Safety and Risk Management Tools and Strategies

Safety and risk management tools and strategies are provided to customers as part of their on-site safety and risk management assessment; however, the tools and strategies are available on an individual basis as well, without the need to purchase the assessment service. Tool bundles are also available.

• Procedure-Specific Informed Consent Forms for Obstetrics and Gynecology
• Ob-Gyn Prenatal Care Bundle
• Shoulder Dystocia Tools and Strategies Bundle
• Shared Decision-Making Tools and Strategies
• Additional Tools, Forms and Strategies
• Additional Documentation, Tools and Forms
• Lab Testing Tracking Bundle
• Telephone Tools, Forms and Strategies Bundle
• Wait Time Bundle
• Guidelines, Policies and Procedures – Templates
• Five-Star Service Excellence Tools for Enhancing Employee Commitment

Certain tools will require a licensing agreement, which will allow the purchaser to photocopy, scan or retype the tool(s) or form(s) that you purchase from OB Consult under the terms of the licensing agreement. The license is in effect for two years from the date you receive the forms. During the two year period, you will receive new copies of the tool(s) or form(s) if they are updated by OB Consult. The licensing agreement fee is dependent on the number of users of the tools/strategies. All tools and strategies are protected by copyright.

Procedure-Specific Informed Consent Forms for Obstetrics and Gynecology
(*Licensing agreement required)

 Obstetrics

• Amniocentesis
• Amniotomy
• Application of internal fetal and uterine monitors
• Augmentation and induction of labor
• Cesarean hysterectomy, cesarean section
• Cerclage Cervical biopsy or conization of cervix in pregnancy
• Circumcision of newborn
• External version of breech
• Manual removal of placenta, uterine curettage
• Normal spontaneous vaginal delivery
• Obstetrical diagnostic procedures, including ultrasonography and other relevant imaging techniques
• Operative vaginal delivery (including the use of obstetric forceps and/or the vacuum extractor)
• Performance of breech and multi-fetal deliveries
• Pudendal and paracervical blocks
• Repair of fourth-degree perineal lacerations or of cervical or vaginal lacerations
• Vaginal birth after previous cesarean section
  

Gynecology

• Adnexal surgery, including ovarian cystectomy, oophorectomy, salpingectomy, and conservative procedures for treatment of ectopic pregnancy aspiration of breast masses
• Cervical biopsy, including conization
• Colpocleisis
• Colpoplasty
• Colposcopy
• Cystoscopy as part of a gynecological procedure
• Diagnostic and therapeutic dilation and curettage
• Diagnostic and operative laparoscopy (other than tubal sterilization)
• Endometrial ablation
• Laparotomy (other than tubal sterilization)
• Hysterectomy, abdominal and vaginal, including laparoscopically assisted
• Hysteroscopy, diagnostic or ablative, excluding the use of the resection technique
• Myomectomy, abdominal
• Operation for treatment of early-stage carcinoma of the vulva, vagina, endometrium, ovary, or cervix
• Operation for treatment of urinary stress incontinence, vaginal approach, retropubic urethral suspension, and sling procedure
• Operation for uterine bleeding (abnormal and dysfunctional)
• Operations for sterilization (tubal ligation, transcervical sterilization [determine whether core or non-core])
• Operative management of pelvic pain
• Diagnosis and management of pelvic floor dysfunction, including operations for its correction (e.g., repair of rectocele, enterocele, cystocele, or pelvic prolapse) uboplasty and other infertility surgery (not microsurgical)
• Uterosacral vaginal vault fixation, paravaginal repair
• Uterovaginal, vesicovaginal, rectovaginal, and other fistula repair
• Vulvar biopsy
• Vulvectomy, simple
  

Ob-Gyn Prenatal Care Bundle
(*Licensing agreement required)

• Prenatal Patient Questionnaire
• Provider Prenatal Care Checklist
• OB Education Log
• Prenatal Genetic Screening Form
• Smoking History Form
• Alcohol Consumption During Pregnancy
• Nutrition Questionnaire
• New OB Patient Checklist
• Kick Count Card
• Diabetes Questionnaire
• Diabetes Checklist
  

Shoulder Dystocia Tools and Strategies Bundle
(*Licensing agreement required)

• Antepartum Shoulder Dystocia Clinical Risk Assessment – Tool for Ob-Gyn
• Patient Acknowledgement Form
• Shoulder Dystocia Documentation Form
• Adverse Event Documentation Form
  

Shared Decision-Making Tools and Strategies Bundle
(*Licensing agreement required)

• Anti-Abandonment Letter (Failure to Follow Treatment Plan)
• Anti-Abandonment Letter (Failure to Pay)
• At Risk Letter Templates
• Guidelines for Providing Written Discharge/After Care Instructions
• Terminating the Physician-Patient Relationship Policy
• Patient Educational Materials/Brochures
• Informed Refusal to Test, Procedure, or Treatment
• Procedure-Specific Informed Consent Form
• Missed Appointment Policy and Procedure
• Scheduling Policy
  

Additional Tools, Forms and Strategies
(*Licensing agreement required)

• Consent for Treatment of Minor Form
• Early Onset Group B Strep (GBS) Documentation Tool
• Gross Placental Examination Form
• Postpartum Depression – Screening Tool and Scoring System
  

Additional Documentation Tools and Forms
(*Licensing agreement needed)

• The New At Risk Letter Templates
• The New Anti-Abandonment Letter Templates
• Emergency Equipment and Medication Check Log
• Informed Refusal to Test, Procedure or Treatment
• Ob-Gyn Office Intake History Form Template
  

Lab Testing Tracking Bundle

• Daily Records of Patient Lab Test (*Licensing agreement required)
• Diagnostic Test Tracking Log (*Licensing agreement required)
• Tracking Referrals and Test Policy
  

Telephone Tools, Forms and Strategies

• Documentation After Hours Calls – Strategies
• Telephone Communication Procedure/Policy
• Telephone Etiquette Audit Tool
• Telephone Etiquette Tips
• Telephone Information Sheet and Sample Telephone Menu
• Telephone Record
  

Wait Time Bundle

• 15 Minute Wait Sign
• Patient Wait Time Sign #2
• Wait Time Audit Tool
  

Guidelines, Policies and Procedures – Templates

• General Chaperone Guideline
• Managing High-Risk Patients Policy
• Cultural Competency/Issues Policy
• Disclosing Medical Errors Policy
• Effective Communication Policy
• Informed Consent and Informed Refusal Policy
• Management of Professional Liability Claims Policy
• Medical Emergencies Policy
• Medication Management Policy
• Missed Appointment Policy
• Patient Complaint Policy and Procedure
• Telephone Communication Procedure/Policy
• Terminating the Physician-Patient Relationship Policy
• Tracking Referrals and Test Policy
  

Five-Star Service Excellence Tools for Enhancing Employee Commitment

• Five-Star Service Attestation for New Employees
• Interview Tools: Sample Scenarios and Open-Ended Interview Questions
• Five-Star Service Excellence Values Statement