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Improved Management of Miscarriage

Tumut District Hospital
Project Added:
9 October 2015
Last updated:
23 October 2015

Improved Management of Miscarriage

Summary

This project created a flowchart to guide clinical staff on the correct procedures for storing, viewing and testing products of conception. Staff education and a new patient feedback process was also implemented.

Aim

To improve the patient experience following miscarriage and ensure correct management of the products of conception (the baby) and storage of these products for pathology.

Benefits

  • Supports patients presenting with miscarriage and improves experience with local health service.
  • Enables correct storage of products of conception, to allow patient viewing and pathology testing if requested.
  • Supports staff with little exposure to miscarriages, especially when there are no midwives on duty.
  • Improves communication between staff on separate shifts, regarding the location of products of conception once the patient is discharged from the emergency department (ED).

Project status

Dates

  • Start: February 2014
  • Finish: December 2014

Status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.

Background

A community member shared her negative experience of the local health service, when she presented with a miscarriage at 12 weeks and wanted to view the foetus. This identified a gap in the service provided to patients who presented with a miscarriage at less than 20 weeks.

Although staff are educated on managing a stillbirth of more than 20 weeks, it is uncommon for patients to present with their products of conception when miscarriage occurs at 12 weeks. Historically, staff did not keep the products of conception when less than 20 weeks. If they did, it was common practice to store those products in formalin, which precludes the ability for chromosome testing. This test is not common practice among visit medical officers, unless the patient specifically requests it.

The policy, procedures and guidelines available to staff did not cover how to manage families’ requests to view a foetus of less than 20 weeks gestation or how to store the products of conception for possible pathology testing. Once a patient was discharged from the ED, a handover was not provided to the next shift about the presentation. As a result, there were communication issues regarding the location of products of conception. It was also found that basic clinical products were not available in the ED for patient comfort following a miscarriage.

Following communication with other rural and remote sites about the patient’s experience at Tumut Hospital, it was identified that issues around the storage, viewing and testing of products of conception at less than 20 weeks were also experienced at other sites. It was clear that a local solution was required to prevent the situation occurring again.

Implementation

  • Consultation took place with many departments within Murrumbidgee Local Health District (MLHD) and metropolitan areas, with research undertaken between April and May 2014 on how to correctly store products of conception so various pathology testing can be attended.
  • A flowchart was developed to assist ED staff manage miscarriages, with clinical support and extensive consultation with the area Clinical Nurse Consultant.
  • Sanitary pads were made available immediately in the ED and an ongoing supply was ensured.
  • The hospital auxiliary continued to provide patient comfort packs for miscarriages.
  • A process was put in place so all products of conception were stored in the pathology fridge.
  • A clinical practice guide for area-wide use is now being developed in consultation with clinical governance, which will further support staff in their practice.
  • Staff education was implemented to:
  • improve their ability to support families when they wished to view their baby, no matter how small it may be
  • demonstrate how to correctly care for stored products of conception and when to check the pathology fridge to determine if a pathology request has been made
  • improve use of the colour-coded chart and Identify, Situation, Background, Assessment and Recommendation (ISBAR) handover
  • improve awareness of resources available to patients, including handouts about when to return if their condition changes.
  • Feedback obtained on the patient’s experience was communicated to other managers in MLHD, so other hospitals could make changes to their practice if the issue was identified as a risk in their facility.
  • Patients presenting with a miscarriage or threatened miscarriage were followed up with a phone call post-discharge, to gain feedback on their experience.

Results

Evaluation of the project took place in December 2014, with the following results.

  • The flowchart assisted with communication issues across shifts, especially when a request for pathology was received on a different shift.
  • Improved staff communication and education on managing products of conception was achieved.
  • Feedback obtained from patient follow-up calls is now presented to staff and at quality meetings.
  • Project results will be provided to the consumer who took the time to tell her story.

Lessons learnt

  • Information on the management and preservation of products of conception for chromosome testing was difficult to find.
  • The process and flowchart is easily transferable to other rural and remote sites.
  • Most hospitals have a hospital auxiliary who can easily be engaged to keep the supply of sanity pads in the ED stocked to ensure patient comfort.
  • Some of the smaller hospitals may only be exposed to this type of presentation once every five years, so the lessons learnt at Tumut will be closely watched.

Contact

Lorraine O’Sullivan
Acting Multi Service Manager, Tumut Hospital
Murrumbidgee Local Health District
Phone: 0428 113 759
lorraine.osullivan@gsahs.health.nsw.gov.au

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