Kahwati Leila C, Sorensen Asta V, Teixeira-Poit Stephanie, Jacobs Sara, Sommerness Samantha A, Miller Kristi K, Pleasants Elizabeth, Clare Hanna Margaret, Hirt Charles L, Davis Stanley E, Ivester Thomas, Caldwell Donna, Muri Janet H, Mistry Kamila B
Social and Health Organizational Research and Evaluation Program, RTI International; Research Triangle Park, North Carolina.
RTI International.
Jt Comm J Qual Patient Saf. 2019 Apr;45(4):231-240. doi: 10.1016/j.jcjq.2018.11.002. Epub 2019 Jan 11.
The Safety Program for Perinatal Care (SPPC) seeks to improve safety on labor and delivery (L&D) units through three mutually reinforcing components: (1) fostering a culture of teamwork and communication, (2) applying safety science principles to care processes; and (3) in situ simulation. The objective of this study was to describe the SPPC implementation experience and evaluate the short-term impact on unit patient safety culture, processes, and adverse events.
We supported SPPC implementation by L&D units with a program toolkit, trainings, and technical assistance. We evaluated the program using a pre-post, mixed-methods design. Implementing units reported uptake of program components, submitted hospital discharge data on maternal and neonatal adverse events, and participated in semi-structured interviews. We measured changes in safety and quality using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators.
Forty-three L&D units submitted data representing 97,740 deliveries over 10 months of follow-up. Twenty-six units implemented all three program components. L&D staff reported improvements in teamwork, communication, and unit safety culture that facilitated applying safety science principles to clinical care. The MAOI decreased from 5.03% to 4.65% (absolute change -0.38% [95% CI, -0.88% to 0.12%]). Statistically significant decreases in indicators for obstetric trauma without instruments and primary cesarean delivery were observed. A statistically significant increase in neonatal birth trauma was observed, but the overall rate of unexpected newborn complications was unchanged.
The SPPC had a favorable impact on unit patient safety culture and processes, but short-term impact on maternal and neonatal adverse events was mixed.
围产期护理安全计划（SPPC）旨在通过三个相辅相成的部分提高分娩（L&D）单元的安全性：（1）培养团队合作和沟通文化；（2）将安全科学原则应用于护理流程；（3）现场模拟。本研究的目的是描述SPPC的实施经验，并评估其对单元患者安全文化、流程和不良事件的短期影响。
我们通过提供项目工具包、培训和技术援助来支持L&D单元实施SPPC。我们采用前后对比的混合方法设计对该项目进行评估。实施单位报告项目组成部分的采用情况，提交有关孕产妇和新生儿不良事件的医院出院数据，并参与半结构化访谈。我们使用改良不良结局指数（MAOI）和其他围产期护理指标来衡量安全和质量的变化。
43个L&D单元提交了数据，代表了10个月随访期间的97740例分娩。26个单元实施了所有三个项目组成部分。L&D工作人员报告称团队合作、沟通和单元安全文化有所改善，这有助于将安全科学原则应用于临床护理。MAOI从5.03%降至4.65%（绝对变化-0.38%[95%CI，-0.88%至0.12%]）。观察到无器械产科创伤和初次剖宫产指标有统计学意义的下降。观察到新生儿出生创伤有统计学意义的增加，但意外新生儿并发症的总体发生率未变。
SPPC对单元患者安全文化和流程有积极影响，但对孕产妇和新生儿不良事件的短期影响好坏参半。
