Texas Perinatal Forum Survey Tips Nathan Drever MD
- Slides: 23
Texas Perinatal Forum: Survey Tips Nathan Drever, MD OB-GYN, MFM TETAF Surveyor July 15, 2019 Confidential and proprietary to Allen Technologies, Inc. 1 facebook. com/texasperinatalservices Texas. Perinatal. Services. org linkedin. com/TETAF @tetaf. org Texas. Perinatal. Services. org
Day One: Medical Records § § Paper Records Electronic Medical Record Two Team Members per Surveyor (MD/RN) Identify Computer Savvy Staff 2 Texas. Perinatal. Services. org
Day One: Guidelines § § Printed Organized Folder of All Guidelines Written policy on what conditions would require a maternal transport 3 Texas. Perinatal. Services. org
Word on Guidelines § § § Start early! Slow and deliberate Feedback Open forums Change is hard! 4 Texas. Perinatal. Services. org
Day One: Credentials § § § Critical Care CMEs MMD develops collaborative relationships with other MMD in the PCR Staff participate in ongoing staff and team-based education and training in the care of maternal patient OB provider employee files with CMEs specific to pregnant and postpartum MMD signs off on credentialing files 5 Texas. Perinatal. Services. org
QAPI Program § § § § Quality Assurance Performance Improvement (QAPI) Sign-in sheets Agenda items Identification of an area to improve Develop and implement improvement plans Evaluate implementation until resolution is complete Aggregate patient data is reviewed for trends and data is submitted Outcome based 6 Texas. Perinatal. Services. org
Day Two: Morning Meeting § § Anesthesia, Laboratory, Pharmacy, Radiology, Respiratory Therapy, Ultrasonography and Blood Bank - 24 hours Anesthesia – Available within 30 minutes, board-certified in charge of OB anesthesia, back-up call § Blood Bank – MTP, emergency release of multiple blood components § Perinatal pathology 7 Texas. Perinatal. Services. org
Day Two: Morning Meeting § Imaging – OB ultrasound available for routine and advanced maternal and fetal assessment – CT, MRI ECHO available with interpretation – X-ray Tech – IR 8 Texas. Perinatal. Services. org
Day Two: Morning Meeting § Staff – – – Pharmacist with experience in perinatal pharmacology Certified Lactation Consultant Social Services Bereavement Support Pastoral care Dietician/Nutritionist plan meals for postpartum and critically ill patients 9 Texas. Perinatal. Services. org
Day Two: Walk-Through § Expect anything! – Talking with MD and RN staff about QAPI – Difficult airway equipment on L&D, Antepartum and Postpartum – Portable ultrasound immediately available in L&D and Antepartum – Posted daily call schedules on L&D, Antepartum, Postpartum 10 Texas. Perinatal. Services. org
Ask us a question! Use the Texas Perinatal Services website to contact us for verification survey services or to ask a question about program development. texasperinatalservices. org Confidential and proprietary to Allen Technologies, Inc. Carla Rider, DNP, MBA, RNC-LRN, TETAF Perinatal Program Director crider@tetaf. org 11 facebook. com/texasperinatalservices Texas. Perinatal. Services. org linkedin. com/TETAF @tetaf. org Texas. Perinatal. Services. org
Physician Education Questions: § § 12 Is there a set number of CMEs they should be providing the facility? Does the facility need to track physician education? Or as long as the physician maintains their board requirements with their CMEs would be sufficient? What is TETAF’s recommendation to be compliant with this requirement? What kind of report would meet the state requirement? Texas. Perinatal. Services. org
Support Question § 13 Do you all perform mock surveys? If so, could you give me information on that. Texas. Perinatal. Services. org
Physician Education § 14 Have you found the physician’s education is getting done with community physicians who have privileges that are not on staff at the hospital? Texas. Perinatal. Services. org
QAPI in Meetings § 15 Is it acceptable to have QAPI to be incorporated into OB section meetings or does it need to be a specific meeting of its own? Texas. Perinatal. Services. org
Community Physicians and OB Section Meetings § 16 These are community physicians that deliver at the hospital, but do not attend OB section meetings, if that makes sense. We are having a hard time getting them to attend because they only deliver their patients at the hospital. They do not cover labor and delivery. Texas. Perinatal. Services. org
Maternal Nursing Liaison § 17 Who is the maternal nursing liaison to the hospital staffing committee and what is this supposed to look like? Texas. Perinatal. Services. org
Maternal Program Manager § 18 Does the maternal program manager have to be active at the bedside to meet requirements? I have heard arguments both ways. Texas. Perinatal. Services. org
Obstetrical Anesthesiologist § 19 I have a question about the requirements for anesthesia. In the anesthesia part, the rules say a board-certified anesthesiologist in-training or experienced in obstetric anesthesia is in charge of the anesthetic OB services. Does this mean we have to have a board-certified obstetrical anesthesiologist in charge and how do we demonstrate their experience? Texas. Perinatal. Services. org
Chart Reviews § 20 What is the process for choosing medical records that you look at? Is it random or is the hospital lining them up by complications? Texas. Perinatal. Services. org
Resuscitation Equipment § 21 Regarding resuscitation equipment what must be in the patient room? Can the equipment remain on the crash cart in the unit? Texas. Perinatal. Services. org
Forum topic idea? Send an email to Carla Rider, crider@tetaf. org 22 Texas. Perinatal. Services. org
Implementing Perinatal Quality Improvement Conference October 11, 2019 Texas Health Dallas (Fogelson Auditorium) Margot Perot Building 8160 Walnut Hill Lane Dallas, Texas 75231 Register at Perinatal. QI. org/events/ 23 Texas. Perinatal. Services. org