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Labor and Delivery (L&D) is a high-acuity, fast-paced work environment, frequently with a large, shifting workforce. In this setting, it can be difficult for personnel to stay current on best practices and updated policies. As policies are introduced or changed, there is variable exposure to the changes and uptake of the novel, desired behaviors. Communication with this type of workforce in this environment can be difficult. While email seems an obvious choice to communicate with the large workforce, we know that high email volume and email fatigue prevents it from being an effective way to disseminate essential updates.1 In-person communication is limited in scope as only a small proportion of personnel are present during any shift.

The Safety Pearl is a 60-second or shorter announcement that occurs at the end of each Team Meeting (Chapter 29, “Whiteboard and Team Meeting”). The format was developed to address the above difficulties in communication. It provides timely, accurate, and succinct information to the clinical workforce on L&D.2 It provides a standardized, consistent message that is easy to repeat across multiple shifts. It also reaches a sizeable portion of the clinical workforce as it is repeated twice a day for an entire week at Team Meeting. This format leads to most personnel having at least one exposure to the critical update (Fig. 30-1).


Sample Safety Pearl format.


  • Communicate to all staff on L&D key learning points from patient safety events.

  • Reinforce a culture of safety by spotlighting patient safety twice a day during Team Meetings.

  • Encourage standardization of care by highlighting correct practice as a way to improve patient safety.3


  • Safety Pearl topics are identified through many channels:

    • Recommendations during a monthly interdisciplinary meeting reviewing policies.

    • Patient safety reports from monthly Department of Obstetrics and Gynecology Quality Assurance/Quality Improvement meeting.

    • Outreach from fellows and residents working on L&D.

    • Input from L&D nurses.

    • Repeating Safety Pearls on core safety concepts.

  • The topic is distilled down to no more than two key takeaways, which can be read in less than 60 seconds.

  • Each Safety Pearl is reviewed by a nurse and physician to ensure accuracy, with a final review by the L&D medical director.

  • The Safety Pearl is read at the end of the Team Meeting, a twice a day meeting that brings together the nursing, anesthesia, and obstetric teams to discuss every patient on the floor.

  • Safety Pearls are based on written policies. Each Safety Pearl is accompanied by a resource sheet with additional information and reference to the policy and potentially relevant literature.

  • Topics are diverse; some examples are as follows:

    • Review Maternal Early Warning System criteria and desired clinical response.

    • Announce changes to visitor policy with changes in COVID-19 incidence.


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