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O147 IMPACT OF ‘HUMAN WORM’ ON SERIOUS ADVERSE INCIDENTS IN OBSTETRIC PRACTICE
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
their learning. Participants found it useful to access the mobile device in the clinical area or in any other location at a time convenient to them. They all reported that they felt empowered to learn and that the flexibility of where the learning could take place enhanced their acquisition of the performance skills required for NIPE.
O146 THE USE OF MOBILE PHONES IN MEDICAL ABORTION FOR SUPPORT, SELF-ASSESSMENT AND FAMILY PLANNING INFORMATION D. Constant1 , J. Harries1 , K. de Tolly2 . 1 Public health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa; 2 Cell-Life, Cape Town, Western Cape, South Africa Objectives: This study investigates using mobile text systems to support women through medical abortion, for self-assessment of abortion completion, and to reinforce family planning messages. This initiative will assess whether mobile phones can be used to reduce the requirement for follow-up visits as is the current standard of care. Materials: This RCT will recruit 460 women seeking medical abortion in the Western Cape, South Africa. Methods: All women receive standard abortion care with mifepristone and home administration of misoprostol and return to the clinic to assess completion. Consenting women are randomised to “standard of care” (SOC) or “SOC plus mobile” intervention study arm. The intervention group are SMSd over 3 weeks coaching them through the abortion process. They are encouraged to selfassess abortion completion through a questionnaire via their mobile phone. Lastly they are given access to comprehensive family planning information via their phones. Interviews are conducted at both clinic visits and at 1 month post abortion. Comparisons are tested using Chi2 or Fisher exact tests for proportions and T-tests for continuous variables. Significance is tested at the 0.05 level. Results: Early results for 131 women showed no significant differences between study arms at baseline for age, education, gestational age, socioeconomic status and anxiety or depression. At exit, intervention women had experienced less stress associated with their abortion (P = 0.042) and were better prepared for the bleeding they experienced (P = 0.001). All recommended the SMSs as a support method for women undergoing same-stage abortion. 85% of intervention women tried the self-assessment and of these, 78% reached an endpoint. Pilot results at 1 month post abortion showed 88% of women were using family planning – in most cases DMPA although the IUD was a method of choice in some younger women. Conclusions: Support SMSs are effective for women undergoing abortion. Final results will assess the feasibility of reducing the need for the follow-up visit when safe to do so according to selfassessment of completion. Where this is the case, uptake of postabortion family planning needs to be promoted and self-efficacy encouraged with respect to continuation of effective usage.
O147 IMPACT OF ‘HUMAN WORM’ ON SERIOUS ADVERSE INCIDENTS IN OBSTETRIC PRACTICE C. Coroyannakis1 , E. Chandraharan1 . 1 Obstetrics and Gynaecology, St George’s Healthcare NHS Trust, Tooting, United Kingdom Objectives: To determine the contribution of the Human Factors (‘Human WORM’) that comprises of Workmanship (lack of knowledge, skills and expertise), Omissions (failure to recognize a problem, failure to incorporate clinical picture and delay in instituting appropriate action), Relationships (failure in effective communication with the patients or among healthcare professionals and failure of team working) and Mentorship (lack of senior input or failure to involve senior or multi-disciplinary input) to serious (untoward) incidents in a Tertiary Referral Centre in London. Materials: All Serious (untoward) incidents at a Tertiary Referral Centre, which were declared according to NHS London Criteria from 2010–2011, were included in the analysis. Only cases where Root Cause Analysis (RCA) investigations have been completed and recommendations and action plans have been made by independent serious incident panels were analysed. Methods: Contribution of the ‘Human WORM’ to overall poor patient outcomes were determined by reviewing individual Serious Incident Reports by author. These were independantly re-analysed by the supervising author to eliminate bias. In addition, the relative frequencies of individual parameters of the Human WORM were also determined. Results: Human factors (Human ‘WORM’) were contributory to 81.8% of all serious (untoward) incidents. More than one parameter of the Human WORM was responsible 86.3% of cases. Among the individual parameters of the ‘Human WORM’, Omissions (59%) and Relationships (47.7%) were the leading contributors to serious (untoward) incidents in obstetric practice and these were followed by Workmanship (29.3%) and Mentorship (29.3%). Overall, 9 % of serious incidents had contribution from all 4 parameters of the Human WORM. Conclusions: There is an urgent need to address the Human Factors (Human ‘WORM’) that contribute to serious adverse incidents in obstetric practice. Despite mandatory, multi-professional and multi-disciplinary training, shortcomings in Workmanship and Relationships continue to contribute significantly to serious adverse incidents. Mentorship issues (lack of senior input, failure to involve senior or multi-disciplinary team) contributed to approximately a third of all serious (untoward) incidents in obstetric practice. Recommendation: We recommend that investigation of serious incidents should include a detailed analysis of contribution of Human Factors using the ‘Human WORM’ Model to identify recurring themes and to improve clinical outcomes. O148 ROBOTIC SINGLE-SITE HYSTERECTOMY IN LOW RISK EARLY ENDOMETRIAL CANCER: A PILOT STUDY E. Vizza1 , G. Corrado2 , E. Mancini1 , E. Baiocco1 , L. Patrizi3 , M. Saltari3 , S. Sindico1 , M. Cimino1 , F. Barletta4 . 1 Gynecologic Oncology Unit, National Cancer Institute “Regina Elena”, Rome, Italy; 2 Gynecologic Oncology Unit, ‘John Paul II’ Foundation for Research and Care, Campobasso, Italy; 3 Department of Surgery, Section of Gynecology and Obstetrics, “Tor Vergata” University, Rome, Italy; 4 Gynecology and Obstetrics Unit, San Giovanni Hospital, Rome, Italy Objectives: To evaluate the feasibility and the safe of robotic singlesite hysterectomy in low risk early endometrial cancer. Materials: Patients with clinical low risk early endometrial cancer were enrolled in prospective cohort trial. Methods: All surgical procedures were performed through a single 2–2.5 cm umbilical incision, with a multi-channel system consisting of a five-lumen port provides access for two Single-Site instruments,
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
their learning. Participants found it useful to access the mobile device in the clinical area or in any other location at a time convenient to them. They all reported that they felt empowered to learn and that the flexibility of where the learning could take place enhanced their acquisition of the performance skills required for NIPE.
O146 THE USE OF MOBILE PHONES IN MEDICAL ABORTION FOR SUPPORT, SELF-ASSESSMENT AND FAMILY PLANNING INFORMATION D. Constant1 , J. Harries1 , K. de Tolly2 . 1 Public health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa; 2 Cell-Life, Cape Town, Western Cape, South Africa Objectives: This study investigates using mobile text systems to support women through medical abortion, for self-assessment of abortion completion, and to reinforce family planning messages. This initiative will assess whether mobile phones can be used to reduce the requirement for follow-up visits as is the current standard of care. Materials: This RCT will recruit 460 women seeking medical abortion in the Western Cape, South Africa. Methods: All women receive standard abortion care with mifepristone and home administration of misoprostol and return to the clinic to assess completion. Consenting women are randomised to “standard of care” (SOC) or “SOC plus mobile” intervention study arm. The intervention group are SMSd over 3 weeks coaching them through the abortion process. They are encouraged to selfassess abortion completion through a questionnaire via their mobile phone. Lastly they are given access to comprehensive family planning information via their phones. Interviews are conducted at both clinic visits and at 1 month post abortion. Comparisons are tested using Chi2 or Fisher exact tests for proportions and T-tests for continuous variables. Significance is tested at the 0.05 level. Results: Early results for 131 women showed no significant differences between study arms at baseline for age, education, gestational age, socioeconomic status and anxiety or depression. At exit, intervention women had experienced less stress associated with their abortion (P = 0.042) and were better prepared for the bleeding they experienced (P = 0.001). All recommended the SMSs as a support method for women undergoing same-stage abortion. 85% of intervention women tried the self-assessment and of these, 78% reached an endpoint. Pilot results at 1 month post abortion showed 88% of women were using family planning – in most cases DMPA although the IUD was a method of choice in some younger women. Conclusions: Support SMSs are effective for women undergoing abortion. Final results will assess the feasibility of reducing the need for the follow-up visit when safe to do so according to selfassessment of completion. Where this is the case, uptake of postabortion family planning needs to be promoted and self-efficacy encouraged with respect to continuation of effective usage.
O147 IMPACT OF ‘HUMAN WORM’ ON SERIOUS ADVERSE INCIDENTS IN OBSTETRIC PRACTICE C. Coroyannakis1 , E. Chandraharan1 . 1 Obstetrics and Gynaecology, St George’s Healthcare NHS Trust, Tooting, United Kingdom Objectives: To determine the contribution of the Human Factors (‘Human WORM’) that comprises of Workmanship (lack of knowledge, skills and expertise), Omissions (failure to recognize a problem, failure to incorporate clinical picture and delay in instituting appropriate action), Relationships (failure in effective communication with the patients or among healthcare professionals and failure of team working) and Mentorship (lack of senior input or failure to involve senior or multi-disciplinary input) to serious (untoward) incidents in a Tertiary Referral Centre in London. Materials: All Serious (untoward) incidents at a Tertiary Referral Centre, which were declared according to NHS London Criteria from 2010–2011, were included in the analysis. Only cases where Root Cause Analysis (RCA) investigations have been completed and recommendations and action plans have been made by independent serious incident panels were analysed. Methods: Contribution of the ‘Human WORM’ to overall poor patient outcomes were determined by reviewing individual Serious Incident Reports by author. These were independantly re-analysed by the supervising author to eliminate bias. In addition, the relative frequencies of individual parameters of the Human WORM were also determined. Results: Human factors (Human ‘WORM’) were contributory to 81.8% of all serious (untoward) incidents. More than one parameter of the Human WORM was responsible 86.3% of cases. Among the individual parameters of the ‘Human WORM’, Omissions (59%) and Relationships (47.7%) were the leading contributors to serious (untoward) incidents in obstetric practice and these were followed by Workmanship (29.3%) and Mentorship (29.3%). Overall, 9 % of serious incidents had contribution from all 4 parameters of the Human WORM. Conclusions: There is an urgent need to address the Human Factors (Human ‘WORM’) that contribute to serious adverse incidents in obstetric practice. Despite mandatory, multi-professional and multi-disciplinary training, shortcomings in Workmanship and Relationships continue to contribute significantly to serious adverse incidents. Mentorship issues (lack of senior input, failure to involve senior or multi-disciplinary team) contributed to approximately a third of all serious (untoward) incidents in obstetric practice. Recommendation: We recommend that investigation of serious incidents should include a detailed analysis of contribution of Human Factors using the ‘Human WORM’ Model to identify recurring themes and to improve clinical outcomes. O148 ROBOTIC SINGLE-SITE HYSTERECTOMY IN LOW RISK EARLY ENDOMETRIAL CANCER: A PILOT STUDY E. Vizza1 , G. Corrado2 , E. Mancini1 , E. Baiocco1 , L. Patrizi3 , M. Saltari3 , S. Sindico1 , M. Cimino1 , F. Barletta4 . 1 Gynecologic Oncology Unit, National Cancer Institute “Regina Elena”, Rome, Italy; 2 Gynecologic Oncology Unit, ‘John Paul II’ Foundation for Research and Care, Campobasso, Italy; 3 Department of Surgery, Section of Gynecology and Obstetrics, “Tor Vergata” University, Rome, Italy; 4 Gynecology and Obstetrics Unit, San Giovanni Hospital, Rome, Italy Objectives: To evaluate the feasibility and the safe of robotic singlesite hysterectomy in low risk early endometrial cancer. Materials: Patients with clinical low risk early endometrial cancer were enrolled in prospective cohort trial. Methods: All surgical procedures were performed through a single 2–2.5 cm umbilical incision, with a multi-channel system consisting of a five-lumen port provides access for two Single-Site instruments,