Perinatal Patient Safety: Preventing Maternal and Infant Injury, A Collaborative Approach

The Perinatal Patient Safety Project goal is to create a “culture of safety” in the Birthing Center and to create a high reliability perinatal unit by modeling constructive team behaviors such as briefings, assertion, and situational awareness with recognition of red flags.  These activities will be aimed at decreasing human error and identifying and improving patient care systems for improvement. 
Phase one consists of SBAR and human factors training.  These are multidisciplinary live classroom sessions in which nurses, providers and ancillary staff members learn the SBAR communication method and factors that impede positive communication at all levels.
Phase two is education of a standardized clinical language for fetal monitoring interpretation.  
The too are live multidisciplinary classroom sessions in which nurses and providers are instructed on the NICHD fetal monitoring language style.  There is a feedback session as well in which teams of nurses and providers review real life patient strips and provide an SBAR report as if they were reporting off to each other.
Phase three is critical event team training.  Critical event sessions take place on the L&D unit during the course of normal activity.  Multidisciplinary teams are signed up to participate, including but not limited to:  nursing, unit secretaries, physicians, nurse midwives, respiratory, unit assistants, and other ancillary personnel.  The group meets for a presentation on “Turning a Team of Experts into an Expert Team”.  Scenarios are then rehearsed in the LDR or operating room utilizing simulation mannequins to create a more life-like scenario. These scenarios are videotaped and observed by members of the team looking for system errors or issues and for positive feedback for the team.  The team then moves immediately into a conference room for a debriefing session to identify issues and prioritize them for change.  The debriefing is done in a discussion manner with a no blame, no finger pointing philosophy.  The videotape is utilized to determine issues that may have been missed in the activity of the emergency and also for the team to see how well and how quickly they work together to prevent an adverse outcome.  These videotapes are then deleted immediately after the session.
Our measurements for success of this project are derived from improvement seen in post simulation surveys, average overall quality scores on inpatient satisfaction, staff retention, ans scores on the staff Safety Attitudes Questionnaires (SAQs).  These measurements are then compared utilizing a benchmarking methodology.
This is an innovative, modern approach to multidisciplinary care.  This project is in alignment with the strategic plan of our healthcare system and with the four cornerstones defining the mission of our organization, as follows:
Quality - empowering staff to take an active role in the practice and improvement in obstetric emergencies
Service - creating an environment conducive to fewer errors for our patients
Innovation – building a cohesive multidisciplinary team focused on superior patient care and the advancement of quality improvement
Teamwork - creating an environment based on a culture of safety, positive communication and a vision of shared ideas in performance improvement.