Cesarean Birth - L&D or Operating Room: Collaboration for Patient Safety

Cesarean Birth – L&D or Main OR: Collaboration for Patient Safety
Rationale for program:
Cesarean births may take place in the setting of an operating room located in the perioperative department or within the perinatal department.  The Joint Commission has stated that patients with the same health status and condition should receive a comparable level of quality care regardless of where that care is provided within the hospital (JCAHO, 2007a).  For maximal safety perinatal departments should therefore maintain comparable standards, procedures, education and maintenance to that found in the main hospital perioperative areas, including the operating room and post anesthesia care unit. 
Purpose of the program:
An evaluation of the perioperative perinatal setting by outside expert consultants and an independent internal review revealed areas of opportunity for standardization of the  operating rooms in the Perinatal service with those in the Perioperative service.  The goal was to bridge the recognized gaps and provide for a optimum environment of safety through standardization of policy and procedure, equipment, staff development, information systems and environmental maintenance.
Program creativity and originality:
This gap analysis opened up the door for the creation of a partnership between the leadership teams of the Perinatal and Perioperative departments to utilize their individual knowledge and expertise to create a model environment for cesarean birth.  This project utilized the resources of the Patient Safety Nurses for the Perinatal and Perioperative areas.  In addition the effort was multidisciplinary, including input from administration, physicians, nurses, educators and environmental support staff.
Description of program outcomes:
Highlighted outcomes include:
-          Redesigned OR orientation program to offer a wider view of all components of the OR experience
-          Development of a Competency Based Orientation packet for PACU care
-          Increased inventory of OR instruments and establishment of a refurbishing program
-          Development of an exchange cart system to improve turn around times with increased volume
-          Introduction of Navicare Information System for tracking patient flow and better communication
-          Upgrading of cleaning and maintenance procedures in both the Main OR and L&B
-          Redesigned staffing pattern
Timeliness of program
With national cesarean rates at all time highs it is imperative to look at ways to guarantee safety for women during cesarean birth.
Relevance of program for women’s health, obstetric and neonatal nursing
Safe, quality care is the number one concern in healthcare today.  We can learn from our peers in other specialties and adopt their best practices for our patient population.
Implications for women’s health, obstetric and neonatal nursing practice, education or research:
Those who practice in women’s services can learn from the best practices and scientific evidence of other medical fields.  This partnership and collaboration must be encouraged and fostered to promote safe environments for our patients.
References:
Joint Commission on Accreditation of Healthcare Organizations (2007a). Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: Author