Patient safety: some progress and many challenges.

Progress in patient safety has been exceedingly slow, hampered by lack of both clarity regarding the definition and standard methodology to assess iatrogenic patient harm in obstetrics and gynecology. Understanding the causes of medical error and strategies to reduce harm is simple compared with the complexity of clinical practice. On the other hand, patient safety interventions will not be successful without a receptive culture of safety.

The efficacy of visual cues to improve hand hygiene compliance.

Background: Guidelines governing healthcare workers' (HCW) hand hygiene (HH) behavior are well established. Despite known hazards of healthcare-associated infection to both HCW and patients, hand hygiene compliance (HHC) rates remain dismally low. To evaluate a potential solution to this ongoing challenge, we used a simulated patient encounter in an actual hospital room to test the efficacy of individual HH triggers.

Physician leadership: essential in creating a culture of safety.

Advances in patient safety require a receptive culture that values transparency, communication, and mutual respect. The Safety Attitude Questionnaire is an effective tool that can be used to assess the safety culture in a variety of clinical settings. Transformational leadership is essential in promoting a culture of safety.

Factors impacting hand hygiene compliance among new interns: findings from a mandatory patient safety course.

Background: Residency is a critical transition during which individuals acquire lifelong behaviors important for professionalism and optimal patient care. One behavior is proper hand hygiene (HH), yet poor compliance with accepted HH practices remains a critical issue in many settings. This study explored the factors affecting hand hygiene compliance (HHC) in a diverse group of interns at the beginning of graduate training.

Blueprint for action: steps toward a high-quality, high-value maternity care system.

Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S.

Interview with a quality leader: Paul Gluck, immediate past chair, National Patient Safety Foundation. Interview by Pamela K Scarrow.

Dr. Paul Gluck, MD, FACOG, has held many leadership positions. He served as the president/chair of the William A.

Medical error theory.

Some errors in health care are inevitable because of human fallibility and system complexity. To improve patient safety we must develop three strategies. First, prevent errors with forcing functions, reducing complexity and providing reminders at the point of care.

Assessing quality obstetrical care: development of standardized measures.

Background: No nationally accepted set of quality indicators exists in obstetrics. A set of 10 outcome measures and three quality improvement tools was developed as part of a study evaluating the effects of teamwork on obstetric care in 15 institutions and > 28,000 patients. Each outcome was assigned a severity weighting score.

Patient safety in women's health care: a framework for progress.

Patient safety research is hampered by lack of a clear taxonomy and difficulty in detecting errors. Preventable adverse events occur in medicine because of human fallibility, complexity, system deficiencies and vulnerabilities in defensive barriers. To make medicine safer there needs to be a culture change, beginning with the leadership.

Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.

Objective: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery.

Methods: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure.

The effect of pregnancy on the course of asthma.

The course of asthma is changed by pregnancy in variable ways for unknown reasons. Although the prospective studies used different criteria to stratify the severity of the patients' asthma, their conclusions were remarkably similar. Over-all, an equal number of women have asthma symptoms that improve, worsen, or are unchanged through pregnancy.

A review of pregnancy outcomes after exposure to orally inhaled or intranasal budesonide.

Background: Inadequately controlled rhinitis is associated with worsening asthma, one of the most common potentially serious causes of pregnancy complications. Recent evidence-based guidelines now stress the importance of inhaled corticosteroids as first-line therapy in controlling asthma during pregnancy, with preference given to budesonide. Both inhaled and intranasal budesonide formulations are rated Pregnancy Category B; all other inhaled and intranasal corticosteroids are rated Pregnancy Category C.

Asthma controller therapy during pregnancy.

Objective: This study was undertaken to educate physicians on the safety of asthma controller use during pregnancy.

Study Design: A comprehensive literature search using MEDLINE, the Cochrane Controlled Trials Register and Database of Systematic Reviews, EMBASE, and selected bibliographies identified human gestational studies of asthma controller medications from which maternal and fetal outcomes were obtained. The US Food and Drug Administration (FDA) pregnancy category ratings were identified from product package inserts.

Peer review in obstetrics and gynecology by a national medical specialty society.

Background: Since 1986 the American College of Obstetricians and Gynecologists (ACOG) has offered a voluntary consultation service (Voluntary Review of Quality of Care [VRQC] program) to assist departments of obstetrics and gynecology in assessing their quality of care.

How The Vqrc Program Works: The VRQC program review team selects three to five topics for on-site medical record review to further investigate the care processes that may contribute to the perceived problems. Each chart is evaluated by a single reviewer with the use of worksheets with explicit, objective criteria that represent practice guidelines.