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!