By John Tingle
Healthcare providers and policy makers can avoid the expense of reinventing the wheel if they try and look beyond their shores for solutions to patient safety problems. In the UK the work of the patient safety unit of WHO in Geneva helps NHS healthcare providers through the development of patient safety tools and other projects. The WHO multi-professional patient safety curriculum guide is one example. The learning from error – video and booklet is another. Recently launched by WHO is the Safe Childbirth checklist and guide to implementation.
The Checklist will be a useful patient safety tool in developing, transitioning and developed countries. The scale of the problem is very disturbing. WHO calculate that in 2013, 289,000 women died during and following pregnancy and childbirth, and 2.8 million new-borns died within 28 days of birth. Most of these events could have been prevented and mostly occurred in low resource settings. Women and their babies are being very conspicuously failed by health systems which should be helping them.
The Checklist will also be useful in resource rich settings. In the NHS in the UK, obstetric claims are always the most expensive in terms of damages; compensation paid out and are high in number. According to the National Health Service Litigation Authority (NHSLA), in the UK: “Overall, obstetrics and gynecology claims account for 20% of the number of all clinical negligence claims notified to the NHSLA and 49% of the total value…” (p.6, NHSLA, (2012), Ten Years of Maternity Claims; An Analysis of NHS Litigation Authority Data, October, NHSLA, London.)
Checklists, guidelines and tramlines
Thinking about Checklists and guidelines from a negligence, tort perspective, they can help to show that a good, reflective, evidence based care environment is in place but at the same time it must be remembered that they do not suspend the clinical judgment of the healthcare provider. They have a utility but it does not mean healthcare providers practice on auto-pilot. Checklists and clinical guidelines are not tramlines and should be deviated from if the patient’s condition contra-indicates their application. Clearly much will depend on the precise situation at hand.
The WHO Safe Childbirth Checklist is designed around four sections or what are termed ‘Pause Points’, evidence-based essential birth practices are stated:
- Pause Point 1: On Admission
- Pause Point 2: Just Before Pushing (or before Caesarean)
- Pause Point 3: Soon After Birth (within one hour)
- Pause Point 4: Before Discharge
Implementation and proper use of the Checklist will be key. The steps given to ensure buy-in by stakeholders and others are very clearly laid out in the implementation guide. There is recognition that just giving a person a Checklist and saying get on with it is not enough. Much more needs to be done. Checklists, like clinical guidelines are good patient safety tools, they usefully order a lot of key information into manageable segments. The WHO checklist is to be welcomed across all health systems and settings and hopefully deaths of mothers and their babies across the world will see a marked reduction.
