Option A: OBI CHeCklist

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The Obstetrics Initiative (OBI) Labor and Delivery Checklist for Low Risk Spontaneous Labor is a tool that can be utilized by labor and delivery triage staff to assess patient readiness for admission and becomes part of the patient chart.  The checklist is designed to ensure the best transition from outpatient to inpatient care for all of the women we serve.  While the goal is to provide consistent care to all women, the checklist is not intended to override clinical judgement.  If the care provider feels that earlier or later admission is indicated, there should be an opportunity to document this at the end of the check list. 

This tool promotes shared decision making between the hospital team and patient. OBI’s hope is this will help both the patient and physicians and/or midwives to confidently and safely delay admission until active labor is established. OBI has offered some resources that are optional for implementation but may help to provide structure for the launch of your program.  These optional resources are the Labor Partnership Worksheet, Coping Scale, timing of admission document, and the triage flow chart available here.

This first year of participation in OBI is about patient and provider education, as well as systems and relationship building.

The OBI Checklist has an emphasis on timing of admission, shared decision making, and support in labor. The Checklist is in Microsoft Word so it can easily be tailored to any institution. The OBI Checklist is adopted from the CMQCC Toolkit to Support Vaginal Birth & Reduce Primary Cesareans Quality Improvement Toolkit.

Watch the Option A: OBI Checklist maternity provider education video.

OBI Checklist slides and webinar on Normal Labor by OBI Co-Director, Elizabeth Langen, MD.

Wondering how to operationalize the OBI Checklist?

See the Implementation Guide.

HOW WILL HOSPITALS REPORT PROGRESS ON IMPLEMENTATION?

The Option A project planning tool was created to assist you in your work.  Your project specific excel document can be used until the registry platform (it is currently being built) is ready to support a similar tracking and reporting tool.  It is meant to be a guide for the planning and implementation of your OBI project, please feel free to edit and re-order as needed. The green cells are suggested items to be working on currently, including goal dates for completion.  We realize the remainder of the project will be managed a bit differently at each site.  Please customize the document according to the needs of your project.

Questions: Contact Clinical Site Engagement Coordinator, Jill Brown, RN at jillbrow@med.umich.edu or (734) 763-2740.

FAQ

Q: How flexible is the OBI Checklist?

A: There is some flexibility to nuance it to your particular hospital, but OBI does not want you to change the checklist so much that its completely different from what we are trying to do. We don’t want you to lose the main essence of it. While the goal is to provide consistent care to all women, the checklist is not intended to override clinical judgement.  If the care provider feels that earlier or later admission is indicated, there should be an opportunity to document this at the end of the check list. 

Q: Who completes the checklist? Should it be the resident physician, or should it be someone else on the team?

A: This can be tailored to fit the needs of your hospital. It should be done by the person who decides whether or not someone should be admitted. It may also be the nurses that are actually documenting it. Or talk to your patients about things that could help them cope and also whether or not they can actually implement these coping mechanisms themselves.

Q. Please clarify what is meant by “reassuring fetal testing” – is this reactive NST or BPP > 6?

A: Reassuring fetal testing is to be determined by the standard practice of each institution.  For most institutions that will mean a reassuring NST that is reactive or category 1 if in labor.

Q. What is meant by “coping with contractions?” – Is this using a coping score or yes/no?

A: For coping, OBI recognized that this is a clinical judgement.  OBI suggests using the Robert's Coping with Labor Algorithm© [Fairchild, E. Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility. Midwifery. 2017 Jul;50:208-218. doi: 10.1016/j.midw.2017.03.008. Epub 2017 Mar 16].  

Q. Is this best implemented on patients using chief complaint or would it be used on all unscheduled patients who arrive in OB Triage?

A: This is meant to be used for anyone presenting with a complaint of labor / contractions

Q. Is the expectation that if any one of the check boxes is checked that an absolute admit or discharge decision is made based on that one checkbox?

A: These check boxes are meant to be a guideline to be sure that all the relevant clinical information is considered prior to not recommending admission to labor and delivery.  If all are checked, the patient is a candidate for discharge.  If some are un-checked, the provider will need to use her or his judgement.  The goal is safely delay admission in early labor.

Questions?

Contact Clinical Site Engagement Coordinator, Jill Brown, RN at jillbrow@med.umich.edu or (734) 763-2740.