You are receiving this survey because you have played an integral role in the implementation of the ACOG District II Safe Motherhood Initiative since 2013.

ACOG District II is busy planning future SMI educational offerings and would like to hear from you regarding your hospital’s bundle implementation activities – even if you haven’t started or have only partially started – it’s designed to help us get a “lay of the land.” In addition to educational planning, survey responses will help us coordinate future data collection efforts.

Complete this bundle evaluation survey and be entered for a chance to win a $50 Amazon gift card! The survey should take you no longer than 5 minutes to complete and your responses will remain confidential.

Remember, this is YOUR SMI.
GENERAL QUESTIONS

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* 1. What is your designated hospital level?

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* 2. Hospital name:

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* 3. Please indicate your hospital's current bundle implementation status:

  Not implemented In progress Fully implemented
Hemorrhage
Severe hypertension
Venous thromboembolism

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* 4. What methods were most valuable in educating staff throughout bundle implementation? (check all that apply)

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* 5. Please indicate if you agree/disagree with the following statements about the SMI:

  Strongly Agree Agree Disagree Strongly Disagree
Provided tools to train staff in standardized management of HEM
Provided tools to train staff in standardized management of HTN
Provided tools to train staff in standardized management of VTE
Provided the opportunity to learn successful bundle implementation strategies from other hospitals in NYS
Provided the opportunity to learn more about hospital's culture of safety
Had a direct impact on ability to initiate practice improvements related to bundle implementation
Data collection & reporting was an integral part of my hospital's bundle implementation

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* 6. Does your hospital currently have an EMR system?

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* 7. Do you anticipate that your hospital's medical record system (paper or EMR) will change within the next 18 months?

HEMORRHAGE BUNDLE

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* 8. Bundle components (check one box for each component):

  Not implemented In progress Fully implemented
Risk assessment (prenatal, antepartum, L&D admission, intrapartum)
Placenta accreta management
Active management of 3rd stage
Massive transfusion protocol
Cart 
Medication kit (including oxytocin dosing schedules)
Hemorrhage team w/education & drills
Staged checklist
Support for patients/families/staff
Huddles & debriefing
Multidisciplinary review of serious hemorrhages
Monitoring of outcomes & processes metrics

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* 9. Which component was the most straightforward to implement?

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* 10. Which component posed the biggest challenge?

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* 11. What is your hospital's biggest barrier to implementing the hemorrhage bundle?

SEVERE HYPERTENSION

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* 12. Bundle components (check one box for each component):

  Not implemented In progress Fully implemented
Risk assessment for persistent HTN
Diagnostic criteria for HTN emergency
Algorithms for first line medications (labetalol, hydralazine, or oral nifedipine)
Documentation guidelines
Checklist for management of preeclampsia
Checklist for management of eclampsia
Checklist for management of postpartum preeclampsia in Emergency Dept.
Monitoring complications/escalation/change of status
Discharge planning: postpartum surveillance
Discharge planning: HTN education for patients

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* 13. Which component was the most straightforward to implement?

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* 14. Which component posed the biggest challenge?

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* 15. What is your hospital's biggest barrier to implementing the severe hypertension bundle?

VENOUS THROMBOEMBOLISM

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* 16. Bundle components (check one box for each component):

  Not implemented In progress Fully implemented
Risk assessment
Pharmacologic prophylaxis (LMWH &/or UFH)
Mechanical prophylaxis
Antepartum management
Postpartum hospitalization
Therapeutic dosing
Monitor outcomes & processes metrics

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* 17. Which component was the most straightforward to implement?

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* 18. Which component posed the biggest challenge?

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* 19. What is your hospital's biggest barrier to implementing the venous thromboembolism bundle?

FINAL QUESTIONS

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* 20. What have you found most valuable about the SMI?

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* 21. What improvements, if any, would you make to the SMI?

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* 22. In what form & to what extent would you continue the SMI (e.g. exchanging guidelines with peers, reporting cases, data collection, etc.)?

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* 23. Would you or someone from your hospital be willing to share your lessons learned regarding implementation by speaking on a future webinar or being featured as a "Spotlight" hospital?

Spotlight hospitals are given the opportunity to showcase their work on the bundles & serve as an example within the greater community.

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* 24. Does the SMI have permission to use your testimonial such as with our collaborative partners, local news outlets, & legislators?

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* 25. Respondent name (Your name will not be used without your permission):

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* 26. ENTER BELOW FOR YOUR CHANCE TO WIN A $50 AMAZON GIFT CARD!

 
Thank you for completing our survey. Click "Done" to record your responses.

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