Clayton Beth Ann, Geisz-Everson Marjorie A, Wilbanks Bryan
is a Certified Registered Nurse Anesthetist and educator at the University of Cincinnati, Cincinnati, Ohio.
is a Certified Registered Nurse Anesthetist and educator at the University of Southern Mississippi, Hattiesburg, Mississippi.
AANA J. 2018 Dec;86(6):464-470.
Maternal morbidity and mortality in the United States continues to be high. Understanding parturient complications and causes of death is critical to determine corrective actions. Analysis of closed malpractice claims evaluates patient care, identifies preventable morbidity and mortality, and offers recommendations for improvement. A review of obstetric anesthesia malpractice claims filed against nurse anesthetists (N = 21), extracted from the American Association of Nurse Anesthetists Foundation Closed Claims database, was completed. The malpractice claims included 18 maternal claims and 3 neonatal claims. The most common adverse maternal outcomes were maternal death (8/18) and nerve injury (4/18). Hemorrhage accounted for the greatest number of maternal deaths (3/8) followed by cardiovascular failure, emboli, and neuraxial opioid overdose. All neonatal claims (3/3) involved hypoxic encephalopathy resulting in 1 neonatal death and 2 cases of neonatal permanent brain injury. The majority of maternal cases were identified as nonemergent (15/18) and involved relatively healthy patients (15 identified as ASA physical status 2). Qualitative analysis of closed claims provides the opportunity to identify patterns of injuries, precipitating events, and interventions to improve care. Themes related to poor outcomes in this study include care delays, failed communication, incomplete documentation, maternal hemorrhage, and lack of provider vigilance.
美国孕产妇的发病率和死亡率持续居高不下。了解分娩期并发症及死亡原因对于确定纠正措施至关重要。对已结案的医疗事故索赔进行分析可评估患者护理情况，识别可预防的发病和死亡情况，并提出改进建议。我们完成了一项对针对麻醉护士提出的产科麻醉医疗事故索赔（N = 21）的审查，这些索赔数据摘自美国麻醉护士协会基金会的已结案索赔数据库。这些医疗事故索赔包括18例孕产妇索赔和3例新生儿索赔。最常见的孕产妇不良结局是孕产妇死亡（8/18）和神经损伤（4/18）。出血导致的孕产妇死亡数量最多（3/8），其次是心血管衰竭、栓塞和椎管内阿片类药物过量。所有新生儿索赔（3/3）都涉及缺氧性脑病，导致1例新生儿死亡和2例新生儿永久性脑损伤。大多数孕产妇病例被认定为非紧急情况（15/18），且涉及相对健康的患者（15例被确定为美国麻醉医师协会身体状况2级）。对已结案索赔进行定性分析为识别损伤模式、诱发事件及改善护理的干预措施提供了机会。本研究中与不良结局相关的主题包括护理延误、沟通不畅、记录不完整、孕产妇出血以及医护人员警惕性不足。
