Getting to havarti: moving toward patient safety in obstetrics

Obstet Gynecol. 2007 Nov;110(5):1146-50. doi: 10.1097/01.AOG.0000287066.13389.8c.


Most health care professionals who are involved in efforts to improve patient safety are aware of James Reason's "Swiss cheese" model of how accidents occur. Some elements and pressures of current obstetric practice may weaken defenses and safeguards against perinatal injury. Several components of obstetric care in labor and delivery units can be used as targets for tightening the "holes" in the Swiss cheese model. These include improving communications, preparing for rare critical events through simulation training, developing protocols for administration of important medications used in labor and delivery (oxytocin, misoprostol, and magnesium sulfate), increasing the in-house presence of obstetricians, developing an effective departmental infrastructure that includes effective peer review, providing risk management education about high-risk clinical areas that have the potential to result in catastrophic injury, and staffing the unit for all contingencies during all hours, day and night. Acceptance by the obstetric medical staff is critical to the implementation of these patient safety elements.

Publication types

  • Editorial

MeSH terms

  • Attitude of Health Personnel
  • Clinical Competence
  • Female
  • Humans
  • Medical Errors / prevention & control
  • Models, Theoretical
  • Obstetrics / standards*
  • Obstetrics and Gynecology Department, Hospital / standards
  • Parturition*
  • Physician-Patient Relations
  • Pregnancy
  • Risk Management / methods*