1300 / Red code in delivery room

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Assessment of risk and harm
Implementation of Patient Safety initiatives / Activities There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
The aim of the PSP is to highlight the work done to revise the procedure, in the light of the transfer of the delivery room into the new hospital building. The transfer has in fact resulted in a greater adherence to Agenas safety standards with particular reference to the paragraph I) “Safe Environment" of the manual "The Standard For assessing birth centers" of November 2012.
Description of the Patient Safety Practice
 
Obstetric emergencies are conditions of risk "quoad vitam" for the mother and / or newborn;
The Italian Ministry of Health has produced Recommendation No. 6 (March 2008) "RECOMMENDATION FOR THE PREVENTION OF MATERNAL DEATH OR SERIOUS ILLNESS RELATED TO THE STRUGGLE OF CHILDBIRTH" stressing, among other things, that "Committees to investigate on maternal mortality, established in several European countries, reveal an incidence of the phenomenon higher than shown by voluntary reporting and estimate that about half of maternal deaths reported could be avoided through better standards of care.” The same document highlights the importance of taking "appropriate care and organizational measures to avoid or minimize adverse events in assisting childbirth and post-partum in order to reduce potentially avoidable mortality" and also that “timely and complete communication between the actors and structures involved in emergency management presents critical aspects: lack of or insufficient exchange of important information on the cases is one of the major risk factors for adverse outcomes"
Based on literature, the following classification have been produced:
• Elective / WHITE: programmable and executable within 24 hours; maternal-fetal risk absent;
• Defined / GREEN: to be started over a few hours, even accepting any priority other childbirth; There is maternal-fetal risk, but that allows waiting for a few hours;
• Urgent / YELLOW: to begin within 30 minutes,
• Emergency / RED: to be completed in the birth as soon as possible, priority for immediate danger to the life of the mother and / or fetus; this category include the conditions of fetal hypoxia with neonatal loss in terms of pH 0.03 points for every minute spent by the fetus in utero, such as cord prolapse, placental abruption with fetal stress, the prolonged deceleration = 6 '
The hospital has moved to the new building in December 2012; the review of all the procedures of the birth path, including the path to the urgency / emergency, has subsequently been carried out.
The "Colour code" has been implemented in our department and delivery room to facilitate communication between the different actors of emergency c-sections and, more specifically, to reduce the decision to delivery interval (DDI) in emergency c-sections called "red code". An ad hoc path was drafted and implemented for optimizing the pathway of the patient. Over a six-months-period, all "red code" c-sections have been independently reviewed by four obstetricians. For each c-section, they had to confirm or reject the indication for "red code" c-section. Decision to delivery interval was also collected. Thirty-five "red code" c-sections were performed representing 1,2 % of all deliveries and 5,1 % of all c-sections. Opinions were discordant in 13 others cases. The average decision to delivery interval was 10.8 minutes. In our department, defining emergency level by "colour code" is associated with a short decision to delivery interval in emergency c-sections.

Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple specialities across different health care settings
Involved health care staff
 
Physicians
Nurses
Health care assistants
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Stefania Rampello
Country: ITALY
Organisation: AO PAPA GIOVANNI XXIII BERGAMO
E-mail: srampello@hpg23.it
Phone: There is no specified text here
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