Retained vaginal swabs: Review of an adverse event in obstetrics through closed claims analysis

Background: An integrated approach to clinical risk management and litigation claims management in the health service is essential to drive and support safe patient care. This approach identifies adverse events and enables learning from those events. Objective: To explore the issue of retained vaginal swabs in the maternity services and to identify common themes and areas for improvement. Methods: Closed claims analysis using retrospective review of legal case records held by the State Claims Agency in Ireland for the period 2004-2011. Subjects: Litigation cases handled by the State Claims Agency regarding alleged vaginal retention of a surgical swab following childbirth. Results: Review of the 16 closed cases revealed 3 major areas of concern; staff clinical performance, workload issues and documentation. Conclusion: Cases of retained vaginal swabs were few in number. However, they represent a significant problem in that they are very difficult to defend in clinical negligence litigation, as they reflect the failure of clinicians to comply with practice standards around a clinical procedure. Maternity service providers must put measures in place to manage this preventable clinical risk.