Barriers and Facilitators to Implementing One Key Question® in a Midwifery Practice within a University Health System

POSTER

Barriers and Facilitators to Implementing One Key Question® in a Midwifery Practice within a University Health System Krista Labbe, Rachael Hemmert, Nickee Palacios, Susan Dearden, Sara Simonsen Key Findings: Among women’s healthcare providers within the University of Utah health system, the most significant facilitator to pregnancy intention screening was inclusion in the electronic medical record and the most significant barrier was lack of time. Background Results •1/2 of all births and about 1.2 million abortions result from unintended pregnancies in the US each year •Utah Statistics: •38% of pregnancies unplanned or mistimed •79% of women did not receive a medical care regarding preconception prior to getting pregnant •Unintended pregnancies are associated with poor health outcomes such as preterm birth •One Key Question (OKQ)® developed by Oregon Foundation for Reproductive Health (OFRH) to provide a systematic way for clinicians to support reproductive intentions • In 2017, midwives working within the University of Utah health system saw 4,827 patients of reproductive age •Training: 18 CNM, 11 OB/GYN •Interviews: 11 MA, 5 CNM, 4 Key Stakeholders •Interview/focus group themes: •Strong MA support for OKQ implementation •Providers concerned for feasibility of implementation system-wide due to other competing priorities •Key stakeholders focused on EMR limitations •Integration into EMR identified as the most important tool to facilitate implementation by all staff positions. •Challenges identified with finding optimal place in integrate into the EMR and also with training other staff outside of the women’s health specialty •Statistically significant change in knowledge (p=0.04) and borderline significant change in confidence in implementing pregnancy intention screening (p=0.007) after education session •Training needs: Information about how to address pregnancy intention with adolescents and their parents •Additional languages identified as priority for education material: Spanish and Arabic AIM Understand barriers and facilitators to OKQ implementation into a Midwifery practice in order to develop an effective implementation plan Methods • Current practice patterns assessed: Data pull and Key Stakeholder interviews with clinic managers and practice directors • Training with pre/post knowledge and confidence assessments of Certified Nurse Midwives (CNM) • Surveys and audio-recorded interviews with medical assistants (MA), CNMs, OBGYNs, and clinic managers assessed practice patterns, barriers, and facilitators • $25 gift cards provided to participants • IRB approved and funded through Utah March of Dimes Community Grant • Statistical analysis included descriptive analyses of survey responses, and analysis of interview transcripts for key quotes • Changes in knowledge and confidence of pre/post tests were assessed using the Wilcoxon Sign Test Conclusions • University of Utah midwifery practice presents the opportunity to ask nearly five thousand women about their reproductive intentions each year • Women’s health care providers are discussing reproductive intentions, but there is no standard method to conduct or document counseling • Although the focus was implementation within a Midwifery Practice, as part of a University Health System, a multi-disciplinary approach is imperative. • Integration into the EMR will be key to the success of implementing routine pregnancy intention screening COLLEGE OF NURSING