Types of AEs, near-misses and their consequences | Strategies to promote interventions to improve PS | Domains related to the WHO’s Patient Safety Competence Outcomes |
HCPs: Psychosocial and physical attribution of blame and responsibility [23] [24] ; Managing risks [26] ; Near-misses and AEs are judged in terms of events and on how others react to them [28] ; Failure to recognize and respond to unexpected changes in a woman’s condition during labour [30] ; Failure to learn lessons [30] | Safety culture [22] [26] [30] and policy development [23] ; Leading and supporting staff [26] ; Promoting reporting and being open when things go wrong [26] [28] [30] ; Learning and sharing safety lessons [26] [28] [30] | Contribute to patient safety culture by increased reporting of AEs and near-misses |
HCPs: Inadequate communication between HCP’s in the healthcare system (community and in-hospital) [24] [27] and with the patient [29] | Feedback and acknowledgement [30] ; Team training, high-risk clinical drills, use of professional guidelines and standard documentation [24] [28] -[30] ; Task description and delineation [29] | Communicate effectively; Teamwork and collaboration |
HCPs: Ethical conflicts due to misunderstanding [30] | Safety climate, the possibility to talk about failure [24] ; Helping to prevent mistakes [28] ; Prioritization of safety [30] | Identify failure modes; Identify maternal near-miss |
HCPs: Inadequate infrastructure [22] ; Referral procedures, risk assessment by telephone triage and technical procedures [29] | Support incident management activities and leadership capacity [22] | Optimize environmental resources to ensure PS |
PH: Loss of trust and responsibility for their own safety [23] [24] | Involving and communicating with patients and the public [26] ; Involving patients in their own care and treatment [26] ; Use of clinical decision support [25] [30] | Optimize patient-centred care |
PH: Wrong obstetric medication resulting in harmful errors [25] ; Medication procedures [29] | Medication administration that enables interdisciplinary quality improvement [25] [28] | Manage safety risks Leadership |
PH: Perinatal cases of patients’ complaints [29] | Clinical management [29] | Manage safety risks |