A dedicated team has done some breakthrough work to make things safer for pregnant women and their babies at Royal University Hospital (RUH) in Saskatoon.

Earlier this year, a mistake proofing team of Saskatoon Health Region staff focused their attention on ensuring the timing of planned caesarean sections (C-sections) is appropriate so that babies born this way are given their best chance to mature.

A C-section is performed

The process for delivering babies by C-section at Royal University Hospital has been made safer thanks to the efforts of a team focused on mistake-proofing.

“Our team worked with the obstetricians to standardize the medical indications for C-sections prior to 39 weeks gestation, when a pregnancy is considered full term, as well as the process for dating a pregnancy,” explained Leanne Smith, a member of the team and the Director of Maternal Services at RUH. “These medical indications are for conditions where it is safer to deliver than to continue the pregnancy either for the baby or mother; for example, twin pregnancies, maternal hypertension or preterm rupture of membranes.”

Before making any of the changes suggested by the team, 1 in 5 planned C-sections at RUH were done before 39 weeks gestation without having one of the approved medical indications for early delivery. This increased the risk of neonatal complications related to baby immaturity.

“Neonatal complications range from the baby having difficulty breastfeeding and maintaining their temperature, all the way up to respiratory difficulties,” Smith explained. “Some of the complications would mean the baby would have to spend some time in the Neonatal Intensive Care Unit (NICU).”

The team worked with physicians’ offices to ensure that physicians booking C-sections for their patients understand the acceptable medical indications for C-sections done prior to the 39-week mark of their pregnancy, and how to complete the surgical booking form to provide the information needed.

Now, nursing staff in the Assessment Unit on Labour and Delivery review the surgical booking card to ensure that C-sections are booked at 39 weeks or later, unless there is an approved exception. The team also developed work standards to assist the staff in dealing with any inappropriately booked surgeries.

“As the team implemented a number of process improvements, the number of inappropriately timed C-sections dropped significantly and we have had no problems with the processes since we implemented them in April of this year,” said Smith.

The team also worked on a number of issues that the physicians indicated were troubling for them.

“We standardized the gestation at which a physician can book the C-section to ensure equal access to the planned C-section slots, as there are a limited number of surgical times available,” Smith explained. “We also streamlined the booking process for C-sections, with surgical scheduling taking over the booking of all planned C-sections. Working on these two long standing issues helped garner the support of the obstetricians and their office staff for the rest of the work.”

All of these changes ensure that women planning to have C-sections to deliver their babies will do so in the safest way possible. It is changes like these that Saskatoon Health Region is celebrating during the latest 90-day cycle of breakthrough improvements, Safer Every Day.

For more information about Safer Every Day, the Region’s new safety initiative, visit www.saskatoonhealthregion.ca/SaferEveryDay.