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AIM Obstetric Hemorrhage Baseline Survey 2019

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) and Virginia Department of Health (VDH).  This person will be responsible for putting their hospital team together and implementing the Patient Safety Bundle.
  *This question is required.
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.
3. What was the last quality improvement (QI) project that the OB Department attempted? 
4. What worked well in the past specific QI efforts?  *This question is required.
5. What barriers have been identified in past OB specific QI efforts?  *This question is required.
6. Is your birth facility currently participating in or has it recently participated in QI efforts with a QI organization (i.e. Perinatal Quality Collaborative, Private, or Not-for-profit QI Organization)? *This question is required.
7. 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 YesNo
Physician
Nurse-Midwife
Nurse-Leader
8. Does your birth facility have a multidisciplinary perinatal quality committee?  *This question is required.
9. Following a challenging OB case, is there a process for "lessons learned" to be addressed and shared with the patient, family and staff?  *This question is required.
Space Cell YesNo
Patient and Family
Staff (OB, CNM, RN)
10. Does the OB Department have standardized processes (i.e. order sets, unit policies, practice protocols) for the following obstetric emergencies? Select all that apply  *This question is required.
Space Cell YesNo
OB Hemorrhage
Severe hypertension/Preeclampsia
11. Does your birth facility Emergency Department have standardized processes (i.e. order sets, unit policies, practice protocols) for obstetric emergencies? 
  *This question is required.
12. How often are the obstetric emergency policies reviewed and updated?  *This question is required.
13. How often are the obstetric emergency policies and protocols (i.e. order sets) used in an obstetric emergency by staff (OB, OB Resident, CNM, Staff RN)?  *This question is required.
14. Does your birth facility have a policy for notification and response to maternal early warning signs?  *This question is required.
15. Does your birth facility conduct regular multidisciplinary in situ (on site) clinical scenario simulation drills for OB emergencies?  *This question is required.
16. How often does the OB department conduct clinical scenario drills? *This question is required.
17. What obstetric emergencies do these clinical scenario simulation drills focus on? Select all that apply  *This question is required.
18. Which frontline providers are required to participate in the OB clinical scenario simulation drills?  *This question is required.
Space Cell N/AYesNo
OBs
OB Residents
OB Anesthesia
Family Practitioners
Certified Nurse Midwives/Certified Midwives
Perinatal Dept. Nursing Staff
Emergency Dept. Staff
19. How does the OB Department obtain data to track unit-based outcomes? Select all that apply  *This question is required.
20. What type of data measures does the OB Department track? Select all that apply *This question is required.
21. What data collection challenges exist in your birth facility? Select all that apply  *This question is required.
22. Has your birth facility participated in a formal "culture of safety" assessment within the last 2 years?  *This question is required.
23. 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?  *This question is required.