AHRQ Safety Program for Perinatal Care
Purpose: To tap into the knowledge and experiences of labor and delivery (L&D) providers and other clinical and nonclinical staff (e.g., health unit coordinators and environmental services personnel) to find out what risks are present on your unit that have or could jeopardize patient safety.
Who should complete this form: All L&D staff (clinical and nonclinical)
How to complete this form: Provide as much detail as possible when answering the two questions. Submit your completed safety assessment form in the location designated by the unit safety coordinator.
When to complete this form: All L&D staff should complete this form at least semiannually. It may also be used as needed and serve as a continuous quality improvement tool. Assessing safety should be considered an iterative process with no defined end. Thus, it can be filled out by any L&D staff member at any time.
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Name (optional): __________________________________________ |
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Please describe any safety issues that require improvement for future patients in the L&D unit. Include any relevant examples that you observed/were concerned about involving patient harm that could have been prevented.
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Please describe what you think can be done to prevent or minimize this harm.
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Thank you for helping improve perinatal safety in your workplace.
