Patient safety in intrapartum care : Adverse events and healthcare professionals’ perceptions of patient safety, patient safety culture and teamwork

Abstract: The overall aim of the thesis was to describe adverse events for women with planned vaginal births and healthcare professionals’ perceptions of patient safety. Further, to test the reliability and validity of a teamwork questionnaire and to investigate patient safety culture and teamwork among healthcare professionals in intrapartum care.Methods: Paper I had a retrospective design, with 311 birth record reviews. Paper II had a descriptive and qualitative design using a phenomenographic approach, including interviews with 19 healthcare professionals in three labor wards. Paper III and IV had cross-sectional designs. Healthcare professionals’ (n=450) in various wards responded to the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) (III). Healthcare professionals’ (n=184) in three labor wards responded to the Swedish version of the Hospital Survey on Patient Safety Culture and the T-TPQ (IV). Confirmatory factor analysis and descriptive and inferential statistics were used.Main results: Adverse events in women occurred in 11% of planned vaginal births (I). Four descriptive categories with nine perceptions described patient safety for women giving birth (II). Confirmatory factor analysis of the T-TPQ indicated a good fit (III). Main and interaction effects of profession and labor ward on patient safety culture and teamwork were found (IV).Conclusions: The results highlight the occurrence of 3rd- or 4th-degree lacerations, distended urinary bladder, and anesthesia-related adverse events. For safe care, it is crucial for healthcare professionals to provide supportive care and to listen to the woman. Using team members’ competences in a tolerant atmosphere, with a reasonable workload, and learning from failure as well as from success are preconditions for patient safety. The Swedish version of the T-TPQ shows acceptable reliability and validity. Differences between labor wards seemed to have a greater impact than differences between professions on patient safety culture and teamwork.