Research indicates that mothers and babies remain at risk of unintended injury during labor and birth in the American healthcare system. The major underlying causes for this risk are human and system errors. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), team communication was the leading root cause in 42 sentinel events involving infant death, and team culture was identified as the underlying cause. Other causes included staff competency, orientation and training process, and inadequate fetal monitoring.
Sponsored by the Department of Health & Mental Hygiene’s Maternal and Child Health Division, the Perinatal Collaborative’s began in 2006 and its mission is to create perinatal units that deliver care safely and reliably with zero preventable adverse outcomes by various proven methods, including:
- Standardization of electronic fetal monitoring (EFM) language
- Training in team coordination and teamwork behaviors
- Assessment of safety culture