Creating Clinical Policy for Nitrous Oxide Use in Labor

This project was undertaken to develop a clinical policy for nitrous oxide use in labor at a tertiary hospital in Salt Lake City, Utah. In 2014, learning needs were addressed and information was provided to key stakeholders in preparation for future policy development and implementation. The resulting policy written for this project can be used at the target institution during a future implementation phase. The first objective of this project was to determine the evidence-based content for a clinical policy for nitrous oxide use in labor. The second objective was to develop the clinical policy with appropriate formatting for the target hospital. The third objective was to disseminate the policy to the key institutional stakeholders. The final objective was to learn the policy approval process for the target institution and to disseminate the project externally at an appropriate venue. Nitrous oxide is an efficacious means of labor analgesia that many women find useful, yet it is not widely available in the United States (U.S.). Advocates have sparked interest in the U.S., which led to a review by the Agency for Healthcare Research and Quality (AHRQ). Researchers with AHRQ found that nitrous oxide is efficacious for some women and has very few side effects, none of which put the mother or fetus at increased risk for adverse outcomes. For this reason, The American College of Nurse Midwives (ACNM) has issued a position statement supporting the use of nitrous oxide in U.S. hospitals. Some women desire less invasive pain management options in labor. Nitrous oxide has been shown to decrease women's anxiety while giving them freedom of movement and allowing them to control their own pain management. It is also inexpensive with very few recurring costs. Side effects of nitrous oxide include nausea, dizziness, or vomiting among some women. In order to initiate nitrous oxide use at the target hospital, all stakeholders must be in agreement on all aspects of implementation. Implementation consisted of using the literature to establish evidence-based content for the policy. Then, in consultation with content experts, a policy was written to address nitrous oxide use during labor. Meetings were held with all stakeholders, who were presented with the policy. Stakeholders had the opportunity to provide input, with the final policy reflecting the feedback received. The policy was submitted to the nurse educator, who will submit it to the approval body at a later date. The project was presented at an ACNM regional affiliate meeting for external dissemination on April 7, 2016. In summary, nitrous oxide can be made available for labor analgesia. Through widespread and historical use in developed nations, including the U.S., use of nitrous oxide is known to be a safe, effective, less invasive, and inexpensive option for analgesia during labor. The development and implementation of policies for offering nitrous oxide in Utah hospitals will increase the options for pain relief for laboring women and potentially increase patient satisfaction.