A Perinatal Safety Plan: Implementing an Obstetrical Emergency Response Team Protocol in a Community Hospital

Women and their unborn fetuses represent a patient population at high-risk for unintended injury. Given the movement toward improved quality of healthcare and the current liability crisis, patient safety must be embraced as a number one priority. Since most obstetric emergencies occur without predisposing factors in laboring women viewed as low-risk, it is imperative that nurses be able to promptly recognize maternal or fetal compromise and initiate actions to expedite delivery of the infant. 

The Perinatal Safety Plan was designed and implemented to improve response times to life threatening maternal-fetal conditions. The plan centers on the development of an interdisciplinary obstetrical emergency response team and provides guidelines for activating the team in an obstetric emergency. Team membership and responsibilities are outlined in a protocol and hospital staff is educated on the criteria for initiating an emergency page. A separate pager system, designated for obstetrical emergencies, was operationalized to simultaneously notify the obstetric team members of the emergent event. Activation of the emergency pager system results in a delineated response from each team member, thereby enhancing teamwork to expedite delivery of the compromised fetus. Labor and Delivery nurses receive ongoing education on the obstetrical emergency response team protocol and participate in mock clinical drills to practice and prepare for these high-risk events. 

Prior to implementing the Perinatal Safety Plan, a designated communication system was not in place to simultaneously notify obstetric team members of emergent situations. Emergency pages to prospective team members were made in the same manner as routine pages and there were no guidelines in place for responding to the emergency page. Pre- and post- Perinatal Safety Plan implementation data was collected regarding obstetrical team member response times and subsequent decision to incision times. In addition, nurses were tested pre- and post-education of the Perinatal Safety Plan and their knowledge of maternal/fetal compromise and appropriate interventions in an obstetrical emergency was compared.