Summary of the example
Miscarriage happens to 1 in 4 pregnancies and about 100 women per month attend the A&E department in Northampton General Hospital each month with either threatened or inevitable miscarriage. At a parent panel for the baby loss charity ‘Saying Goodbye’ the feedback was that pain relief in miscarriage is lacking, which the patients interpret as an absence of care. Anecdotally, the women offered pain relief have less mental health issues post loss. Discussion with prescribers showed that there was reluctance to prescribe for these women as they were unsure what of appropriate choices of medication. A Guideline for Prescribing and Administration of Acute Pain Relief and Anti-emetics in Pregnancy was developed and implemented in Northampton General Hospital.
Why we think it’s important
Pain relief choices for a non-pregnant patient seem simple to prescribers but when a pregnancy is involved this adds a complication. This guideline was developed due to the lack of pain relief given to women at various gestation losses but it also covers the pregnant patients who attend for non-pregnancy related pain problems. There is information available nationally but in the high pressured Emergency Department (ED) environment it is often overlooked unless presented in a simple way. Anti-emetics were included in this guideline for this reason.
Women also fed back that they were nervous of taking pain relief as they were still hoping for a successful pregnancy, so it was important to develop any guideline to look at the safest medication available for each stage of viable pregnancies. It is important that the care provided for patients, as much as possible, does not impact negatively on their future mental or physical health and providing pain relief choices with acute pain in pregnancy could ensure this.
Learn more about the example
Aims and objectives of the work
To improve the management of acute pain in pregnant women within the ED with new guidelines Objectives include:
- Developing pain in pregnancy guidelines and easy to use resources for the healthcare professionals working in ED
- Develop and provide training to the Obstetrics and Gynaecology teams
- Measure change with regards to appropriate pain relief
The notes of pregnant women attending A&E with PV bleeding or other conditions (including non-pregnancy related issues) at NGH were audited over 1 week at three stages:
- Baseline (Pre-guideline launch) June 2018
- Post-guideline launch December 2018
- Following additional multidisciplinary team training February 2019
Data collection reviewed pain scores and whether these were acted on appropriately.
Staff involved in the development of the guideline included the midwifery staff, bereavement midwives, Obstetrics and Gynaecology Consultant and Emergency Department Consultants. The training was given to the Obstetrics and Gynaecology medical staff, Emergency Department doctors, nurses and healthcare assistants.
A total of 84 patients were audited at three stages. The gestation ranged from 3 weeks to 27 weeks.