Keystone Perinatal Patient SAFETY PROJECT

Objective:  Preventable harm to mothers and babies during childbirth is a significant patient safety and professional liability issue. The purpose was to use a comprehensive unit-based safety program to promote safe care practices during labor and birth. Standardization of key clinical protocols and policies in the inpatient obstetric setting such as elective births, fetal assessment, labor induction, and second stage labor care has the potential to improve care processes, ultimately resulting in better patient outcomes and decreased professional liability.

Design: Perinatal teams were enrolled in a comprehensive patient safety program over 12 months. Before and after data were used to measure success on implementation of six care processes during labor and birth.

Setting: Perinatal units in 15 Michigan Hospitals.

Patients/Participants: Perinatal teams in 15 Michigan Hospitals representing 34,090 births in 2009.

Methods: The goal was to encourage adoption of six standardized evidence-based care practices: avoidance of elective inductions and elective cesarean births <39 wks, appropriate care during labor induction, augmentation and second stage, and timely rescue of a fetus in jeopardy. Monthly coaching calls, education via webinars and two face-to-face conferences, tools to evaluate care processes, and email/phone contact with the project team were provided. Teams randomly selected 20 cases/month to evaluate four of the care processes (n = 8,703 cases) and all eligible cases for elective births (n= 25,705 term births). Process measures were evaluated using the "all or nothing" approach; all expected aspects of care for each process measure had to be performed to be considered successful.

Results:  Data were analyzed using descriptive statistics, t-tests, percent change tests and Pearson's Chi-Square analysis. From January to November 2009, elective inductions <39 wks decreased 62%, from 15% to 5.7%, p = .008, elective cesareans <39 wks decreased 73%, from 14.6% to 4.2%, p = .003, "met all expected aspects of induction care" increased 117%, from 31.5% to 67.5%, p = .003, "met all aspects of augmentation care" increased 91.5%, from 38% to 72.8%, p =.012, perfect scores on the fetal failure to rescue tool increased 80%, from 33.62% to 60.75%, p =.001; and "met all aspects of care during second stage" increased 106%, from 43.3% to 70.1%, p = .004.

Conclusion/Implications for nursing practice: A comprehensive unit-based perinatal patient safety program can reduce elective births <39 weeks, improve care during labor induction, augmentation and second stage, and improve timely rescue of a fetus in jeopardy.

Keywords:  perinatal patient safety, standardization, elective births, labor induction/augmentation, second stage care, failure to rescue