Every clinician wants to provide the safest care possible for childbearing women and their infants. Patient safety is a requisite to consistent evidence-based quality care. Yet how can you be sure whether care is safe on your unit? Retrospective review of rare adverse outcomes that occur in obstetrics, although it may be valuable for the future, is too late for the patient. A prospective, carefully planned approach to promoting safety and quality is ideal. New quality measures are available from the National Quality Forum1 and The Joint Commission,2 which are useful in objectively determining the quality and safety of many aspects of perinatal and neonatal care. Using the measures as a basis for evaluating current care practices and planning changes to promote safer and higher-quality care is discussed in detail in the article by Bingham and Main. Critical evaluation of selected perinatal quality performance measures along with strategies for successful adoption is presented. Readers may use this information to move forward with promoting perinatal patient safety and quality care in their own institutions. It is widely acknowledged that teamwork, respectful communication, and genuine interdisciplinary collaboration are critical to keeping mothers and infants safe during labor and birth. Mahlmeister's review of the literature on these topics is a valuable contribution and can be used as conversation and a catalyst for evaluating current clinical and professional environments and planning for improvement. The ability to take action on actual or perceived threats to patient safety is not well studied in the perinatal literature, yet this ability or "agency" is vital in minimizing risk of preventable harm. Lyndon and Kennedy offer a discussion on this topic including a review of the theoretical foundation and an exemplar case study applicable to everyday clinical practice. This scholarly review should prompt thoughtful evaluation of conditions that support perinatal nurse agency and barriers that exist to its full realization in each institution. One of the most common procedures in labor and birth units these days is elective labor induction. Various operational, clinical, and financial costs of this procedure, when performed only for convenience, are presented by Simpson along with potential strategies for reducing elective induction of labor. Safe care is quality care. Mothers and their families expect to be safe from harm while in our care. We hope that you enjoy reading these articles and find something useful to apply to clinical practice on your unit in order to promote perinatal patient safety and quality.
The neonatal section of this issue focuses on evidence-based practice and a systems approach to patient safety. Evidence-based practice is replacing tradition-based practice in neonatal care, and this is an important area of leadership for neonatal nurses.
Gennaro provides an overview for translating scientific evidence into perinatal and neonatal nursing practice. She cites the science, barriers to implementation, and examples of patient, provider, and systems factors that influence how evidence is translated into practice and offers suggestions for practice change when evidence is incomplete.
The CE article by Renaud Smith and Donze is practice based. It offers pragmatic and necessary steps to assess environmental readiness for shifting to an evidence-based practice culture. The authors confront the realities of organizational, interdisciplinary, and nursing issues and interactions to help nurses understand their important role in supporting this shift.
Melnyk et al provide an implementation study on translating the COPE (Creating Opportunities for Personal Empowerment) program for parents of premature infants. Their results showed that the neonatal nurses in the 2 "pods" in which the program was being implemented reported higher belief in evidence-based practice and greater implementation than did nurses in control pods.
The article by Schwoebel and Creeley describes one organization'ssystem-based program to inculturate patient safety. Strategies utilized and described include unit-based interdisciplinary safety teams, tools and techniques to analyze and prioritize risk, resources, and staff engagement. Several outcomes are provided.
-Audrey Lyndon, PhD, RNC
-Kathleen Rice Simpson, PhD, RNC, FAAN
Perinatal Guest Editors
-Susan Bakewell-Sachs, PhD, RN, PNP-BC
Neonatal Guest Editor
REFERENCES