To begin, each site must evaluate the foundation upon which safety improvements will be made. Answer the following questions. Gather documents in a central location in preparation for working on strategies.
- Do you have a document explaining how obstetrical clinical guidelines are developed, implemented and revised?
- Do you have a committee or an individual charged with this task?
- How do you monitor for and respond to changes in standard of care?
- What is your obstetrical QA process?
- How do you share obstetrical outcomes with staff?
- Do you have a written description of how this works?
- What are your OB/GYN indicators?
- What regular QA/QI meetings do you have?
- What is the schedule?
- Who leads/attends the meetings?
- How do you conduct credentialing and privileging in Obstetrics? Reappointments?
- Do these processes apply to all physicians and midwives?
- Who is accountable for this process?
- Do these processes apply to all physicians and midwives?
- How do you orient new nurses in obstetrics?
- What annual education and training do you require for nurses?
- What do you have in place regarding the chain of communication (previously called chain of command)?
- Do you have statements or guidelines regarding consultation, referral or transfer of care?
- Provide your documentation templates.
- Provide clinical guidelines or other documents which address:
- EFM and fetal heart auscultation
- induction and augmentation of labor
- terms to convey urgency regarding cesarean section
- diagnosis/management of hypertensive disorders of pregnancy
- post-EDD management
- GBS screening and prophylaxis
- DVT prevention
- antibiotic prophylaxis
- access to prenatal records at intrapartum site
- Describe drills you currently conduct or require.
- Are there any other documents in place that address obstetrical care at your site?