Author

country

Aim and

Research question

Subjects and study setting

Method/design

Data analysis

Types of AEs and near-misses

Support intervention

Allen et al.

[22]

Australia

To report a case study examining the safety culture

Midwives, obstetric registrars, medical officers and obstetric staff specialists. n = 210 n = 15

Descriptive case study;

Questionnaires;

Semi-structured interviews

Descriptive

Statistics; Mean score

template analysis

Incident reports were highlighted; No specific types of AEs were reported.

Infrastructure and capacity to support management activity; Improved leadership to strengthen the safety culture

Lawton et al. [23]

UK

To explore the assessment of PS, the outcome of care (harm or not) and relationship (good or bad) with the care provider

N = 98 mothers, who had between one and five children

Four hypothetical vignettes in a questionnaire,

Multivariate analysis

Referral for big baby; VE after ruptured membrane; Discussion of the prescription of iron tablets and pethidine

Theory and policy development; Improving relationships between patients and professionals

Gephart et al. [24]

USA

To describe failure to rescue in neonatal intensive care and outline the nursing and system rescue actions that can be taken to rescue

Nurses; Respiratory therapist; Transport team; Neonatologists; Pharmacist; Auxiliary staff

3 cases of failure

Interpretation of the rescue process; Activating a team response; Surveillance; Timely recognition of complications and Taking action

Premature labour, not adequately managed and prenatal steroids not given; Infant delivered to mother with positive group B streptococcus not treated in labour; Preterm infant who developed necrotizing enterocolitis

Team training, high-risk clinical drills, use of professional guidelines, standardized documentation; The CUS technique “I am Concerned, I am Uncomfortable This is a Safety issue”

Kfuri et al. [25] USA

To discuss prescription and use of medication during pregnancy and analysis of medication errors in obstetrics

Labour/delivery;

Maternity ward;

Obstetric recovery room

Series of case reports on medication errors in obstetrics

N = 4583

Analysis of the MEDMARX Medication error reports of omission, wrong time, improper dose, unauthorized/wrong drug, extra dose, drug prepared incorrectly, wrong administration technique, wrong patient, wrong dosage form

Intrapartum infection; Lower analgesic efficiency; Severe depression; Bleeding; Hepatitis; Nausea; Maternal death; Malaise; Arrest of labour; Multiple-drug resistant MRSA

Pharmacy-led medication safety team; On-line reporting; Computerised physician order entry/Clinical decision support; Medication related; Barcode-enabled point-of-care; Pharmacy barcode; E-prescribing barcode

Scholefield

[26] UK

To report structures and processes for improving quality of care and patient safety

Staff and patients at women’s and neonatal services

Implementation

Debriefing with patients and after complications

Managing haemorrhage, delay in providing blood transfusion, poor use of protocols, or failure to call senior staff; Handover was recognized as an area of risk; Delay in transfer to other units

Team briefings; Regular meetings and “walk-about”; Appropriate and learning multidisciplinary learning; Supporting as opposed to blaming staff in difficult circumstances; Involving and communicating with and involving patients in their own care and treatment; Mapping and analysing the events

Simpson et al. [27]

USA

To describe communication between nurses and physicians during labour within the context of the nurse-managed

labour model

n = 54 nurses and n = 38 obstetricians;

Labour and birth units in community hospitals

Focus groups and in-depth interviews

Inductive coding methods

Discussion of oxytocin rate to maintain adequate contractions, time for admission and epidural anaesthesia

PS is enhanced when the hierarchy is flattened so that all team members are encouraged and feel obliged to voice concerns about situations with a potential risk of patient harm; Interdisciplinary teamwork

Symon et al. [28]

UK

To investigate midwives’ understanding and recollections of clinical near misses

Midwives in four obstetric maternity units n = 34; Group interviews with midwives n = 26; Antenatal clinic, home birth, labour ward, obstetric theatre, postnatal unit and postnatal community care

A postal survey;

Questionnaire

Interviews

Descriptive statistics

Open-text analysis and interpretation of midwives’ understanding of and

response to near misses

Case management problems;

Communication failure; Equipment failure; Failure to diagnose/act appropriately; Syntocin infusion problems

Drug errors

Helping to prevent mistakes by learning from past errors; Continuity of care; Clinical supervision; The need for openness in clinical practice

Martijn et al. [29]

Netherlands

To perform a structural analysis of determinants of the risk of critical incidents in care

N = 71 critical incidents in primary midwifery care and subsequent in-patient hospital care

Instrument to identify determinants of adverse outcomes and near misses

Case-by-case analysis

Maternal death; Severe maternal morbidity; Perinatal death; Severe morbidity of the child

Diagnostic procedures and medical treatment; Organization of emergency care; Task description and delineation; Record keeping; Communication between care providers; Structural training Written protocols

Currie & Richens

[30] UK

To describe midwifery staff’s perception of safety culture and make recommendations for a positive safety culture

N = 5 senior midwifery managers, n = 6 community midwives, n = 17 midwifery students and n = 5 midwifery support staff; Obstetric hospital

Focus groups

Qualitative analysis included descriptions of group context, group interaction, use of humour and any areas of disagreement

Error reporting and under-reporting; Client expectation of the service;

Decision-making and staffing; Communication;

Prioritization of safety;

Staff safety

All staff should be given authority to report accidents, incidents, near-misses and safety concerns; Feedback and dissemination mechanisms need to be improved to guarantee learning outcomes