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Adverse events in women giving birth in a labor ward: a retrospective record review study
Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).ORCID-id: 0000-0002-0756-8833
Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013). Norwegian University of Science & Technology, NOR.ORCID-id: 0000-0003-3385-3731
Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013). Ostfold University College, NOR.ORCID-id: 0000-0002-9608-336X
Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).ORCID-id: 0000-0003-1382-4386
2021 (Engelska)Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 1093Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Background Childbirth could negatively affect the woman's health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. Methods The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson's Chi-square test and Student's t-test were used. Results A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of 'prolonged hospital care' (63.2%) and 'temporary harm' (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. Conclusions This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3(rd)-or 4(th)-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2021. Vol. 21, nr 1, artikel-id 1093
Nyckelord [en]
Adverse events, Childbirth, Global trigger tool, Harm, Labor, Obstetric care, Patient safety, Record review
Nationell ämneskategori
Omvårdnad
Forskningsämne
Omvårdnad
Identifikatorer
URN: urn:nbn:se:kau:diva-87283DOI: 10.1186/s12913-021-07109-5ISI: 000707340900002PubMedID: 34649538Scopus ID: 2-s2.0-85117335020OAI: oai:DiVA.org:kau-87283DiVA, id: diva2:1613319
Tillgänglig från: 2021-11-22 Skapad: 2021-11-22 Senast uppdaterad: 2022-09-15Bibliografiskt granskad
Ingår i avhandling
1. Patient safety in intrapartum care: Adverse events and healthcare professionals’ perceptions of patient safety, patient safety culture and teamwork
Öppna denna publikation i ny flik eller fönster >>Patient safety in intrapartum care: Adverse events and healthcare professionals’ perceptions of patient safety, patient safety culture and teamwork
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The overall aim of the thesis was to describe adverse events for women with planned vaginal births and healthcare professionals’ perceptions of patient safety. Further, to test the reliability and validity of a teamwork questionnaire and to investigate patient safety culture and teamwork among healthcare professionals in intrapartum care.

Methods: Paper I had a retrospective design, with 311 birth record reviews. Paper II had a descriptive and qualitative design using a phenomenographic approach, including interviews with 19 healthcare professionals in three labor wards. Paper III and IV had cross-sectional designs. Healthcare professionals’ (n=450) in various wards responded to the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) (III). Healthcare professionals’ (n=184) in three labor wards responded to the Swedish version of the Hospital Survey on Patient Safety Culture and the T-TPQ (IV). Confirmatory factor analysis and descriptive and inferential statistics were used.

Main results: Adverse events in women occurred in 11% of planned vaginal births (I). Four descriptive categories with nine perceptions described patient safety for women giving birth (II). Confirmatory factor analysis of the T-TPQ indicated a good fit (III). Main and interaction effects of profession and labor ward on patient safety culture and teamwork were found (IV).

Conclusions: The results highlight the occurrence of 3rd- or 4th-degree lacerations, distended urinary bladder, and anesthesia-related adverse events. For safe care, it is crucial for healthcare professionals to provide supportive care and to listen to the woman. Using team members’ competences in a tolerant atmosphere, with a reasonable workload, and learning from failure as well as from success are preconditions for patient safety. The Swedish version of the T-TPQ shows acceptable reliability and validity. Differences between labor wards seemed to have a greater impact than differences between professions on patient safety culture and teamwork.

Abstract [en]

Patient safety is a global health priority. Knowledge about patient safety and adverse events for women giving birth is necessary. Patient safety culture and effective teamwork are important for safe care provided by midwives, physicians and nursing assistants. The overall aim of the thesis was to describe adverse events for women with planned vaginal births and healthcare professionals’ perceptions of patient safety. Further, to test the reliability and validity of a teamwork questionnaire and to investigate patient safety culture and teamwork among healthcare professionals in intrapartum care. A birth record review, interviews and two questionnaires were used. Adverse events were identified in 11% of the birth records, but no permanent harm. Listening to the woman and having a tolerant teamwork atmosphere were important. Both profession and labor ward are important for healthcare professionals’ perceptions of patient safety culture and teamwork in intrapartum care.

Ort, förlag, år, upplaga, sidor
Karlstad: Karlstads universitet, 2022. s. 82
Serie
Karlstad University Studies, ISSN 1403-8099 ; 2022:6
Nyckelord
adverse events, construct validity, healthcare professionals’ perceptions, interviews, intrapartum care, questionnaire, patient safety, patient safety culture, record review, reliability, teamwork, women giving birth
Nationell ämneskategori
Hälsovetenskaper
Forskningsämne
Omvårdnad
Identifikatorer
urn:nbn:se:kau:diva-89110 (URN)978-91-7867-269-1 (ISBN)978-91-7867-279-0 (ISBN)
Disputation
2022-06-03, 1B364 Frödingsalen, Universitetsgatan 2, Karlstad, 10:00 (Svenska)
Opponent
Handledare
Anmärkning

Article 4 which was included in the thesis as a manuscript is now published. 

Tillgänglig från: 2022-05-03 Skapad: 2022-03-16 Senast uppdaterad: 2022-09-15Bibliografiskt granskad

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Skoogh, AnnikaHall-Lord, Marie LouiseBååth, CarinaSandin-Bojö, Ann-Kristin

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