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Because the majority of perinatal death and injury cases reported root causes related to problems with organizational culture and with communication among caregivers, JCAHO offers these recommendations:
1. Conduct team training in perinatal areas to teach staff to work together and communicate more effectively.
2. For high-risk events, such as shoulder dystocia, emergency cesarean delivery, maternal hemorrhage and neonatal resuscitation, conduct clinical drills to help staff prepare for when such events actually occur, and conduct debriefings to evaluate team performance and identify areas for improvement.
3. Use a standardized maternal fetal record form for each admission.
4. Review and apply standards of care from professional organizations to facilitate these goals:
a. Develop clear guidelines for fetal monitoring of potential high-risk patients, including nursing protocols for the interpretation of fetal heart rate tracings.
b. Educate nurses, residents, nurse midwives, and physicians to use standardized terminology to communicate abnormal fetal heart rate tracings.
c. Review organizational policies regarding the availability of key personnel for emergency interventions.
d. Ensure that designated neonatal resuscitation areas are fully equipped and functioning.
e. Develop guidelines for the transfer of patients to a higher level of care when indicated, if essential services cannot be readily provided as required by professional guidelines.