Exit this survey Nebraska AIM Baseline Survey Question Title * 1. It is important to designate an unit-based Labor and Delivery staff member (OB Provider, Staff RN, or Charge RN) to complete the AIM Baseline Survey. Name of Birth Facility Labor and Delivery Survey Designee Email Question Title * 2. Does your birth facility have a multidisciplinary perinatal quality committee? Yes No Question Title * 3. Following a challenging OB case, is there a process for 'lessons learned' to be addressed and shared with the patient, family and staff? Yes No Patient and Family Patient and Family Yes Patient and Family No Staff (OB, CNM, RN) Staff (OB, CNM, RN) Yes Staff (OB, CNM, RN) No Question Title * 4. Does the OB Department have standardized processes (i.e. order sets, unit policies, practice protocols) for the following obstetric emergencies? Select all that apply. Yes No OB Hemorrhage OB Hemorrhage Yes OB Hemorrhage No Severe Hypertension/Preeclampsia Severe Hypertension/Preeclampsia Yes Severe Hypertension/Preeclampsia No Question Title * 5. Does your birth facility Emergency Department have standardized processes (i.e. order sets, unit policies, practice protocols) for obstetric emergencies? Yes No Do not have an Emergency Department Question Title * 6. How often are the obstetric emergency policies and protocols reviewed and updated? Every year Every 2 years Every 3 years Question Title * 7. How often are the obstetric emergency policies and protocols (ie. order sets) used in an obstetric emergency by staff (OB, OB Resident, CNM, Staff RN)? N/A 25% 50% 75% 100% Question Title * 8. Does your birth facility have a policy for notification and response to maternal early warning signs? Yes No Question Title * 9. Does your birth facility conduct regular multidisciplinary in situ (on site) clinical scenario simulation drills for OB emergencies? Yes No Question Title * 10. How often does the OB department conduct clinical scenario simulation drills? N/A Monthly Quarterly Annually Other (please specify) Question Title * 11. What obstetric emergencies do these clinical scenario simulation drills focus on? Select all that apply. N/A OB Hemorrhage Severe Hypertension/Preeclampsia Eclamptic Seizure Sepsis Emergent Cesarean Section Maternal Code Other (please specify) Question Title * 12. Which frontline providers are required to participate in the OB clinical scenario simulation drills? N/A Yes No OBs OBs N/A OBs Yes OBs No OB Residents OB Residents N/A OB Residents Yes OB Residents No OB Anesthesia OB Anesthesia N/A OB Anesthesia Yes OB Anesthesia No Family Practitioners Family Practitioners N/A Family Practitioners Yes Family Practitioners No Certified Nurse-Midwives/Certified Midwives Certified Nurse-Midwives/Certified Midwives N/A Certified Nurse-Midwives/Certified Midwives Yes Certified Nurse-Midwives/Certified Midwives No Perinatal Dept. Nursing Staff Perinatal Dept. Nursing Staff N/A Perinatal Dept. Nursing Staff Yes Perinatal Dept. Nursing Staff No Emergency Dept. Staff Emergency Dept. Staff N/A Emergency Dept. Staff Yes Emergency Dept. Staff No Question Title * 13. How does the OB department obtain data to track unit-based outcomes? Select all that apply. Chart Review Computer generated reports Other (please specify) Question Title * 14. What type of data measures does the OB department track? Select all that apply. Process measure-frequency of performing a diagnostic test or treatment related to an outcome (i.e. rate of antibiotic prophylaxis at Cesarean birth, rate of obstetric hemorrhage risk assessment on L&D admission) Structure measure-identify information about policies, equipment, and staff that are relevant to the QI project and are often noted once when the task is completed (i.e. annual policy review, staff training sessions) Outcome measures-examines the impact on patient's health and well-being (i.e. severe maternal morbidity and mortality rates) Question Title * 15. What data collection challenges exist in your birth facility? Select all that apply. Incorrect Coding Inadequate Documentation Lack of Trained Staff Time Burden None Other (please specify) Question Title * 16. Has your birth facility participated in a formal 'culture of safety' assessment within the last 2 years? Yes No Question Title * 17. Does your OB department have a 'stop the line' policy where staff know that they have the responsibility and authority to stop a procedure when patient safety is a concern? Yes No Question Title * 18. What do you see as the greatest need to improve OB specific QI efforts in your birth facility? Done
