Missed nursing care is a key indicator of patient safety and has been linked to safety climate. Survey responses from 3,429 labor and delivery nurses from 253 hospitals across the United States found an average of 11 of 25 aspects of essential nursing care were occasionally, frequently, or always missed. Higher perceived safety climate was associated with less missed care. The authors discuss the importance of strategies to reduce missed care, such as adequate nurse staffing, ensuring nonpunitive responses to errors, and promoting open communication.

Missed nursing care appears to be associated with higher rates of adverse events. More than 3,600 registered nurses (RNs) were surveyed about missed care during labor and birth in the United States. Three aspects of nursing care were reported missing by respondents: thorough review of prenatal records, missed timely documentation of maternal-fetal assessments, and failure to monitor input and output.

Analyzing trends can provide insights into areas of focus for individual and organizational improvement efforts. This commentary summarizes weaknesses identified through liability trend analysis and suggests actions to enhance the safety of perinatal practice. Strategies highlighted include reducing the use of copy and paste and text messages while providing care.

Labor and delivery care is considered high risk for sentinel events should something go wrong. This review discusses how audible surveillance in this setting can contribute to alert fatigue and distraction among nurses and raises concerns that no standards exist to improve the effectiveness of electronic fetal monitoring.

Surgical specimen identification errors occur regularly and preventing misidentification errors is a National Patient Safety Goal. This study reports on an effort to develop process measures for monitoring the quality of specimen identification.

Building on the success of the landmark Keystone ICU project, this study demonstrated that a similar intervention could nearly eliminate central line–associated bloodstream infections throughout Hawaii.

… safety in perinatal care for both mothers and infants. … Simpson KR. Perinatal patient safety and quality.  J Perinat …

This review provides background on high-reliability organizations and discusses how these concepts are applied in obstetric care.

An organization-wide quality improvement program resulted in reductions in perinatal adverse events over a 5-year period.

High-alert medications receive this designation when they involve a high risk of causing patient harm if improperly administered. This study discusses the types and frequency of errors with oxytocin, a high-alert medication used often in obstetrics.

The labor and delivery process at community hospitals is generally managed by nurses who communicate with physicians on an as-needed basis. This study used focus groups, structured interviews, and medical record review to describe communication between nurses and physicians and its relationship to patient safety at four Midwestern community hospitals. Nurses functioned independently for most of the labor process, communicating with physicians for only 2-4 minutes during routine labor. Although nurses and physicians shared the same overall goal of ensuring a safe delivery, both perceived problems with communication during labor. Management of oxytocin to induce labor was a particular source of conflict, with physicians preferring an "aggressive" approach that frequently conflicted with nurses' preferences for physiologic dosing. Physicians also strongly preferred to work with experienced nurses, which created tension and communication difficulties for newer nurses. As documented in other research, physicians had a more positive impression of the overall level of teamwork than nurses did.

The author discusses four methods for measuring patient safety—structure measures, process measures, outcome measures, and safety attitude and climate surveys.

… and perinatal care processes in 15 Michigan hospitals. … Simpson KR; Knox GE; Martin M; George C; Watson SR. …