improves significantly. Every team member is critical to the safety and best care for the patient for whom they are a part of the caregiving team. "Team training is also reflective of a changing environment in medicine to focus less on individual achievements and more on the importance of the team," Dr. Chervenak said. practice protocols for patient care. Once the best way to manage a clinical situation, such as inducing labor with oxytocin (Pitocin), is having all clinicians follow the same template of care, so that not only do all patients benefit from the best dosing protocol, but also everyone on the team knows what to expect during the induction. Since all patients are being cared for in a standard way, it is also more obvious when the patient is not doing well or having an adverse response. At Cornell, Dr. Chervenak explained, they indeed have developed a standardized oxytocin protocol that is used by all clinicians. Having one protocol is critical, he said, since there is too much risk for miscommunication when several are in use. Miscommu- nication is what Dr. Chervenak calls the "deadliest sin." When every- one is giving patients different treatments that are not standardized, there is an increased potential for errors. Part of Weill Cornell's standardized policy for oxytocin features standardized doses of drug and templates of management. As well, not only the clinicians, but also the nurses are able to decrease or stop oxytocin if they observe that the fetal heart has been negatively affected. the implementation of as part of the obstetric patient safety program include: allowing for simultaneous updating the next responsible person is notified to address the issue more easily distinguish between different medications like oxytocin and magnesium sulfate (both of which are among the top L&D medications associated with patient harm) them and following them makes a dramatic difference in the safety and care of patients, especially obstetrical patients. The positive results of these patient safety initiatives implemented by Drs. Chervenak and Grunebaum and their team were reported in an article that was published in the Journal of Perinatal Medicine in 2012. team found a marked reduction in Cesarean delivery rates at Cornell. In fact, the rates decreased incrementally from 41.6 percent in 2004 to 32.7 percent in 2012--a reduction seen in all of the age groups studied. Another of the team's studies, published in the American Journal of Obstetrics and Gynecology, $50.9 million in 2003 to $250,000 in 2009. developing patient safety systems: eliminated from every clinical situation. Everyone must be held accountable for communication that will ultimately benefit the patient. protocol; find what is the safest from evidence-based data and use these protocols as the template of care. for the new mom and her baby, is not enough. Each L&D has to go a step further: "It's not enough to improve patient safety. You have to humanize the hospital experience. Make the hospital a comfortable place to have a baby and an enjoyable experience for the patient, her baby, and her family." provider-patient partnership." Make sure the patient is part of the interaction when being given a medication. In conjunction with the idea of patients taking an active role their care, enhancement of patient autonomy is a core value, said Dr. Chervenak. He noted that there has to be constant reinforcement of these values. As he summarized, it is key that health care professionals and staff patient care and safety. This is truly a situation for Stop, Look, and Listen! |