Getting to havarti: moving toward patient safety in obstetrics.

Most health care professionals who are involved in efforts to improve patient safety are aware of James Reason's "Swiss cheese" model of how accidents occur. Some elements and pressures of current obstetric practice may weaken defenses and safeguards against perinatal injury. Several components of obstetric care in labor and delivery units can be used as targets for tightening the "holes" in the Swiss cheese model.

Disruptive behavior in obstetrics: a hidden threat to patient safety.

Objective: This study was to determine the frequency of disruptive behavior on labor and delivery units, its effect on work performance, and its contribution to adverse outcomes.

Study Design: One hundred questionnaires were sent to nurse managers of labor and delivery units in selected hospitals in Washington, Oregon, and California regarding the occurrence of disruptive behavior and the consequences of this behavior with respect to patient safety.

Results: Fifty-six percent of questionnaires were returned.