These steps require careful consensus building and will incur regular costs. We have learned that implementing these cornerstones of obstetric patient safety will demand support from your organizational leaders by providing education funds and administrative support staff, and by approving time away from clinical responsibilities.
- Require completion of verifiable, uniform EFM education or certification by RNs, CNMs, and MDs, and consider tying this to continued employment and/or professional staff reappointment.
- Plan and execute multi-disciplinary drills for obstetrical emergencies on a regular schedule.
- Form a standing multi-disciplinary committee (e.g., Obstetric Practice Committee) to establish evidence-based guidelines in your organization. This committee monitors the local, regional, and national practice environment; identifies trends and needs; provides a mechanism to distribute and discuss documents that define or change a guideline or standard; and works by consensus to define the organization's standard ("the fence of safety").
- Establish a feedback loop between this committee and a robust quality assurance process supported by efficient data collection. The QA committee is an early warning system to identify individual and collective problem areas and actively address variations and deviations from the standard.
- Initiate near-miss reporting and act on lessons learned. Start "track and trend" programs to identify small, chronic breakdowns that can affect patient and staff satisfaction.
- Participate in OBNET.