On behalf of the Wisconsin Association for Perinatal Care (WAPC), April 2016
Dr. Amy Gilliland interviewed Marie Walter*, then the Clinical Nurse Specialist at Gundersen Lutheran Hospital’s birth center in La Crosse, who organized and implemented the first nitrous oxide program in Wisconsin.
0:00 – 1:30 Introductions and opening remarks
1:30 – What was it like to implement
this, Marie?
“A lot like herding cats!”
An interdisciplinary Collaborative Practice Committee decided on the project.
What was the impetus?
An
obstetrician had heard about nitrous oxide use at an ACOG conference a few years before. The midwifery program was interested and we decided to go ahead.
It took only five months from idea to implementation - everyone worked together.
3:30 – Who needed to be involved with planning and approving
the NO program?
We started with a core group of seven: OB/GYN physicians, Family Practice physicians, Midwifery, Labor and Delivery manager, Pediatrics, Anesthesia, L & D nurse educator, Quality Inspection
representative
But then seven other people needed to be included: Safety officer/manager; Charge master analyst; HUC representative; HIM or EHR rep to create standing orders; Pharmacy; Logistics (storage of
equipment)
5:30 Anesthesia quickly decided they didn’t need to be involved. Why not?
6:35 Patient experiences with nitrous oxide
8:00 Rules for use
8:40 How does having nitrous oxide available affect the use of
other medications?
Gundersen Lutheran has a 45-50% epidural rate to begin with.
11:00 What other interventions or side effects are needed with nitrous oxide use?
Youtube: Nitrous Oxide Use in Labor by Perinatal Foundation
Not in the Podcast but in Amy's notes from WAPC Conference session:
1. Nurses from
other WI hospitals stated that the Anesthesia department is usually the stumbling block in getting NO available because of fear of loss of income due to lowered epidural use. However, so far in the U.S. most hospitals with a 50% epidural rate show little change.
[Amy: I'm curious about hospitals with an 80% epidural rate - I wonder if they experience a decrease? Or if the fear of loss of income keeps it from being available so we can find out.]
2. Nitrous oxide can be used when laboring person is in the shower or bathtub.
3. An anesthesia consult is not necessary for NO use. It is consider within the nurse's scope of practice.
4. Every shift needs a NO champion to answer questions and bolster confidence of coworkers.
*More about Marie Walter, MS, RN, C-EFM, CPLC
here: http://www.gundersenhealth.org/resolve-through-sharing/about-us/
