623 Patient safety challenges during pregnancy hospitalizations: wrong-patient orders on obstetric vs. Non-obstetric units

Abstract

Patient safety in obstetrics is critical and peripartum patients may be at high risk of wrong-patient order errors due to similar characteristics and admission diagnoses. This study compares rates of wrong-patient orders among obstetric patients with reproductive age medical-surgical patients. This cross-sectional study was conducted in a large health system from January 1, 2016 to December 31, 2018. The primary outcome was near-miss, wrong-patient orders identified using the National Quality Forum-endorsed Wrong-Patient Retract-and-Reorder (RAR) measure. All electronic orders placed for eligible patients were extracted retrospectively from the data warehouse. Eligibility criteria included women aged 18 years or older receiving care in obstetric units and women aged 18–50 years admitted to medical-surgical units. Multilevel logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing the probability of RAR events in obstetric and medical-surgical units overall, and in subgroups by clinician type and order timing. 676,643 obstetric order sessions from 45,436 patients and 652,820 medical-surgical order sessions from 12,915 patients were included with lower mean age and higher proportion of non-Hispanic white and privately insured patients on obstetric units (Table 1). The rate of 79.5 RAR events/100,000 order sessions in obstetrics was significantly higher than the rate in the medical-surgical population of 42.3/100,000 order sessions (OR 1.98, 95% CI 1.64–2.39) (Figure 1). The obstetric RAR event rate was significantly higher for attendings and housestaff compared to advanced practice providers and there were no significant differences in error rates between day and night shifts. Wrong-patient orders occurred at significantly higher rates for obstetric patients than for reproductive age women on medical-surgical units. Systems strategies shown to decrease these events in other high-risk specialties should be explored in obstetrics in efforts to render maternity care safer.View Large Image Figure ViewerDownload Hi-res image Download (PPT)