Question Answers/Format Hospital can document IPLARC placement in IT/EMR systems. Does your hospital have IT /EMR revisions Have not started implemented for tracking and Working on it documentation of immediate postpartum In placement of IUDs? 16a. If place,” where does Delivery template Providers IUD “in – documentation occur? Delivery template nurses (check all that – Separate EMR form providers – Separate EMR form nurses – Other: _____________ If place,” which IT / EMR revisions have EMR for consent “In been completed to assure adequate EMR for contraceptive choice counseling, including tracking, and documentation for IUDs IPLARC (check all that apply) sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Does your hospital have IT /EMR revisions Have not started implemented for tracking and Working on it documentation of immediate postpartum In placement of implants? 18a. If place,” where does implant Delivery template Providers “in – documentation occur? (check all that Delivery template nurses – Separate EMR form providers – Separate EMR form nurses – Other: _____________ If place,” which IT / EMR revisions have EMR for consent “in been completed to assure adequate EMR for contraceptive choice counseling, including tracking, and documentation for implants? IPLARC (check all that apply) Order sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Hospitals have provided education materials for affiliated prenatal care sites and to patients at their hospital during delivery admission Number of affiliated prenatal care sites Number: _______________ Have you provided patient education Yes, one or more materials and counseling protocols and Yes, all process flow for affiliated prenatal care No sites regarding IPLARC, including all contraception options? 21a. If yes, one or more, please specify the Number: _____________ number of affiliated prenatal care centers to whom you’ve provided materials
Question Answers/Format Hospital can document IPLARC placement in IT/EMR systems. Does your hospital have IT /EMR revisions implemented for tracking and documentation of immediate postpartum placement of IUDs? Have not started Working on it In 16a. If “in place,” where does IUD documentation occur? (check all that Delivery template – Providers Delivery template – nurses Separate EMR form – providers Separate EMR form – nurses Other: _____________ If “In place,” which IT / EMR revisions have been completed to assure adequate tracking, and documentation for IUDs (check all that apply) EMR for consent EMR for contraceptive choice counseling, including IPLARC sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Does your hospital have IT /EMR revisions implemented for tracking and documentation of immediate postpartum placement of implants? Have not started Working on it In 18a. If “in place,” where does implant documentation occur? (check all that Delivery template – Providers Delivery template – nurses Separate EMR form – providers Separate EMR form – nurses Other: _____________ If “in place,” which IT / EMR revisions have been completed to assure adequate tracking, and documentation for implants? (check all that apply) EMR for consent EMR for contraceptive choice counseling, including IPLARC Order sets Pharmacy system (acquisition and stocking) Billing system Tracking tools Other: ____________ Hospitals have provided education materials for affiliated prenatal care sites and to patients at their hospital during delivery admission Number of affiliated prenatal care sites Number: _______________ Have you provided patient education materials and counseling protocols and process flow for affiliated prenatal care sites regarding IPLARC, including all contraception options? Yes, one or more Yes, all No 21a. If yes, one or more, please specify the number of affiliated prenatal care centers to whom you’ve provided materials Number: _____________
ILPQC%20IPLARC%20Data%20Form_Paper%20Version_FINAL_8.20.18.docx