Patient safety in obstetrics

Abstract

Obstetrical care providers are highly trained, highly skilled professionals working with complex systems in an unpredictable environment. Perinatal units have many built-in mechanisms that work to prevent errors from occurring. Unintentional failures usually are the result of a chain of events, almost never from a single cause or a single provider. Within most unintentional failures, there is usually no single explanatory cause for the event. Rather, there is a complex interaction between a varied set of systems, including human behavior, performance and interdependency, technological aspects, socio-cultural factors, and a range of organizational and procedural weaknesses. To enable meaningful analysis of the underlying causes of an adverse event, errors and near-misses must be made visible. The challenge lies in the integration of labor and delivery clinical core business with high-reliability organization principles. The human factors knowledge should be considered a required part of the undergraduate and postgraduate medical education. Safety science and human factors engineering need to be applied to perinatal care, and each health care professional should be able to recognize the basic theories, rules, and principles. Business and industry provide many lessons for perinatal care when focusing on error prevention through standardization, information technology, and, last but not least, acknowledging the relationship between team-building and improved performance. This will allow all obstetrical caregivers to build and maintain confidence and competency in their daily clinical activities, which ultimately is believed to result in reduction of clinical error. This review on current patient safety issues as they are applicable to the field of perinatal care attempts to create a sense of urgency towards the creation of a safety-conscious culture in obstetrics. Such a culture fosters a collective approach of responsibility to learn and improve constantly. This process takes time to develop and requires dedicated and highly visible leadership support at every level.