SIVB Phase II Learning Session 1 May 22, 2012 Synopsis of Opportunities-Barriers-Action Plans

Opportunities (to supporting vaginal birth) Create Triage Admission Criteria Create Elective Induction Criteria (41 weeks in nullips) Educate Triage Staff, Providers, Nursing, Patients and Patients Family on the importance of spontaneous labor in nulliparous patients Provide Feedback to Providers and Nursing on their own vaginal birth (or CS) rate Provide Patient Education at 36 week prenatal visit on importance of labor Posting of Unit Vagina Birth rate Education on the Intelligent active management of Labor Create team dedicated to improving vaginal birth rate and meet regularly Utilize hospital website to promote ways to support vaginal birth Recruit a Physician and Administrative Champion Invite out-side speakers to promote the importance of supporting vaginal birth Collaborate with other hospitals in finding solutions Barriers (to supporting vaginal birth) Imaginative Definitions of Labor given at admission Buy-In lacking from Providers, Nurses, Hospital Administration, Patient families and/or Patients Lack of Patient Education information Lack of Provider/Nursing Education information Military Obligation Differential practice behavior between providers/practices Lack of Time, Space, and/or Expertise in triage to diagnose labor No Provider Champion Weak Peer-review process Providers do not want their vaginal birth (or CS) rate tracked Action Plans (to supporting vaginal birth) Vidant Med. Center Improve triage environment Staff Education on labor support Move Nulliparous Elective Inductions Protocol through OB executive committee Patient Education in triage

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Johnston Health Involve Providers Involve Administration Post Stats Patient Educational video to be run in clinic waiting rooms Forsyth Med. Center Share PQCNC message and data Provider Score Cards Patient Information Cape Fear Valley Med. Center MD champion to present to other OB providers Post PQCNC data and message in Staff Lounges Labor Support education to staff Onslow Memorial Increase Communication with Staff Increase CNMW and MDs on SIVB team PQCNC posters in waiting rooms and triage Adopt elective induction guidelines use in other hospital systems Wilkes Reg. Med. Center Share Data with MDs Post PQCNC posters Develop labor support topic for patient education channel CMC Pineville Invite outside speaker to present PQCNC data and message to providers Duke

Meet as SIVB team Compare our data to aggregate Establish standards Provider Feedback on CS rates

Presb. - Huntersville Evaluate Triage Criteria Evaluate expertise in triage Presb. Matthews Post PQCNC posters Why labor is Important Provide Patient education during Prenatal visit on importance of labor

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Rex Health Outside speaker to present PQCNC message and data to RNs and MDs Find MD champion Patient Education RN score card Central Carolina CNMW score card Add MD Champion to SIVB team Elective Induction Protocol Staff education Flyers in offices and triage on importance of labor Outside speaker to present PQCNC message and data to RNs and MDs Nash

Evaluate elective induction of labor practice Outside speaker to present PQCNC message and data to RNs and MDs

UNC Hospitals Education of new interns Present data to staff (MD and RNs) monthly Patient information in labor rooms and D/C instructions Add another MD to SIVB Team Use CNM template Communicate with Triage RNs Columbus Regional Healthcare System Use available resources Post the importance of labor info in labor rooms and triage Educate RNs on labor support Education material on labor support to Health Department Granville Health System Improve patient education on labor support Improve MD support for initiative Add another MD champion to SIVB team Womens Hospital of Greensboro Labor support education for new RNs Outside speaker to present PQCNC message and data to RNs and MDs Monthly SIVB team meetings Monthly Reports Add MFM to team Labor Support posters in Triage

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