PACC Impact Statement: Use the PACC Impact Statement to showcase and communicate your hospital's results with C-suite executives and leadership teams.

PACC One-Pager: As the PACC Initiative wraps up, hospitals have exceeded their initial goals across a myriad of key metrics. Learn more about PACC successes and plans for sustainability at the link!

PACC Patient Saves: Hospitals are seeing a difference in outcomes through their work with the PACC Initiative. These teams are proud of their work and have given us permission to share these patient saves. 

NEW!

• PACC Team Button Template: Why 2 Weeks?

FPQC PACC Key Resources

• PACC Toolkit Document
• PACC Key Driver Diagram
• PACC Quick Start Guide

FPQC PACC Data Resources

• PACC Data Webinar Recording (11/17/22) - Webinar Slides
• Patient-level Data Collection Form
• Hospital-level Data Collection Form
• Measurement Grid

FPQC PACC General Resources

• PACC Comprehensive Overview PowerPoint Presentation (Non-Narrated)
• PACC Brief Overview Narrated PowerPoint Presentation
• PACC Kickoff Meeting Combined Slides (Non-Narrated) (10/27/22)
• PACC Implementation Guidance Narrated PowerPoint Presentation
• PACC Implementation Guidance Slide Deck (Non-Narrated)
• Voice of a Patient (Handout): Tips List to Build Patient & Family Relationships within Your Hospital
• Perinatal Mental Health Guidance for Obstetricians and Gynecologists from ACOG
• Uplifting the Patient Voice (Video Snippet): Tips from our Patient Advocate, Mandi Gross, on how to build and strengthen patient and family relationships within your hospital.

Other Important Resources

• Postpartum Discharge Transition Safety Bundle from the Alliance for Innovation on Maternal Health (AIM)

General Reference Materials:

• Key Driver #1 Narrated PowerPoint Presentation: Overview of the PACC Initiative Key Driver #1 from PACC Clinical Co-Lead, Kimberly Fryer, MD.
• Key Driver #1 Slide Deck (Non-Narrated)

Secondary Driver 1a: Develop a process flow to schedule early risk-appropriate PP visits/encounters prior to discharge and align policies and procedures accordingly

Reference Articles: 

• ACOG Committee Opinion #736: Optimizing Postpartum Care: This committee opinion describes the recommended timing of postpartum care with first postpartum visit in the first 3-weeks after delivery.

FPQC Resources:  

• PP Discharge Flow Poster:  An FPQC example postpartum discharge flow diagram that can be displayed in common provider areas.
• PP Discharge Flow PPT: A slide for providers with the PP Discharge Flow.

Secondary Driver 1b: Conduct a PP discharge assessment prior to discharge

Reference Articles:

• Florida Maternal Mortality Review Committee Report 2019:  The most recent pregnancy-related mortality report and committee recommendations.
• ACOG Practice Bulletin #222: Gestational Hypertension and Preeclampsia: Diagnosis and treatment for pre-eclampsia and gestational hypertension.

FPQC Resources:

• PP Discharge Assessment PDF: To be completed just prior to discharge updating the provider if needed.
• PP Discharge Assessment Poster: Poster to be displayed in common provider areas.
• PP Discharge Assessment PPT: A provider and staff slide deck with vitals to check just prior to discharge.

Other Resources:

• Electronic Medical Record Discharge Risk Assessment Sample (Tampa General)
• EPIC Discharge Checklist Sample (AdventHealth for Women)
• EPIC Discharge Note Sample (Lee Health Cape Coral Hospital)

Secondary Driver 1c: Implement maternal discharge risk assessment & schedule/arrange risk-appropriate PP care including obstetrical, specialty, & community services before discharge

Reference Articles:

• ACOG Practice Bulletin #212: Pregnancy and Heart Disease: Recommends a postpartum follow-up visit (early postpartum visit) with either the primary care provider or cardiologist is recommended within 7–10 days of delivery for women with hypertensive disorders or 7–14 days of delivery for women with heart disease/cardiovascular disorders.
• Society for Maternal-Fetal Medicine Special Statement: Quality metric for timely postpartum follow-up after severe hypertension. Because postpartum exacerbation of severe hypertension is common, the American College of Obstetricians and Gynecologists recommends that patients with severe hypertension during the childbirth hospitalization be seen within 72 hours after discharge.
• Scheduling the Post-Birth Health Check Sample (Tampa General)

Screening Tools:

Validated screening tools for depression:

• Edinburgh Postnatal Depression Scale (EPDS) – recommended as gold standard
• Patient Health Questionnaire-2 (PHQ-2) 

Screening approaches and validated screening tools for substance use disorder: 

• Screening, Brief Intervention, Referral to Treatment (SBIRT): This is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders (SUD), as well as those who are at risk of developing these disorders. A validated SUD screening tool should be integrated into the first step of this process.

Validated SUD screening tools include:

• NIDA Quick Screen 
• 5 P’s 
• CRAFFT

FPQC Resources:

• Maternal Discharge Risk Assessment PDF: Use when patient is admitted to determine appropriate discharge timing and follow-up plan.
• Maternal Discharge Risk Assessment Poster: Poster to be displayed in common provider areas.
• Maternal Discharge Risk Assessment PPT: Slide deck with an in-depth rationale of topics, when and how to use, and its importance.

Links to community resources:

• Florida BH IMPACT consultation line: “Clinician to clinician” help line for mental and behavioral health issues for all Florida providers with a next business day response. Phone number is 833.951.0296
• SAMHSA Substance Use Treatment Locator: Link to assist patients in finding treatment centers for substance abuse and mental health disorders.
• Naloxone Patient Education Brochure: Infographic for patients with information on opioid safety and how to use naloxone.
• FL Healthy Start Connect: This one-stop entry point provides phone numbers by county to link pregnant women and families with Healthy Start services.
• Findhelp.org: Links to local resources for food, housing, and other needs; searchable by zip code.

General Reference Materials:

• Key Driver #2 Narrated PowerPoint Presentation: Overview of the PACC Initiative Key Driver #2 from PACC Clinical Co-Lead, Margie Boyer, RN.
• Key Driver #2 Slide Deck (Non-Narrated)
• FPQC PP Mortality Brief Handout: Describes Florida’s high mortality rate, underlying causes and risk factors, and potential preventability and strategies.
• AWHONN Post-Birth Warning Signs Education program: Includes patient video, clinician education modules and toolkit (available for a fee), patient education flyers in multiple languages and other resources.
• Hear Her campaign poster on PP Early Warning Signs: Patient, family/friends, and healthcare provider resources developed by CDC and available in multiple languages for download.

Secondary Driver 2a: Verbally educate patients on the benefits of early risk-appropriate PP visits/encounters (PP safety checks)

• FPQC 2-week Post-Birth Health Check handout: Patient handout explaining the importance of the 2-week Post-Birth Health Check; can be used as part of discharge education and includes space to write information about the scheduled appointment. Spanish version. Creole version.
• FPQC My Post-Birth Wallet Card: Wallet card for patient information on date of giving birth, date of Post-Birth Health Check, provider contact, complications, and medications. Can be used as part of discharge education. Spanish version. Creole version.

Secondary Driver 2b: Verbally educate all patient on PP Warning Signs and provide written materials

• AWHONN PBWS: AWHONN Post-Birth Warning Signs (PBWS) is a FREE 1-page handout on PBWS available in over 20 languages. Illustrates signs and symptoms for the patient to report immediately to provider and/or 911. Additional materials are available for a cost including the take home magnet for patients and the AWHONN PBWS clinician education platform.
• CDC Hear Her Campaign: Free materials available in over 20 languages. Emphasizes listening to patient concerns with a focus on pregnancy- one year PP. Includes website materials, guides and palm cards for individuals and friends/family; and warning signs poster with pictographs of urgent maternal warning signs.
• Preeclampsia Foundation: PP Preeclampsia handout: Infographic educates on signs, symptoms of preeclampsia. Website has numerous handouts, posters that cover hypertensive disorders of pregnancy (HDP). Includes prenatal and PP tear pads, symptom magnets, clinic posters, plus more in-depth brochures for those wanting more information about HDP and the long-term risks of heart disease. Available in English, Spanish and Creole. Posters offer place to insert local contact information. All materials can be obtained for a small fee to cover shipping.
• PP Support International (PSI): Helpline provides worldwide resources for individuals and families with Perinatal Mood Disorders through online support groups, specialized coordinators, and local chapters. Call or text 1-800-944-4773 #1-Spanish, #2-English.
• PSI Poster: Poster provides patient information on how find help at PP Support International.
• National Maternal Mental Health Hotline: FREE, confidential, 24/7 mental health support for moms and families before, during, and after pregnancy. English and Spanish-speaking counselors are available. TTY Users can use a preferred relay service or dial 711 and then 1-833-943-5746.

Secondary Driver 2c: Verbally educate patients on the benefits of and options for pregnancy spacing, family planning and contraceptive choice and provide written materials

• FPQC Infographic on Birth Spacing: This handout was developed for FPQC LARC and MORE Initiatives. It covers family planning options for the patient to go over with provider with an emphasis on healthy birth spacing. Spanish version. Creole version.
• March of Dimes Birth Spacing Handout: Free Family Planning 1 page handout available in English and Spanish. Includes video link for more information. Includes conversation starter to have when meeting with provider.

Secondary Driver 2d: Establish a system to ensure that all patients receive recommended and documented PP education and discharge information

• ACOG Poster on PP Care Team: Infographic illustrates the importance of the patient knowing her support team during pregnancy and PP. Supportive poster for families for a fee of $9 per poster plus shipping costs.

General Reference Materials:

• Letter from the ACOG District XII Chair: Supports the PACC Initiative to share with outpatient and inpatient providers.
• Implementing Early Postpartum Care in a Florida Private Practice Video Snippet (Dr. Megan Bagwell): Learn about the 2-Week Post Birth Health Check and how to incorporate it within your practice.
• Key Driver #3 Narrated PowerPoint Presentation: Overview of the PACC Initiative Key Driver #3 from PACC Clinical Co-Lead, Julie DeCesare, MD.
• Key Driver #3 Slide Deck (Non-Narrated)

Secondary Driver 3a: Develop a strategy to engage and educate inpatient and outpatient providers and staff using initiative promotional and education materials

• FPQC Preventing Maternal Mortality Overview Presentation: Intended for ED clinicians to present and adapt for Grand Rounds and other trainings.
• Modifiable PACC explanation letter for hospitals: To customize and share with outpatient and inpatient providers.
• Post-Birth Health Check Billing/Coding document: To share with OB provider offices which details strategies necessary to receive additional reimbursement for the early postpartum visit.
• FPQC “Post-Birth Health Check...Follow the B’s “ Patient-Facing Handout: This double-sided infographic educates patients on what to expect during their PP visit. It is intended for provider offices to give to patients to utilize for their visit as a conversation starter and for resources after the visit. The back side lists national help lines for PP patients and families. Spanish version. Creole version.
• FPQC “Post-Birth Health Check...Follow the B’s” Provider Poster: Resource for providers to utilize during the PP visit. This follows the topics the patient also receives regarding what to expect at their Post-Birth Health Check.
• CDC Hear Her Campaign: Free and comprehensive components for clinical teams to utilize (includes videos, patient stories, bias training)
• AWHONN PBWS: Comprehensive 1 contact hr. offering. Cost involved.
• ACOG Maternal Mental Health Provider Education: Toolkit for OB and other women’s health care providers to follow to care for women with perinatal mood and anxiety disorders: Includes webinar on perinatal mood and anxiety disorders: Perinatal Mood and Anxiety Disorders webinar
• Postpartum Support International (PSI) Perinatal providers Psychiatric Consult Line: Free consultation line is available for medical professionals who have questions about the mental health care related to pregnant and postpartum patients and pre-conception planning.
• Florida Behavioral Health Impact: The Florida Behavioral Health Improving Maternal and Pediatric Access, Care and Treatment for Behavioral Health maintains a toll-free hotline, Mon-Fri 9a-5p, for healthcare providers looking to expand their PP evaluation and follow-up care related to perinatal mental health needs.
• ILPQC PP QI Experience: 30-minute training on the experience with PP Care in Illinois.
• Case: Woman Presents to ED With Headache and Hypertension (medscape.com): The CDC and Medscape have recently published a case challenge on postpartum preeclampsia. Authored by several experts across the country, including Dr. Carolyn Holland.
• Two-Week Post-Birth Health Check Guidelines Sample (Tampa General)

Secondary Driver 3b: Plan in place to continue to engage and educate new hires

• We encourage teams to utilize the resources in Secondary Driver 3a to educate new hires.

Secondary Driver 3c: Develop a strategy to engage and educate ER physicians & staff about pregnancy/PP care including PP screening & care practices.

• ER Driver Narrated PowerPoint Presentation: This presentation discusses ER components of the PACC Initiative, and is narrated by FPQC Executive Director, William Sappenfield, MD, MPH, CPH.
• ER Driver Slide Deck (Non-Narrated)
• Postpartum ER Training Slides: FPQC ER physician and staff postpartum condition educational slide presentation. This example presentation is for use annually in providing education to ER providers and staff on postpartum conditions.
• FPQC PACC ER PP Conditions and Management Website: Information on common postpartum diagnoses and their management.
• FPQC ER PP Conditions Poster: 11x17 poster with visuals and QR codes for the most complications/diagnosis for PP period that links to guidelines for care.
• FPQC ER PP Conditions 8x11 Handout: The 8x11 version of our FPQC ER PP Conditions Poster.
• Postpartum Conditions Diagnoses and Treatment Clinical Management Guide for ERs: Booklet outlining the most common PP complications and how to manage.
• Sample 2-Week Post-Birth Health Check Algorithm (Tampa General)

• ER Driver Narrated PowerPoint Presentation: This presentation discusses ER components of the PACC Initiative, and is narrated by FPQC Executive Director, William Sappenfield, MD, MPH, CPH.
• ER Driver Slide Deck (Non-Narrated)
• Postpartum ER Training Slides: FPQC ER physician and staff postpartum condition educational slide presentation. This example presentation is for use ally in providing education to ER providers and staff on postpartum conditions.
• FPQC PACC ER PP Conditions and Management Website: Information on common postpartum diagnoses and their management.
• FPQC ER PP Conditions Poster: 11x17 poster with visuals and QR codes for the most complications/diagnosis for PP period that links to guidelines for care.
• FPQC ER PP Conditions 8x11 Handout: The 8x11 version of our FPQC ER PP Conditions Poster.
• Postpartum Conditions Diagnoses and Treatment Clinical Management Guide for ERs: Booklet outlining the most common PP complications and how to manage.
• ED Triage EMR Example: An example of how the "have you been pregnant in the past year?" screening question has been incorporated into an EMR. 

Visit our Postpartum ED Resources page for updates!

Respectful maternity care (RMC) is a universal component of every PACC driver and activity. Here are some RMC resources for your hospital teams:

FPQC Resources

• RMC Narrated PowerPoint: This presentation discusses RMC components of the PACC Initiative, and is narrated by FPQC Senior Quality Improvement Analyst, Nicole Pelligrino, MPH, MCHES, Certified Doula. 
• RMC Slide Deck (Non-Narrated) 
• The PACC Pledge: Customizable pledge for hospital teams to demonstrate their commitment to providing patients with RMC in the hospital, in the transition to home, and during the PP period.  

Strategies and Guidelines

• ACOG Committee Opinion #587: Effective Patient–Physician Communication: Physicians’ ability to effectively and compassionately communicate information is key to a successful patient–physician relationship. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient–physician communication. Involving advanced practice nurses or physician assistants may improve the patient’s experience and understanding of her visit. 
• Respectful Maternity Care Implementation Toolkit (RMC-IT [AWHONN]): The Respectful Maternity Care Implementation Toolkit (free for AWHONN members and available for a small fee for non-members) provides the tools and resources needed to implement the 10-Step “C.A.R.E. P.A.A.T.T.H.” within organizations. Make the commitment today to provide Respectful Maternity Care to every patient, every interaction, every time. 
• New York City Standards for Respectful Care at Birth: This brochure is useful for both patients and providers and discusses shared decision-making and respect for human rights during pregnancy, labor, and childbirth. 

Reference Articles and Reports

• Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review: Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation.
• Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Reports from a Landscape Analysis (USAID): This is an important review by Bowser and Hill of the evidence on the topic of disrespect and abuse in facility based childbirth. The primary purpose of the report is to review the evidence in published and gray literature with regard to the definition, scope, contributors, and impact of disrespect and abuse in childbirth, to review promising intervention approaches, and to identify gaps in the evidence.
• Respectful Maternity Care: The Universal Rights of Childbearing Women (White Ribbon Alliance): By design, this document focuses specifically on the interpersonal aspects of care received by women seeking maternity services. A woman’s relationship with maternity care providers and the maternity care system during pregnancy and childbirth is vitally important. Not only are these encounters the vehicle for essential and potentially lifesaving health services, women’s experiences with caregivers at this time have the impact to empower and comfort or to inflict lasting damage and emotional trauma, adding to or detracting from women’s confidence and self‐esteem. Either way, women’s memories of their childbearing experiences stay with them for a lifetime and are often shared with other women, contributing to a climate of confidence or doubt around childbearing.