Patient Safety, Adverse Healthcare Events and Near-Misses in Obstetric Care —A Systematic Literature Review

Abstract

Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals' perspectives on ethical conflicts, attributing blame and responsibility, and patients' perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge * Corresponding author. E. Severinsson et al.1111 about the risk of AEs and the use of best practice guidelines are also essential.

Links between patient safety and fear of childbirth—A meta‐study of qualitative research

“…Despite the development of technology and medical advances in maternity care, accidents, incidents and near‐misses still occur, thus safety concerns must be acknowledged to prevent harm (Martijn et al, ). A PS culture is characterized by open communication and a willingness to learn from adverse events (Severinsson et al, ). This contrasts with the study by Lyndon et al () on 3,282 physicians, midwives and registered nurses who care for women during labour and birth, where 90% of the respondents reported witnessing shortcuts, lack of competence, disrespect or performance problems in the preceding year.…”

“…PS culture includes system, organizational and behavioural interventions, both individually and in combination. Teamwork training and improved communication with patients and between professionals are of the utmost importance for PS practice (Severinsson, Haruma, Rönnerhag, & Berggren, ). With regard to PS sub‐cultures in maternity care, it is likely that communication and woman‐centred care contribute to relieving fear of childbirth (FOC).…”

“…New mothers' physical and emotional experiences influence their well‐being (Waldenström & Rudman, ). Challenges concerning PS in the provision of quality maternity and postnatal care have been identified (Lyndon et al, ; Severinsson et al, ). Healthcare system users' experiences should be fundamental when assessing the quality of care (Berwick, ) and healthcare providers should be aware of what women need and want for a safe childbirth, as FOC is a problem for a significant number of women.…”

Risk management—Evaluation of healthcare professionals' reasoning about and understanding of maternity care

“…This study is part of a larger research programme with the primary objective of implementing and evaluating the WHO model that takes PS into consideration from the perspectives of childbearing women and HCPs (Rönnerhag et al, ; Rönnerhag, Severinsson, Haruna, & Berggren, ; Severinsson, Haruna, Rönnerhag, & Berggren, ; Severinsson et al, ).…”

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

“…The WHO [3] designed an implementation guide to improve the quality of care provided to women giving birth. Learning about adverse events and near-misses is essential for enhancing maternity and obstetric care [4]. A recently published review reveals that effective communication and learning from adverse events are important.…”