Modern Approaches to Identification of Adverse Events in Perinatal Medicine

Abstract

Introduction. In the past two decades, among the various international initiatives aimed at enhancing the quality of medical care, the greatest number of them is aimed at improving the patient's safety situation. Scientific sources suggest that severe evadable adverse events complicate up to 15% of all hospitalizations, of which approximately 0.7-0.9% of cases can lead to death. It is considered that in perinatal practice, mistakes less frequently lead to adverse events and harm, due to a healthier contingent of patients and the modern paradigm of support for normal and physiological processes, instead of diseases. However, according to scientific literature, up to 1-4% of births are complicated by adverse events, of which up to 2/3 can be considered as preventative.The aim of the research is to determine the content of the major modern organizational tools for identification and registration of adverse events and medical errors in perinatal medicine.Materials and methods. We conducted the content analysis of scientific medical and methodological literature, aimed at identifying the key characteristics and content of organizational instruments for identification and registration of medical errors in perinatal medicine.Research results. Content analysis of printed materials and electronic Internet resources allowed us to determine the main requirements for incident reporting system. The subject of analysis can be any incident of patient safety: a medical error and an adverse event. The review of literature allowed us to reveal the evolution of organizational instruments for registration of adverse events in perinatal medicine. At the lower level, there is the analysis of all cases of deaths of mothers, fetuses and newborns, at the second level – registration of all adverse events with causing harm to the patient; at the third level –registration of near-misses events, the list of which can be personally developed by the department / institution management, adapting the already known tools to their own conditions and to the level of the existing patient safety culture; at the fourth level – registration of the so-called triggers, identification of which in the medical documentation is the basis for its detailed analysis in order to identify the adverse event that occurred during the treatment of patient, and, finally, the fifth level – voluntary reporting of medical errors, occurring at the department. The next, higher level of registration of adverse events and medical errors in perinatal medicine is identification and registration of the so-called uncompleted, timely prevented adverse events. The literature review has shown that most countries have implemented the WHO Maternal Near Miss Tool at the national level. However, it is noted that the main disadvantage of this tool is the lack of registration of uncompleted adverse events associated with the newborn. The standard for detecting adverse medical events was a voluntary incident-reporting system. Yet, these systems in a large number of cases do not reveal the actual frequency of adverse events. Public health researchers found that medical staff volunteered to report only 10-20% of errors, of which from 90 to 95% did not cause any harm to patients. Therefore, hospitals need a more effective way of detecting events that harm patients in order to quantify their degree and severity, as well as determine the effectiveness of the measures taken to improve the patient's safety during the treatment and diagnostic process. In this aspect, the Global Trigger Tool, developed by the Institute for Healthcare Improvement (USA), could be the most effective in assessing the safety of in-patient care provision. This methodology represents a list of triggers (prompts) that are defined for their purpose-oriented search in medical paper / electronic documentation. Perinatal trigger tool includes 8 indicators that may indicate an adverse event associated with pregnancy and childbirth. Currently, the global trigger methodology provides for prospective monitoring of clearly defined indicators online in the application of electronic medical documentation, and retrospective monitoring – in the analysis of medical records after the patient's discharge from the hospital.Conclusions. The latest global trends in the provision of medical care, namely the emphasis on patient safety, require new approaches to address the problem of medical errors and adverse events in perinatal medicine. Incident-reporting systems and the culture of patient safety, essential for their successful operation, should be the key elements of patient safety systems, which are implemented at the hospital, regional and national levels.