue Pitocin and notify physician/CNM if:
• Absent variability for 10 minutes
• Recurrent late decelerations
• Prolonged deceleration or bradycardia
• Three variable decelerations exceeding 60 seconds in duration and decreasing more than 60 bpm from
baseline in a 30 minute period
12. Management of tachysystole, hypertonus or tetanic contraction(s)
If accompanied by prolonged decelerations or bradycardia:
• Initiate Intrauterine Resuscitation Measures
• If unsuccessful, give terbutaline (Brethine) 0.25 mg subcutaneously x 1
• Notify physician/CNM
13. When Pitocin is discontinued and is to be restarted, obtain order and dose from physician/CNM.
ONE SET OF ORDERS PER PAGE / Physician’s Signature _ ______________________________________ I.D. #: ______________
MARK THROUGH BLANK LINES /
AND
Print Name: _______________________________________ Date: ___________ Time: _______
SCAN ALL ORDERS
SCANNED DATE: _______
*07600BDO802*
TIME: _______ INITIALS: _______
DO #802 Rev. 11/13/14
07600BDO802