Current situation of causative factors and preventive measures for near-miss events during labor based on P-mSHELL model analysis

Abstract

　The purpose of this study was to elucidate the current situation in midwifery care, including the causative factors for near-miss events during labor and preventive measures for such events using the P-mSHELL model. Among the data obtained from the authors’ previous study^1）, near-miss events during labor that left the greatest impressions on midwives, including 45 “delays in judging rapid progression of labor” and 32 “errors in intravenous antibiotics,” were analyzed in the present study. Using the P-mSHELL model, categories of causative factors and preventive measures identified by midwives were extracted from these events by the seven model components. Results indicated that, the main causes of miss event during labor were rapid labor is difficult to predict, the lack of personnel, poor judgment of the progression of labor, violation of manuals, and lack of collaboration. Preventive measures were thought to include understanding rapid labor, securing personnel, strengthening the ability to judge the progress of labor, creating manuals, and to strengthen the collaboration. Furthermore, to prevent accidents and near-miss events during labor, its importance was shown to improve the individual midwife’s skills and have an organizational initiative, together with an approach that involves both technical and non-technical skills.