Monitoring adherence to standards of safe clinical practice during operative vaginal delivery: as basis of an effective risk reduction strategy

Abstract

Background Adhering to standards of safe clinical practice in Operative vaginal delivery helps minimise risk of morbidity and likelihood of litigation without limiting maternal choice. Setting East Lancashire Hospitals Maternity Unit. Methodology Review of 150 consecutive cases of OVD (operative vaginal delivery) identified through Athena in 2009 (75 in room,75 in theatre). Results 76% were primigravida. 18.6% were low risk on midwife led care who could have potentially given birth at home or birthing centre risking intrapartum transfer. Documentation regarding consent was noted in 97.3% of OVD in theatre and only 17.3% of OVD in room. This was absent in 44% overall and 2.7% of theatre OVD. Documentation on analgesia was absent in 6.6%, Position of head not stated in 18.6%, Sequential instruments used in 12.6%, 92% had episiotomy or perineal tear with 2.6% having third degree tear. Failure rate was 8.6% overall, with nil failure in room and 17.3% in theatre. Cord gases were not performed or inappropriate (only venous) in 16.6% with 4% babies having arterial PH<7.1. Documentation regarding incident reporting was missing although 21.3% fulfilled maternity trigger list criteria. Conclusion and Recommendations Scope for improvement in standards of safe clinical practice was highlighted in all areas. Continuous audit of OVD has since been implemented within the unit. All OVD cases are discussed at case review meetings at shift changes three times daily since November 2009. Areas of deficiency are identified and rectified immediately, reducing likelihood of risk recurrence through this strategy of team based reflection and proactive risk management.