Simpson Kathleen Rice, Kortz Carol C, Knox G Eric
St. John's Mercy Medical Center, St. Louis, USA.
Jt Comm J Qual Patient Saf. 2009 Nov;35(11):565-74. doi: 10.1016/s1553-7250(09)35077-1.
To achieve the goal of safe care for mothers and infants during labor and birth, Catholic Healthcare Partners (CHP; Cincinnati) conducted on-site risk assessments at the 16 hospitals with perinatal units in 2004-2005, with follow-up visits in 2006 through 2008. ON-SITE RISK ASSESSMENTS: In addition to assessing overall organizational risk, the assessments provided each hospital a gap analysis demonstrating up-to-date and outdated practices and strategies and resources necessary to make all practices consistent with current evidence and national guidelines and standards. CRITICAL ASPECTS OF CLINICAL CARE: Review of claims and near-miss data indicate that fetal assessment, labor induction, and second-stage labor care comprise the majority of risk of perinatal harm. Therefore, these clinical areas were the focus of strategies to promote safety. To promote consistency in knowledge and practice, in 2004 a variety of strategies were recommended, including interdisciplinary fetal monitoring education and routine medical record reviews to monitor ongoing adherence to appropriate practice and documentation.
Success in implementing essential structural and process components of the perinatal patient safety program have resulted in improvement from 2003 to 2008 in specific outcomes for the 16 perinatal units surveyed, including reduction of perinatal harm, number of claims, and costs of claims.
The program continues to evolve with modifications as needed as more evidence becomes available to guide best perinatal practices and new guidelines/standards are published. A patient safety program guided and supported by a health care system can result in safer clinical environments in individual hospitals and in decreased risk of preventable perinatal harm and liability costs.
为实现分娩期间母婴安全护理的目标，天主教医疗合作伙伴组织（CHP；辛辛那提）在2004 - 2005年对16家设有围产期病房的医院进行了现场风险评估，并在2006年至2008年进行了随访。
除了评估整体组织风险外，评估还为每家医院提供了差距分析，展示了最新和过时的做法以及使所有做法符合当前证据、国家指南和标准所需的策略和资源。
对索赔和险些发生的不良事件数据的审查表明，胎儿评估、引产和第二产程护理构成了围产期伤害风险的大部分。因此，这些临床领域是促进安全策略的重点。为促进知识和实践的一致性，2004年推荐了多种策略，包括跨学科胎儿监测教育和常规病历审查，以监测对适当实践和记录的持续遵循情况。
围产期患者安全计划基本结构和流程组成部分的成功实施，使2003年至2008年接受调查的16个围产期病房的特定结果得到改善，包括围产期伤害的减少、索赔数量和索赔成本的降低。
随着有更多证据可用于指导最佳围产期实践以及新指南/标准的发布，该计划将根据需要不断改进。由医疗保健系统指导和支持的患者安全计划可在各医院营造更安全的临床环境，并降低可预防的围产期伤害风险和责任成本。
