Florida Perinatal Quality Collaborative
PROMPT Initiative Toolbox
The PROMPT toolbox is a one-stop shop for all of your PROMPT resources! Check back often for updates!
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FPQC PROMPT Key Resources
FPQC PROMPT Data Resources
- PROMPT Data Webinar Recording - coming soon
- Patient-level Data Collection Form
- Hospital-level Data Collection Form
- Measurement Grid
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1a: Develop standard protocols/processes for identification, management, and treatment of severe hypertension
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ACOG Practice Bulletin #222 Gestational Hypertension and Preeclampsia: ACOG recommends treatment for persistent, severe hypertension within 30-60 minutes.
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ACOG CO #667 Hospital-Based Triage of Obstetric Patients: ACOG recommends collaborating with other departments to create guidelines for triage of pregnant women in all hospital settings and standardized triage protocols.
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ACOG Practice Bulletin #203 Chronic Hypertension in Pregnancy: When antihypertensive therapy is used during pregnancy, an important consideration is the context of therapy, which is either 1) chronic treatment to lower blood pressure to maintenance levels, sometimes slowly during 24–48 hours often in the outpatient setting, or 2) acute lowering of critical hypertension in the hospital setting.
- SMFM Special Statement: A quality metric for evaluating timely treatment of severe hypertension
- Winnie Palmer Protocol: management of hypertensive disorders in pregnancy and postpartum.
- AdventHealth Algorithms – coming soon
- ACOG Identifying and Managing Obstetric Emergencies in Nonobstetric Settings
- Florida EMS protocol – coming soon
1b: Ensure rapid access to severe hypertension medication
- ACOG Practice Bulletin #222 Gestational Hypertension and Preeclampsia: ACOG recommends urgent blood pressure control with antihypertensive medications such as labetalol, hydralazine and immediate release nifedipine.
- Kantorowska et al. 2020: Timely treatment of severe hypertension in pregnancy is crucial to prevent end organ damage and may be facilitated though expedited medication access.
- Martin et al. 2021: Use of a standardized order set for the management of severe hypertension in pregnancy improves the timely administration of antihypertensive medications.
- FPQC Sample Acute-Onset, Severe Hypertension and Eclampsia Medication Kit – Sample Emergency Access Medication Kit for OB Patients with Severe Hypertension. Includes antihypertensives and seizure prophylaxis.
- FPQC OB Emergency Cart – coming soon
- ACOG Labetalol Algorithm
- ACOG Hydralazine Algorithm
- ACOG Oral Nifedipine Algorithm
- CMQCC Sample Acute-Onset, Severe Hypertension and Eclampsia Medication Kit
- AdventHealth Tampa OB Emergency Cart – coming soon
- Winnie Palmer EPIC Order Sets
1c: Integrate a patient advisor on your QI team
- Family Engagement at the Systems Level: A Framework for Action Family-centered care that involves patients at the individual and system-wide levels as allies in their care has been associated with improved quality and safety, cost savings, improved health outcomes, increased patient and provider satisfaction, and more effective policies.
- Alberta Health Guide to Patient Engagement
- FPQC Involving Patients in QI One Pager
- Institute for Patient- and Family-Centered Care (IPFCC)
- AHRQ Guide to Patient and Family Engagement in Hospital Quality and Safety
- Working with Patient and Families as Advisors Implementation Handbook
- MoMMA’s Voices AIM Webinars: This webinar series builds on the MoMMA’s Voices Lived Experience Integration into QI Work Community of Learning and includes Navigating Risk Management with CANDOR, Working with Patients on QI Projects, and Holding Safe Spaces.
- TGH Patient/Family Advisor Brochure – coming soon
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2a: Assess and document if patient presenting is pregnant or has been within the past year in all care settings
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ACOG Identifying and Managing Obstetric Emergencies in Nonobstetric Settings: ACOG recommends screening for pregnancy in the last year in all non-obstetric settings. This ACOG resource also contains ED algorithms for care of OB patients in non-obstetric settings
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The Florida Maternal Mortality Review Committee findings have noted an increase in maternal morbidity and mortality through 12 months postpartum secondary to HTN and its complications, which predominantly occur postpartum. This webpage provides a link to the 2-page report on severe hypertension outcomes.
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AWHONN and ENA joint statement on care of OB patient in ED: This position statement from AWHONN & ENA provides standards on caring for the OB patient outside of OB unit.
- Statement from ACOG District XII on caring for the OB Patient - coming soon
- Statement from the Florida Emergency Department Medical Directors on caring for the OB patient outside of OB - coming soon
- FPQC ED Signage: Information with visuals and QR codes for the most complications/diagnosis for postpartum period that links to guidelines for care.
- FPQC 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 and Haitian Creole versions are also available.
- ACOG/AHA statement on opportunities to reduce maternal risk postpartum: This joint statement provides guidance for hospitals to improve maternal outcomes.
- PACC EMR Examples/Screenshots - coming soon
2b: Ensure accurate blood pressure measurement and assessment
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Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement from the American Heart Association: The American Heart Association states: “Accurate blood pressure measurement is crucial for classifying hypertension and initiating treatment, regardless of pregnancy status.”
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FPQC BP assessment (PPT) - coming soon
- FPQC BP clinician competency - coming soon
- Clinician Infographic: BP Key elements
- AWHONN: Back to basics for clinicians on how to take an accurate blood pressure.
- Million Hearts: Compendium on hypertension in pregnancy. Infographic on page 11 explaining how to take an accurate BP.
- 4th Trimester Resources: A list of postpartum resources, handouts, and videos. The 4th Trimester site is designed to provide the latest medical evidence and offer real, honest stories to inform postpartum planning. The information on the website has been reviewed by physicians, midwives, and nurses. However, we encourage women to always contact their health care provider with questions or concerns.
2c: Provide verbal and written HTN education to patients and support persons
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ACOG CO #736 - Optimizing Postpartum Care: ACOG recommends patients and support persons receive education on warning signs for hypertensive disorders.
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ACOG CO #676 - Health Literacy to Promote Quality of Care: Learning preferences and levels of health literacy vary among patients. Materials accessible to all patients are essential to communicate with a diverse population (health literacy, multiple languages, appropriate reading level, infographic style).
- AWHONN Post-Birth Warning Signs (PBWS) Digital Download: The AWHONN PBWS is an evidence-based tool that educates patients and families on warning signs and is available in over 23 languages. This digital download makes it easy for new parents to download and keep on their device for 1 year postpartum.
- AIM Maternal Early Warning Signs: This infographic can be used as a poster or handout for pregnant and PP patients with pictures of early warning signs,
- Patient Handout-Signs and Symptoms of Preeclampsia including Postpartum Preeclampsia: This one-page handout from The Preeclampsia Foundation educates patients on signs and symptoms of postpartum preeclampsia.
- Patient Handout: ACC Heart Health After Pregnancy: This one-page infographic educates PP patients on heart health with signs and symptoms to report.
- FPQC Wrist Cuff Patient Education - coming soon
- FPQC Arm Cuff Patient Education - coming soon
- Preeclampsia Foundation Video Link to Self-Measured Blood Pressure: This video demonstrates for patients how to take their own BP. Some hospitals load this on their hospital learning platform for ease of patient use.
- AWHONN PBWS Online Course: The POST-BIRTH Warning Signs online course and program resources educate nurses and clinicians about postpartum maternal morbidity and mortality crises in the United States, and provides a respectful, evidence-based approach to postpartum pre- and post-discharge education for all patients, regardless of risk factors.
- CDC Hear HER: Free and comprehensive components for clinical teams to utilize (includes videos, patient stories)
- FPQC 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 and Haitian Creole versions are also available.
- IHI Teach-Back Method: The Always Use Teach Back! tools can be used to confirm patient understanding of care instructions by asking patients to repeat the instructions using their own words. An extensive suite of tools is available for download from IHI.org.
- Health Literacy Module: This free course, presented in joint sponsorship with the Florida Perinatal Quality Collaborative and Baptist Health will equip perinatal care clinicians with key health literacy principles to apply to postpartum care. This will create a meaningful difference in patients’ postpartum health literacy, which will better prepare them for postpartum transitions; help them understand the importance of identifying early warning signs and post-birth health checks; facilitate follow-up and continuing care; and prioritize health literacy within healthcare organizations.
2d: Provide interdisciplinary clinician team training for early recognition and treatment of OB hypertensive emergencies (ED, OB, Cardiology, ICU)
- The Joint Commission (TJC): Standards PC 06.03.01: for Maternal Safety: Reduce the likelihood of harm related to maternal severe hypertension/preeclampsia. TJC recommends interdisciplinary team training providing role-specific education to all staff and providers who treat OB patients about the hospital’s evidence-based severe hypertension/preeclampsia procedure. At a minimum, education occurs at orientation, whenever changes to the procedure occur, or every two years. In situ drills including representatives from all members of the obstetrical team with debriefs is essential to decrease obstetric related morbidity and mortality by improving the team’s communication and response in a true emergency.
- TJC: Element of Performance (EP) 3 and 4: EPs provide the criteria for hospitals to demonstrate performance above standards. Included in EP 3 is the need for interdisciplinary team training. EP 4 emphasizes the need for in situ drills at least annually to determine system issues as part of ongoing quality improvement efforts. Severe hypertension/preeclampsia drills must include a team debrief for identification of system gaps and plans for correction.
- Free Contact Hour AIM Severe Hypertension bundle: This free contact hour for both physicians and nurses is an online module which review the AIM Severe HTN bundle components.
- FPQC Sample Simulation Link - coming soon
- Simulation Examples from CMQCC
- AIM Obstetric In-Situ Drill Program Manual: This compendium published in 2022 is an additional resource for hospitals to utilize for developing in situ OB simulation drills.
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3a: Implement standardized protocol for treatment of severe hypertension
- TJC PC.06.03.01: Reduce the Likelihood of harm related to preeclampsia EP2: written procedures should be developed by multidisciplinary team that includes representation from obstetrics, ED, Anesthesiology, Nursing, Lab and Pharmacy.
- ACOG Practice Bulletin #222 Gestational Hypertension and Preeclampsia: ACOG recommends treatment for persistent, severe hypertension within 30-60 minutes.
- SMFM Hypertension in Pregnancy Change Package: SMFM recommends quality improvement and implementation of evidence-based tools to improve maternal morbidity and mortality.
- Powell et al. A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project.
- AWHONN:
- CMQCC:
- AIM MEWS example protocol
- Standing orders in Cerner (Baycare)
- EPIC Hypertension Order Set: Pregnant to 12 Weeks
- Hypertension Workflow Example (Tampa General Hospital)
- Documentation of completion - coming soon
- Example policies (e.g. what nurses can and cannot order) - coming soon
- How to hardwire processes into EHR - coming soon
- Sample Gemba Walk - coming soon
3b: Provide trauma-informed support for patients
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ACOG CO #825- Caring for patients who have experienced trauma: ACOG recommends that the entire clinical team implements a trauma-informed approach in a physical and psychologically safe context when interacting with patients. This includes recognition of prevalence of trauma and effect on patients and providers, building a trauma-informed workforce, and universal screening for a history of and current trauma with attention to avoiding stigmatization and prioritizing resilience. Providers and hospital systems should also recognize the stress on providers caring for patients in traumatic events. Hospital systems may develop peer-to-peer counseling and debriefs to initiate the process of healing from events, identifying when additional resources are needed and preventing burnout.
- Sachs & Wheaton. Second Victim Syndrome
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Birth Trauma Resources (Preeclampsia Foundation)
- What to Expect in the Hospital (FPQC)
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Am I Providing Trauma-Informed Care? (FPQC) One-pager with actionable strategies for clinical teams.
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Trauma Care for Clinical Teams (FPQC) - coming soon
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Code Lavender guidelines (Stryker): This solution-focused toolkit outlines the importance of Code Lavender programs and how they can be implemented to support the physical, emotional and spiritual wellbeing of patients, families and care team members.
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Code Lavender: A Tool for Support Staff (Cleveland Clinic): Patients, family members, volunteers, and healthcare staff can call a Code Lavender when a stressful event or series of stressful events occurs in the hospital.
3c: Schedule postpartum encounter 3-7 days after discharge
- ACOG CO #736 - Optimizing Postpartum Care: ACOG recommends that patients with hypertensive disorders of pregnancy have a BP check in 3-7 days postpartum and receive education on warning signs for hypertensive disorders.
- Pregnancy-Associated Stroke and Outcomes Related to Timing and Hypertensive Disorders: Patients who suffer from hypertension are at an increased risk for stroke. It is important that patients are educated on these risks and symptoms, and may require additional monitoring throughout the postpartum period and beyond.
- Bitar et al. Pregnancy-Associated Stroke and Outcomes Related to Timing and Hypertensive Disorders
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Adapted from PACC:
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Adopted from PACC:
- Maternal Discharge Assessment
- Postpartum Discharge Assessment
- Scheduling Postpartum Visit Sample (TGH)
- Post-Birth Heath Check Billing/Coding: To share with OB provider offices which details strategies necessary to receive additional reimbursement for the early postpartum visit.
- Post-Birth Health Check: Follow the B's!: Checklist for providers to utilize during the postpartum visit and to display in clinics. There are also patient-facing versions in English, Spanish, and Haitian Creole.
- 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. Haitian Creole version.
- March of Dimes Low-Dose Aspirin During Pregnancy Campaign
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Respectful maternity care (RMC) is a universal component of every PROMPT driver and activity. Here are some RMC resources for your hospital teams:
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.