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Medical errors in the administration of group B streptococcus prophylaxis
adequate training in primary care screening techniques and guidelines. Physicians graduating from residency prior to 1990 were more likely to agree that the role of the ob-gyn should include screening for diabetes mellitus (P ⫽ 0.005) or hyperlipidemia (P ⫽ 0.007) or treating hypertension (P ⫽ 0.029) than more recent graduates. Regional variations in practice patterns exist for some primary care diseases; physicians practicing in
Southern states are more likely to screen for diabetes mellitus (P ⫽ 0.04). Overall knowledge of diabetes screening recommendations and tests was high, although recent changes in guidelines were less well-known.
RISK MANAGEMENT
Medical Errors in the Administration of Group B Streptococcus Prophylaxis
Failed Forceps and Vacuum: A Case-Control Study of Predictors and Complications Radhika Dasmahapatra, BA Columbia University College of Physicians and Surgeons, New York, NY
Laxmi V. Baxi, MD OBJECTIVE: To identify trends, predictors, and complications of failed forceps (FD) and vacuum (non-metal cup) deliveries (VD). STUDY DESIGN: This is a case-control study of all failed FD and VD at a tertiary care center between January 1998 and June 2001. Each case was compared with the two immediately preceding successful FD or VD, matched by parity and delivery method (FD or VD). Parameters were age, parity, body mass index, gestational age, birth weight, fetal position, operator experience, and gender. Outcome variables were trauma, hemorrhage, and asphyxia. Data were analyzed by chi-square analysis. RESULTS: In 361 forceps and 181 vacuum deliveries, failure rates were 2.7% (n ⫽ 10) and 4.2% (n ⫽ 8), respectively. Factors associated with failure included station ⱕ ⫹ 2 (P ⫽ 0.003) and head position other than occipito anterior (P ⫽ 0.004). Maternal exhaustion as the main indication for assisted delivery was associated with greater success (P ⫽ 0.002). Apgar scores at 1 minute were lower (P ⫽ 0.037) and reported blood loss was higher (P ⱕ 0.001) in failed cases. Serious complications were higher in failed cases (P ⫽ 0.01) and included infant trauma and seizure, focal infant seizure, cesarean delivery wound separation, and bladder trauma at emergent cesarean delivery. These cases accounted for 50% of serious complications in all operative vaginal deliveries in this time period. Overall admission rates to neonatal intensive care were similar. Failure rates between FD and VD were not statistically significant. CONCLUSION: Stringent selection criteria, resorting to guidelines, tentative forceps, awareness of potential for failed procedures, and timely abandonment of the procedure may reduce failed FD and VD and their complications.
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
CONCLUSION: Screening and treatment of many primary care diseases by ob-gyns is widespread and accepted by the majority of survey respondents.
Mark G. Newman, MD Woman’s Hospital of Baton Rouge, Baton Rouge, LA
Ronald K. Jaekle, MD, Alfred G. Robichaux, MD, and Charles M. Stedman, MD OBJECTIVE: To determine the rate of medical errors in administration of group B streptococcus prophylaxis (GBSP) in term gestations in an institution without a formal policy for GBSP. STUDY DESIGN: Two hundred consecutive term singleton admissions to the labor and delivery unit at the authors’ institution were prospectively identified. Staff were blinded to the existence of the review process. All charts were analyzed for compliance with Centers for Disease Control and Prevention (CDC) guidelines for GBSP. Medical error was defined as deviation from CDC GBSP guidelines. The Fisher exact test was used to evaluate the rate of medical error. RESULTS: One hundred ninety-two patients (96%) were managed using culture-based CDC guidelines (CB), whereas eight (4%) were managed using risk-based guidelines (RB); 22.9% of CB and 25% of RB groups met criteria for GBSP. The CB group rate of medical error was 3.13% (five were given GBSP with negative cultures, one was not given GBSP with a positive culture). The RB group rate of medical error was 37.5% (two were not given GBSP with risk factors, one was given GBSP without risk factors). The overall rate of medical error was 4.5% and was higher in RB (OR 18.6; 95% CI, 3.59 –96.48). The rate of errors that placed a neonate at risk for sepsis was 1.5%, and was higher in RB (OR 63.7; 95% CI, 5.05– 802.7). This would lead to one case of error-related early-onset neonatal sepsis per 15,873 term deliveries. CONCLUSION: A lack of institutional policy for GBSP does not appear to encourage excessive numbers of medical errors in GBSP. The rate of medical error appears to be higher among patients managed using risk-based CDC guidelines.
WEDNESDAY POSTERS
99S
Southern states are more likely to screen for diabetes mellitus (P ⫽ 0.04). Overall knowledge of diabetes screening recommendations and tests was high, although recent changes in guidelines were less well-known.
RISK MANAGEMENT
Medical Errors in the Administration of Group B Streptococcus Prophylaxis
Failed Forceps and Vacuum: A Case-Control Study of Predictors and Complications Radhika Dasmahapatra, BA Columbia University College of Physicians and Surgeons, New York, NY
Laxmi V. Baxi, MD OBJECTIVE: To identify trends, predictors, and complications of failed forceps (FD) and vacuum (non-metal cup) deliveries (VD). STUDY DESIGN: This is a case-control study of all failed FD and VD at a tertiary care center between January 1998 and June 2001. Each case was compared with the two immediately preceding successful FD or VD, matched by parity and delivery method (FD or VD). Parameters were age, parity, body mass index, gestational age, birth weight, fetal position, operator experience, and gender. Outcome variables were trauma, hemorrhage, and asphyxia. Data were analyzed by chi-square analysis. RESULTS: In 361 forceps and 181 vacuum deliveries, failure rates were 2.7% (n ⫽ 10) and 4.2% (n ⫽ 8), respectively. Factors associated with failure included station ⱕ ⫹ 2 (P ⫽ 0.003) and head position other than occipito anterior (P ⫽ 0.004). Maternal exhaustion as the main indication for assisted delivery was associated with greater success (P ⫽ 0.002). Apgar scores at 1 minute were lower (P ⫽ 0.037) and reported blood loss was higher (P ⱕ 0.001) in failed cases. Serious complications were higher in failed cases (P ⫽ 0.01) and included infant trauma and seizure, focal infant seizure, cesarean delivery wound separation, and bladder trauma at emergent cesarean delivery. These cases accounted for 50% of serious complications in all operative vaginal deliveries in this time period. Overall admission rates to neonatal intensive care were similar. Failure rates between FD and VD were not statistically significant. CONCLUSION: Stringent selection criteria, resorting to guidelines, tentative forceps, awareness of potential for failed procedures, and timely abandonment of the procedure may reduce failed FD and VD and their complications.
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
CONCLUSION: Screening and treatment of many primary care diseases by ob-gyns is widespread and accepted by the majority of survey respondents.
Mark G. Newman, MD Woman’s Hospital of Baton Rouge, Baton Rouge, LA
Ronald K. Jaekle, MD, Alfred G. Robichaux, MD, and Charles M. Stedman, MD OBJECTIVE: To determine the rate of medical errors in administration of group B streptococcus prophylaxis (GBSP) in term gestations in an institution without a formal policy for GBSP. STUDY DESIGN: Two hundred consecutive term singleton admissions to the labor and delivery unit at the authors’ institution were prospectively identified. Staff were blinded to the existence of the review process. All charts were analyzed for compliance with Centers for Disease Control and Prevention (CDC) guidelines for GBSP. Medical error was defined as deviation from CDC GBSP guidelines. The Fisher exact test was used to evaluate the rate of medical error. RESULTS: One hundred ninety-two patients (96%) were managed using culture-based CDC guidelines (CB), whereas eight (4%) were managed using risk-based guidelines (RB); 22.9% of CB and 25% of RB groups met criteria for GBSP. The CB group rate of medical error was 3.13% (five were given GBSP with negative cultures, one was not given GBSP with a positive culture). The RB group rate of medical error was 37.5% (two were not given GBSP with risk factors, one was given GBSP without risk factors). The overall rate of medical error was 4.5% and was higher in RB (OR 18.6; 95% CI, 3.59 –96.48). The rate of errors that placed a neonate at risk for sepsis was 1.5%, and was higher in RB (OR 63.7; 95% CI, 5.05– 802.7). This would lead to one case of error-related early-onset neonatal sepsis per 15,873 term deliveries. CONCLUSION: A lack of institutional policy for GBSP does not appear to encourage excessive numbers of medical errors in GBSP. The rate of medical error appears to be higher among patients managed using risk-based CDC guidelines.
WEDNESDAY POSTERS
99S