Implementation of Carbohydrate-Based Liquid Nutrition in Labor

Abstract

Problem and Purpose: At a large community hospital in the mid-Atlantic region, with over 2,400 deliveries yearly, all women were kept fasting during labor. This outdated practice can lead to increased stress, pain and dissatisfaction with the labor experience. The primary purpose of this quality improvement project was to implement an evidence-based policy for oral carbohydrate-based liquid nutrition in laboring women at low risk of operative delivery. Methods: An evidence-based tool was developed to assess risk of operative delivery. Women at low risk were cleared to receive a carbohydrate-based clear liquid diet. The unit personnel were educated on the new policy, assessment tool, and orders prior to implementation. Implementation tactics included staff specific policy verbal and email reminders. Inpatient charts were reviewed to track and evaluate the number of high and low risk patients, diet orders and frequency of high-risk characteristics. Data analysis included the use of descriptive statistics and a run chart with daily staff compliance rates. Results: A total of 235 women had vaginal deliveries (58% high-risk, 42% low risk) during the nine-week project implementation. Following staff education, diet order compliance rates in both high and low risk groups was 61%, increasing to 75% by the end of implementation. The initial compliance for low risk patients was only 38% following education but increased to 55% by the end of the implementation. In contrast, the compliance rate for high-risk women was 98% after education and 100% at the end of implementation. There were no recorded incidences of pulmonary aspiration or complications during implementation. Conclusion: This project was successful in implementing a policy and assessment tool for carbohydrate-based liquid nutrition for women in labor. Barriers to compliance included the additional step of adding the clear liquid diet order in the electronic medical record and disagreement with the high-risk characteristics in the assessment tool. Recommendations for continued success include adding the clear liquid diet order to the admission order set and adjusting the risk factors in the assessment tool to allow more women to be categorized as low risk of operative delivery and receive carbohydrate-based liquid nutrition.