Key Perinatal Safety Elements Examples Debrief and analyze near Unit can decide its approach to debriefing events misses and adverse events and on seriousness of event, expertise available, the contribution of EFM use, and data monitoring and tracking capabilities. EFM interpretation, and debriefings by clinical team communication of EFM findings immediately following event using an approach that does not shame or blame individuals. This allows for understanding of what went well, what could have gone better, and what could be done differently next time. with a multidisciplinary team can help the unit learn from defects and sensemaking using the following tools: Discovery form Root cause analysis Eindhoven model Failure mode and effects analysis Probabilistic risk assessment Causal tree worksheet Interdisciplinary case reviews Have a process in place to Unit can decide its approach to reviewing of review severe maternal or severe maternal or neonatal morbidity or mortality. neonatal morbidity and mortality This might include an existing medical peer-review events. process or review by a perinatal safety or quality committee. A sample process and for a committee review are available at the Council on Patient Safety in Women’s Health Care. . Select SMM menu. “Get Share outcomes or process Sites can decide how often, how much, and with improvements from the informal whom this information will be shared and whether (debriefing) and formal analysis this is specified in a unit policy or is handled more with staff to achieve informally. transparency and organizational learning. Simulation (SPPC Program Pillar) Key Perinatal Safety Elements Examples
Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse events and the contribution of EFM use, EFM interpretation, and communication of EFM findings Unit can decide its approach to debriefing events on seriousness of event, expertise available, and data monitoring and tracking capabilities. debriefings by clinical team immediately following event using an approach that does not shame or blame individuals. This allows for understanding of what went well, what could have gone better, and what could be done differently next time. with a multidisciplinary team can help the unit learn from defects and sensemaking using the following tools: Discovery form Root cause analysis Eindhoven model Failure mode and effects analysis Probabilistic risk assessment Causal tree worksheet Interdisciplinary case reviews Have a process in place to review severe maternal or neonatal morbidity and mortality events. Unit can decide its approach to reviewing of severe maternal or neonatal morbidity or mortality. This might include an existing medical peer-review process or review by a perinatal safety or quality committee. A sample process and for a committee review are available at the Council on Patient Safety in Women’s Health Care. . Select “Get SMM menu. Share outcomes or process improvements from the informal (debriefing) and formal analysis with staff to achieve transparency and organizational learning. Sites can decide how often, how much, and with whom this information will be shared and whether this is specified in a unit policy or is handled more informally. Simulation (SPPC Program Pillar) Key Perinatal Safety Elements Examples
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