Keys to Patient Safety for
Obstetrics and Gynecology
As the first medical professional liability insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.
Provide your patients with educational material on reproductive health.
Keep in mind that the functional education level of your patient population may affect the quality of your medical care. The educational material you distribute should be viewed as an opportunity to raise your patients’ awareness of the health issues that might affect their reproduction. Always encourage your patients to understand their medical issues, what action they need to take, and why it is important for them to follow their health plan.
Eliminate “No news is good news.”
Review your tracking systems to ensure follow-up and patient notification for all test results, including mammograms and Pap smears. All test results need to be seen and initialed by the physician and communicated to the patient before being placed in the medical record.
Recommend colonoscopy as the preferred method for colorectal cancer screening.
ACOG now recognizes colonoscopy as the standard for colon cancer screening. Document all exam and screening recommendations and patient refusals in the medical record.
Maintain a consistent, complete prenatal record at all times.
No single type of medical record is considered to be the gold standard. If information is deemed important enough to be included in the record, it should be filled in consistently. Failure to do so may be interpreted as a breach of your own adopted standard. Utilizing one of the nationally recognized prenatal records can reduce your risk by having a record that is universally recognized by nursing and other staff at your practice facility.
Discuss labor and delivery issues with your patient during the third trimester.
Issues such as the use of oxytocin, vacuum, forceps, episiotomy, and the possibility of C-section should be discussed in detail when your patient has time to make informed decisions about her care. During labor is not an appropriate time to discuss an adequate informed consent. Document any discussions and your patient’s decisions in the prenatal record that is sent to the hospital so that it is available to staff and any covering physician during your patient’s treatment.
In the event a patient might deliver while you are not available, clearly communicate your patients’ wishes to the covering physician(s) before signing out. If you know that one of your partners does not agree with any portion of your patient’s birth plan (for example, using a birthing tub or rejecting fetal monitoring), communicate that information to your patient early on in the pregnancy. This will give her an opportunity to meet with your partner to resolve any issues or choose another practice.
Document the medical reason for induction.
Adopt an “induction checklist” based on the national guidelines recommended by the American College of Obstetricians and Gynecologists (www.acog.org).
The following elements need to be documented in the medical record:
- Cervical/vaginal exam prior to induction
- Vaginal exam prior to placement of any instrument to accomplish delivery
- Adopt a pre- and postprocedure evaluation checklist for vacuum and forcep-assisted deliveries
- Frequent review of fetal monitor tracings
Prepare for emergency situations.
Encourage OB safety drills at your practice facility focusing on response times, staffing, and resources available for emergency situations.