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 |