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Maternal Safety
Last Updated: November 22, 2021
Created By: Agency for Healthcare Research and Quality (AHRQ)
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Description
Ensuring maternal safety is a patient safety priority. This library reflects a curated selection of PSNet content focused on improving maternal safety. Included resources explore strategies with the potential to improve maternal care delivery and outcomes, such as high reliability, care standardization, teamwork, unit-based safety initiatives, and trigger tools.
Primers (1)
Pregnancy, childbirth, and the postpartum year present a complex set of patient safety challenges. Numerous maternal safety initiatives aim to prevent errors and harm, while enhancing readiness to address maternal complications.
Perspectives (1)
This perspective examines the troubling decline in maternal health outcomes in the United States and summarizes recent national initiatives to improve safety in maternity care. Read More
Other items from the Collection (18)
Ogunyemi D, Hage N, Kim SK, et al. Jt Comm J Qual Patient Saf. 2019;45(6):423-430.
The rise in maternal morbidity and mortality is one of the most pressing patient safety issues in the United States. Formal debriefing after adverse events is an important method for analyzing and improving safety. In this study, an academic hospital... Read More
Macrae C, Draycott T. Safety Sci. 2016;117:490-500.
Simulation training can enhance teamwork, identify latent problems, and contribute to improved patient outcomes. This commentary explores the value of frontline obstetric simulation to develop high reliability. The authors discuss relational... Read More
Grunebaum A, Chervenak F, Skupski D. Am J Obstet Gynecol. 2011;204(2):97-105.
Implementing a comprehensive safety program, which included teamwork training, additional staffing and reduction of work hours, electronic medical records, and a dedicated patient safety nurse, was associated with a sharp reduction in malpractice... Read More
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All Library Content (20)
Organizational Policy/Guidelines
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Morton CH, Hall MF, Shaefer SJM, et al. J Obstet Gynecol Neonatal Nurs. 2021;50(1):88-101.
Individuals involved in adverse maternal events require support both physically and emotionally. This guidance combines readiness, recognition, response, and reporting and systems-learning steps to aid birthing facility nurses and management in providing standardized help for mothers, families, and care team members that experience care-related harm.
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Stanford, CA; California Maternal Quality Care Collaborative: January 22, 2020.
This toolkit focuses on identification of, and rapid response to, sepsis in obstetric patients. It includes screening, evaluation and monitoring, and antibiotic use recommendations for maternal sepsis patient.
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Laderman M, Renton M. Boston, MA: Institute for Healthcare Improvement; 2020.
Maternal care safety is challenged by operational, public health and individual provider limitations. The report outlines specific areas of concern for rural hospitals and suggests avenues for improvement. Strategies suggested using simulation to prepare staff and training on implicit bias.
Newspaper/Magazine Article
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The Joint Commission. R3 Report. August 21, 2019;24:1-6.
Maternal safety in the United States is gaining momentum as a system-level patient safety concern. This report reviews the new Joint Commission Provision of Care, Treatment, and Services (PC) standards developed to improve the reliability of maternal care. Actions for improvement include patient risk assessment for conditions at admission and role-specific education for staff and providers who treat maternal patients regarding hemorrhage processes and procedures.
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This perspective examines the troubling decline in maternal health outcomes in the United States and summarizes recent national initiatives to improve safety in maternity care.
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Simpson KR, Knox GE, Martin M, et al. Jt Comm J Qual Saf. 2016;37(12):544-551;AP3.
Building on the success of the Keystone ICU project model, this study also implemented a comprehensive unit-based safety program (CUSP) to improve safety culture and perinatal care processes in 15 Michigan hospitals.
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Macrae C, Draycott T. Safety Sci. 2016;117:490-500.
Simulation training can enhance teamwork, identify latent problems, and contribute to improved patient outcomes. This commentary explores the value of frontline obstetric simulation to develop high reliability. The authors discuss relational rehearsal, system structuring, and practice elaboration as elements of a successful simulation-focused organizational learning initiative.
Share
Pregnancy, childbirth, and the postpartum year present a complex set of patient safety challenges. Numerous maternal safety initiatives aim to prevent errors and harm, while enhancing readiness to address maternal complications.
Share
Ogunyemi D, Hage N, Kim SK, et al. Jt Comm J Qual Patient Saf. 2019;45(6):423-430.
The rise in maternal morbidity and mortality is one of the most pressing patient safety issues in the United States. Formal debriefing after adverse events is an important method for analyzing and improving safety. In this study, an academic hospital adopted a systems-based morbidity and mortality conference model to review cases of serious maternal harm and implemented several safety measures (including teamwork training) to address issues that were identified through structured review.
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Kahwati LC, Sorensen A, Teixeira-Poit S, et al. Jt Comm J Qual Patient Saf. 2019;45(4):231-240.
Labor and delivery is an inherently high-risk care setting. The Agency for Healthcare Research and Quality adapted its Comprehensive Unit-based Safety Program, a best practice toolkit incorporating teamwork, human factors engineering principles, and simulation training, for labor and delivery. In this pre–post evaluation study, staff reported improved safety culture and teamwork. Obstetric trauma and primary cesarean delivery rates declined after the intervention, but neonatal birth trauma rates increased. The authors note that incomplete implementation and lack of sustained program participation observed in the study should be addressed in order to improve obstetric and neonatal care safety. A recent Annual Perspective emphasizes the rising rate of severe maternal morbidity and summarizes national initiatives to improve safety in maternity care.
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Riley W, Meredith LW, Price R, et al. Health Serv Res. 2016;51(suppl 3):2453-2471.
Improving patient safety provides an opportunity to reduce malpractice claims and associated costs, particularly in higher risk clinical areas such as obstetrics. This study examined medical malpractice claims and cost data in the perinatal units of hospitals before and after implementation of safety interventions focused on decreasing perinatal harm. Interventions consisted largely of standardizing best practices and implementing team training. Investigators found that improving perinatal safety led to substantial reductions in both the frequency and total cost of malpractice claims. The role that the medical liability system plays in driving up health care costs and in promoting the practice of defensive medicine—which can lead to adverse events through unnecessary tests and procedures—was highlighted in a past WebM&M commentary.
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Riley W, Begun JW, Meredith L, et al. Health Serv Res. 2016;51(suppl 3):2431-2452.
Prior research has shown that reducing preventable perinatal harm leads to a decrease in malpractice claims. In this prospective study involving the perinatal units across 14 hospitals from 12 states and accounting for almost 350,000 deliveries, researchers found that successful implementation of 3 standard care processes resulted in a 14% decrease in harm in perinatal care from the baseline period.
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Main EK, Dhurjati R, Cape V, et al. Jt Comm J Qual Patient Saf. 2018;44(5):250-259.
This study describes the implementation of a quality improvement initiative for obstetric safety across California. Instead of a traditional statewide collaborative, this program divided participating health systems into groups of six to eight hospitals, led by a physician and nurse dyad as mentors. Participants reported that this mentored approach functioned better than the larger quality improvement collaborative model.
Multi-use Website
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American College of Obstetricians and Gynecologists
This website provides information from a multidisciplinary collaboration whose mission was to support safe health care for women. The site, maintained by the American College of Obstetricians and Gynecologists, includes collections of patient safety bundles, tools to facilitate review of maternal morbidity, a toolkit for implementing safety initiatives, and educational presentations focused on improving the safety of women's health care. The council ceased to function as an distinct entity in August 2021.
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Rockville, MD: Agency for Healthcare Research and Quality. June 2017.
Communication in labor and delivery units can be challenging. This AHRQ-funded program draws from comprehensive unit-based safety program principles to reduce errors in maternal and neonatal care. The toolkit provides guidance and materials focused on enhancing teamwork skills, implementing perinatal safety strategies, and utilizing in situ simulation. Team training modules and care bundles are shared to enable skill development. A previous WebM&M commentary explored a near miss with a neonate.
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Pettker CM, Thung SF, Norwitz ER, et al. Am J Obstet Gynecol. 2009;200(5):492.e1-8.
A multifaceted approach to patient safety resulted in improvements in both patient- and provider-related outcomes over a 3-year time frame. The strategy was developed after consultation with obstetric safety experts and included teamwork training, standardization of care protocols, and establishment of a robust quality assurance mechanism (including a dedicated patient safety nurse). Progressive implementation of the safety interventions was associated with a steady reduction in maternal and fetal adverse events, as well as improvement in the overall perception of safety culture (as measured by the Safety Attitudes Questionnaire). Prior research has demonstrated the effectiveness of crew resource management training in improving obstetric safety.
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Shields LE, Wiesner S, Klein C, et al. Am J Obstet Gynecol. 2016;214(4):527.e1-527.e6.
Many organizations, including The Joint Commission and the National Partnership for Maternal Safety, recommend the use of early warning systems when treating maternity patients. This prospective study evaluated a maternal early warning trigger tool that was internally developed and piloted at six hospitals within a large health system. The tool was pathway specific and targeted the four most common causes of maternal morbidity: hemorrhage, preeclampsia, sepsis, and cardiac dysfunction. Severe maternal morbidity, as defined by the Centers for Disease Control and Prevention, and composite morbidity significantly decreased following implementation of this tool compared with both baseline rates and control hospitals. In 2010, The Joint Commission issued a sentinel event alert on preventing maternal death.
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Cornthwaite K, Alvarez M, Siassakos D. Best Pract Res Clin Obstet Gynaecol. 2015;29(8):1044-1057.
Obstetric care is considered a high-risk environment. Highlighting the importance of coordinated teamwork during obstetric emergencies, this review discusses strategies to augment clinical outcomes in this setting, including team training, communication improvement, and situational awareness.
Review
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Knox E, Simpson KR. Am J Obstet Gynecol. 2011;204(5):373-377.
This review provides background on high-reliability organizations and discusses how these concepts are applied in obstetric care.
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Grunebaum A, Chervenak F, Skupski D. Am J Obstet Gynecol. 2011;204(2):97-105.
Implementing a comprehensive safety program, which included teamwork training, additional staffing and reduction of work hours, electronic medical records, and a dedicated patient safety nurse, was associated with a sharp reduction in malpractice lawsuits and sentinel events at an academic hospital.
