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December 04-05, 2019 | Dubai, UAE
Annual Congress on
Midwifery and Gynaecology 2019
December 04-05, 2019
Midwifery nursing and Gynaecology
J Nurs Res Pract, Volume 3 |
ISSN: 2632-251X
Volume 3
Journal of Nursing Research and Practice
Quality improvement project: Reducing the swab retention during vaginal delivery
Ana Luisa Cavaco
Ministry of National Guard Heath Affairs, UAE
I
n a universe of 8500 deliveries per year, between December of 2015 and March 2016, 4 incidents of
swabs left in the vagina during the delivery were described on the safety reported system, with respective
readmission of the patients for treatment. This repeated occurrence in a period of 4 months was an opportunity
to reflect on clinical practices.
Swabs are used by obstetricians and midwives during vaginal delivery and perineal repair to clean and absorb
blood.Theycanbedifficult to identifyonce soaked inbloodandareoccasionally left inside thevaginabymistake.
Retained vaginal swabs were more common than surgical swabs or any other category of foreign object. The
impact of retained vaginal swabs can be severe. Women may experience serious physical and psychological
complications including infection, secondary post-partum hemorrhage, sepsis, and depression, lack of bonding
with their baby due to re-hospitalization and finally, loss of trust in the health organization with consequent
discredit by the population. In addition, they represent a significant problem in that they are very difficult to be
defended in clinical negligence litigation, as they reflex the failure of clinician to comply with practice standard.
The repercussions canharmthe professionals as a ‘secondvictim’. Organizational consequences canbe financial
and reputational, as never events are considered to reflect quality and safety processes within an organization.
Therefore, maternity service provider must put measures in place to manage this preventable clinical risk.
Aim of the Project:
To implement a highly reliable and standardized count process during all vaginal births
that was more in line with structured counts of the perioperative process. As consequence was expected to
reduce the risk of retained swabs during vaginal delivery.
Strategies for improvement:
The 4 incidents that happed in the maternity during December 2015 and March
2016, 3 were very similar situations. After delivery, the 3 patients needed to undergo perineum revision /
repair under general anesthesia. The L/D team is a different team from OR and on these 3 cases, the handover
does not contemplate that the patients were with vaginal swab to contain the blood lost.
cavacoanaluisa@sapo.pt