FALLING THROUGH THE CRACKS: Appendix 3

Hospital Survey

I. Integration of systems during pregnancy

Communication and care coordination

What information about risk factors and ongoing prenatal services do you receive from prenatal providers and prenatal home visitors when patients are admitted for labor and delivery?

Whom do you contact to obtain this type of information?

If PMAP patient, do you get a copy of the latest risk assessment form when the prenatal chart is forwarded to the delivery hospital? Do you get a copy of the care plan to address the risks identified if any?

How do you find out what happened during the last month of PNC when the patient’s chart is forwarded to the hospital at 36-37 weeks? (Or earlier?)

Please describe the communication system between PNC providers, home visiting staff, labor and delivery staff.

II. Testing and treatment at the hospital during pregnancy:

Interpreters

Describe (or provide) protocols for use of interpreters for testing and treatment during pregnancy.
What training and certification do your interpreters have? What is the availability of interpreters during non traditional business hours?

Domestic Violence

Describe (or provide) protocols for domestic violence screening, assessment, interventions, and referrals when a woman is being tested or treated during pregnancy.

Smoking Cessation

Describe (or provide) protocol for assessing smoking status, interventions, and referrals when a woman is being tested or treated during pregnancy.

III. Labor and Delivery

Interpreters

Describe (or provide) protocol for use of interpreters during labor and delivery.

Domestic Violence

Describe (or provide protocol) for domestic violence screening, assessment, interventions, and referrals during labor and delivery.

IV. Post Partum Newborn Care

Interpreters

Describe (or provide protocol) for use of interpreters during post partum care and teaching.

Domestic Violence

Describe (or provide protocol) for domestic violence screening, assessment, interventions, and referrals during post partum care.

Smoking Cessation

Describe (or provide protocol) for assessment of smoking status, interventions, and referrals during post partum care and teaching.

SIDS Risk Reduction and Sleep Safety

Describe (or provide protocol) for teaching SIDS risk reduction techniques and infant sleep safety issues.Do nursery nurses model Back To Sleep? Describe (or provide protocol) for nursery sleep position for newborns.

V. Discharge Planning

Home Visits

Describe (or provide protocol) how you determine who gets a referral for a home visit after discharge.
How do you determine what type of home visitor to refer?
Please list your referral sources for home visits.
Does the home visitor meet the mother at the hospital before discharge?
What is the volume of your referrals for home visits?

Other Referrals

Describe other referrals that are made at discharge.
Please list other referral sources you commonly use.

Appointments and Other Follow Up

Are appointments made for medical follow up before discharge?

Pediatric newborn care:
Post partum care:

Does the mother have information on infant symptoms requiring immediate medical attention?
Does the mother have a number to call for advice on infant care?
For post partum care?

VI. Grief Support

Do hospital staff get grief support training at regular intervals?
Describe training or provide protocols.
Are float or temporary nurses who care for OB patients included in grief support training?
Are technicians who do testing during pregnancy included?
Describe (or provide) protocols for how technicians should respond when they determine a bad outcome.

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