Quality Improvement and Patient Safety on Labor and Delivery

Sabol, Bethany; Caughey, Aaron B.

doi:10.1016/j.ogc.2017.08.002

Cited by 11 publications

(20 citation statements)

References 22 publications

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“…This study replicates and extends prior research regarding the occurrence of failing to speak out and advocate on behalf of patients when adverse events or near misses occur. This study, like previous studies, exemplifies that there remains a need to integrate a culture of safety into the foundation of nursing practice, whereby RNs feel free to speak out for patient safety concerns without fear of retaliation (Agency for Healthcare Research & Quality, ; Alingh et al, ; Godlock et al, ; Sabol & Caughey, ; Vrbnjak et al, ). Nurses' failure to speak out regarding patient safety concerns is further humanized through the Joint Commission's, Sentinel Alert Event.…”

Section: Conclusion and Implications For Nursing Administrationsupporting

confidence: 64%

“…To establish workplace cultures that foster open dialogue regarding advocacy and patient safety concerns, it is recommended that nursing leadership consider the following interventional measures: Embed safer practices and mindfulness into existing structures and practices through policy enforcement (The Joint Commission, ) “Establish an organizational baseline measure on safety culture performance using the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS) or another tool, such as the Safety Attitudes Questionnaire (SAQ) ” (The Joint Commission, , p. 4) Integrate safety culture training into quality improvement projects and strategic plans (Echevarria & Thorman, ; The Joint Commission, ) Provide a transparent dissemination of favourable and unfavourable care outcomes in order to promote accountability, ownership and pride of performance when advocacy and patient safety measures are evident (Echevarria & Thorman, ), and that distinguish between inadvertent human error, reckless actions and errors that are induced from poorly designed system approaches (The Joint Commission, ) Examine what elements of nursing care are often missed in acute and post‐acute settings in order to improve patient outcomes (Orique, Patty, & Woods, ) Leaders should model professionalism, respect and provide blame‐free communication opportunities that empower staff to speak out without fear of retaliation or confidential breaches, and provide opportunities for staff to learn from adverse events, close calls and unsafe practices (AHRQ, ; Hall et al, ; The Joint Commission, ; Vrbnjak et al, ) Solicit interdisciplinary and hierarchal input that seeks out solutions to address patient safety issues (AHRQ, ) Create/refine data reporting systems that capture near misses in order to determine resolutions that improve outcomes (Thoroman et al, ) Development of evidence‐based quality indicators to detect and review adverse events (Sabol & Caughey, ) …”

Section: Conclusion and Implications For Nursing Administrationmentioning

confidence: 99%

“…Establishment of culture of safety environments encompasses the following key characteristics: (a) acknowledgement of the high‐risk nature of an organization's activities and the determination to achieve consistently safe operations; (b) a blame‐free environment where individuals are able to report errors or near misses without fear of reprimand or punishment; (c) encouragement of collaboration across the ranks and disciplines to seek solutions to patient safety problems; and (d) organizational commitment of resources to address safety concerns (Agency for Healthcare Research & Quality, ). To Err is Human acknowledges the individual dedication and collective contributions of hospital staff who do their best to improve and save patient lives (Godock, Miltner, & Sullivan, ; Sabol & Caughey, ). However, while hospitals respond aggressively to patient safety issues with new technologies (Echevarria & Thorman, ) and quality improvement systems, there is a deeper problem that must be resolved, namely the need for nurses to speak out regarding issues and concerns that can potentiate patient harm (Hall, Klein, Betts, & DeRanieri, ), which is also a global concern (Alingh, Wijngaarden, Voorde, Paauwe, & Huijsman, ; Picolotto, Barrella, Moraes, & Gasperi, ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

et al. 2019

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Aim:To identify workplace factors that influence patient advocacy among registered nurses (RNs) and their willingness to report unsafe practices.Background: A prior study by Black illustrated that 34% of respondents were aware of conditions that may have caused patient harm but had not reported the issue. The most common reasons identified for failing to report issues were fear of retaliation and a belief that nothing would prevail from the reports. Method:Using Black's study as a model, reporting data were collected from a sample of RNs actively practicing in acute care hospitals.Results: While reasons for reporting are consistent with Black's study, data suggest that a nurse's experiences and working environment are prime factors in their willingness to report patient care issues. Conclusion:Although RNs may not have personally experienced workplace retaliation, fear of retaliation when reporting unsafe patient care practices still exists.Nursing leadership's ability to facilitate a culture of safety by proactively addressing unsafe practices fosters a level of comfort for patient advocacy and willingness to report issues. Education, professional associations and existing protection laws are available resources which contribute to organizational support systems. Implications for Nursing Management:The findings of this study are consistent with the literature in that organizations need to create a supportive workplace environment whereby, through collective input and leadership, reporting protocols are in place that empower RNs to report unsafe conditions. Direct care nurses are positioned, especially well to identify and speak up regarding conditions that may result in near misses or actual adverse events. Therefore, it is the responsibility, and duty, of nursing management to create and facilitate reporting systems that will be utilized without fear of retaliation and that will contribute to a culture of safety and patient advocacy. K E Y W O R D S patient advocacy, registered nurses, workplace factors | 1177 COLE Et aL.

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Section: Conclusion and Implications For Nursing Administrationsupporting

confidence: 64%

Section: Conclusion and Implications For Nursing Administrationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

et al. 2019

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“…While clinical guidelines and checklists are core components of patient safety efforts within L&D units (3), the implementation of new guidelines or work ow processes within healthcare is challenging and often hampered by several expected and unexpected barriers (4)(5)(6). The identi cation of barriers and facilitators is vital in establishing an e cient strategy for change (7), as described in established frameworks such as the Consolidated Framework for Implementation Research (CFIR) (8)(9)(10) and Expert Recommendations for Implementing Change (ERIC) (11,12).…”

Section: Background Obstetrics and Covid-19mentioning

confidence: 99%

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Zucco

Levy

et al. 2021

Preprint

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Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation a novel comprehensive perioperative checklist for care of the COVID-19 parturient.Methods: Implementation of a novel workflow for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time.Conclusion: We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

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“…While clinical guidelines and checklists are core components of patient safety efforts within L&D units (2), the implementation of new guidelines or work ow processes within healthcare is challenging and often hampered by several expected and unexpected barriers (3)(4)(5). The identi cation of barriers and facilitators is vital in establishing an e cient strategy for change (6), as described in established frameworks such as the Consolidated Framework for Implementation Research (CFIR) (7)(8)(9) and Expert Recommendations for Implementing Change (ERIC) (10,11).…”

Section: Obstetrics and Covid-19mentioning

confidence: 99%

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Zucco

Levy

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success.Methods: A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time.Conclusion: We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.

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Quality Improvement and Patient Safety on Labor and Delivery

Cited by 11 publications

References 22 publications

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

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