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The hidden foetus
BJOG: An International Journal of Obstetrics and Gynaecology ; 129:179, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1956666
ABSTRACT

Objective:

Healthcare teams often forget the possibility of pregnancy when fecund women present for non-obstetric problems. In this patient group, routine pregnancy tests are often omitted and related documentation is missing. This patient safety issue was further highlighted by an anecdotal story when a surgical procedure was performed and mid surgery a pregnancy was identified. Prior to our intervention, simple point of care testing was limited to the emergency department. At ward level, pregnancy tests could only be performed using blood serum. Also, the admission forms did not specifically ask to exclude a pregnancy.

Design:

We reviewed whether all female surgical admissions of childbearing age underwent pregnancy testing. A baseline audit highlighted the need to introduce point of care pregnancy kits on the surgical ward. The initial audit was presented to surgical and anaesthetic departments. In collaboration with management, funding was secured to provide pregnancy kits for the surgical wards and the admission protocol was changed accordingly.

Method:

The project was completed over a period of 19 months (delayed by Covid). The base-line data collection was from November to December 2019 with presentation of the results in December 2020. Introduction of pregnancy kits in April 2021 and follow-up data collection in May to June 2021. A total of 159 case notes were reviewed using the hospital patient information system named 'Portal'. In the baseline survey, 86 case notes were screened for pregnancy tests and whether the findings were documented. After the introduction of pregnancy kits, the survey was repeated involving 73 women. The mean age was 32 with a range from 17 to 52 years of age.

Results:

Results were obtained retrospectively using the Portal system to screen for pregnancy tests (urine/serum β-HCG), any radiation exposure and surgical intervention. In 2021, prior to intervention, 75% of fecund patients were exposed to radiation and 95% underwent surgery without pregnancy testing. In 2021 the rates dropped to 32% for radiation exposure and surgery without pregnancy testing to 27%. Overall pregnancy testing in fecund women for surgical admission improved to 60%.

Conclusions:

Omitting pregnancy tests and subsequent documentation could be due to time pressures in particular during same day admissions. The remaining 40% could be captured by using a computer-based admission protocol which prompts the health care staff to undertake a pregnancy test, but adds more complexity to an already busy surgical admission ward.
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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Idioma: Inglês Revista: BJOG: An International Journal of Obstetrics and Gynaecology Ano de publicação: 2022 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Idioma: Inglês Revista: BJOG: An International Journal of Obstetrics and Gynaecology Ano de publicação: 2022 Tipo de documento: Artigo