EFFECT OF A COMPREHENSIVE OBSTETRIC PATIENT SAFETY PLAN
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Obstetrical negligence can occur in many settings, from the office of the obstetrician to clinics, emergency rooms, operating rooms and delivery wards. Failure to perform the proper prenatal tests, monitor a pregnancy or properly conduct labor and delivery can result in serious injuries, such as cerebral palsy, Erb’s palsy, developmental delays, speech problems, blindness, or infections.
Medical errors in the labor and delivery department are among the most common sources of avoidable injury to a fetus or newborn. However, a recent study performed by a major metropolitan area hospital has reported that the best way to reduce the incidence of medical malpractice in the obstetrical ward is to institute a comprehensive and ongoing patient safety program.
The report is the result of a six-year implementation of a comprehensive and ongoing patient safety program at New York Weill Cornell Medical Center. From 2003- 2009, the program included such simple measures as electronic medical record charting, having a dedicated gynecology attending on call so that obstetricians would not be pulled from the labor and delivery floor to consult on gynecology cases, standardized pitocin protocols, premixed and safety color-coded labeled magnesium sulfate and oxytocin solutions, electronic fetal heart monitor interpretation certification, obstetric emergency drills, and other protocols.
The results were stunning. As a result of this common-sense program, the 2009 total medical malpractice payouts from obstetrical claims in this hospital was reduced by 99.1% compared to the average payments in the years 2003-2006. Indeed for the years 2008 and 2009 there were no professional liability suits commenced involving a brain damaged infant born at the hospital. These efforts are commendable and will hopefully continue to improve medical care received by women and their babies.
Unfortunately many hospitals have failed to institute the type of straightforward patient safety plan described above. For example, magnesium sulfate is one of the most dangerous solutions used on the labor and delivery unit and it is frequently prescribed to prevent seizures in preeclampsia or to arrest preterm labor.
However, without the use of premixed and color-coded magnesium sulfate containers and intravenous lines, the risk of negligent dosage of this powerful medication remains, including misread physicians’ orders and pharmacy errors. Such medical mistakes pose enormous risk to both mother and baby. For example, maternal respiratory arrest can occur after receiving overdoses of magnesium sulfate.
Most errors resulting in maternal and fetal injury were due to unfamiliarity with safe dosage ranges and signs of toxicity, inadequate patient monitoring, pump programming errors, and mix-ups between magnesium sulfate and oxytocin. As the Weill Cornell report shows, these injuries can easily be avoided if the proper precautions are taken.