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AIM Obstetric Hemorrhage Wave 1--Jan 2020

AIM Obstetric Hemorrhage Wave 1--January 2020

The focus on the Wave 1 data collection will be to collect these measures:

Process Measure 1: Unit Drills (Questions 5, 6, 7)
Process Measure 3: Nursing Education (Questions 8, 9)
Process Measure 4: Hemorrhage Risk Assessment (Question 10)
Structural Measure 2: Debriefs (Question 11)
Structural Measure 4: Hemorrhage Cart (Questions 12, 13)
Structural Measure 5: Unit Policy and Procedure (Questions 14, 15)

1. Please designate an unit-based Labor and Delivery staff member (OB Provider, Staff RN, or Charge RN) to be the AIM Champion.
This person will be the lead at the hospital and contact between the Virginia Neonatal Perinatal Collaborative (VNPC). This person will be responsible for putting their hospital team together and implementing the Patient Safety Bundle.
*This question is required.

Name of Birth Facility
AIM Champion
Email

2. Please designate an AIM Data Champion, a unit-based Labor and Delivery staff member (OB Provider, Staff RN, or Charge RN).This can be the same person as the hospital AIM champion, but preferably an additional person that will be responsible for submitting the baseline AIM data and quarterly AIM data. *This question is required.

AIM Data Champion
Email
Same Person as above

3. Does the OB Department have an OB provider (Physician, CNM) or a nurse leader that participates in QI projects?
*This question is required.

Space Cell	Yes	No
Physician	Physician: Yes	Physician: No
Nurse-Midwife	Nurse-Midwife: Yes	Nurse-Midwife: No
Nurse-Leader	Nurse-Leader: Yes	Nurse-Leader: No

4. Does your birth facility have a multidisciplinary perinatal quality committee? *This question is required.

5. Does your birth facility conduct regular multidisciplinary in situ (on site) OB hemorrhage scenario simulation drills? *This question is required.

6. Which frontline providers are required to participate in the OB hemorrhage scenario simulation drills? *This question is required.

Space Cell	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

7. How often does the OB department conduct OB Hemorrhage scenario drills? *This question is required.

Please enter an 'other' value for this selection.

8. How many registered nurses are on staff in your unit? *This question is required.

9. How many of the registered nurses on staff in your unit, have completed an educational program specific to OB Hemorrhage in the last 2 years? *This question is required.

10. Does your birth facility utilize a postpartum risk assessment tool? *This question is required.

11. Following an OB Hemorrhage, is there a process for "lessons learned" to be addressed and shared with the patient, family and staff? *This question is required.

Space Cell	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

12. Does your unit have an OB hemorrhage cart? If No, skip to number 14. *This question is required.

13. How often is the OB hemorrhage cart checked to ensure all the necessary items are good (not expired), replenished and fully stocked?

14. Does the OB Department have a standardized process (i.e. order sets, unit policies, practice protocols) for obstetric hemorrhage? *This question is required.

15. How often are the obstetric hemorrhage policies and protocols (i.e. order sets) used in an obstetric hemorrhage by staff (OB, OB Resident, CNM, Staff RN)? *This question is required.