Perinatal Loss in the Emergency Department

Abstract

Session C presented Thursday, September 27, 1:00-2:00 pm Purpose: The aim of this MSN capstone project was to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives were to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The basis of the project formed recently developed multidisciplinary guidelines for care of women and families presenting to the emergency department with actual or threatened miscarriage. Design: This capstone project was implemented in the form of a voluntary educational presentation, which described the development of a position paper on the care of pregnancy loss in the ED and suggestions for implementation of some of the multidisciplinary guidelines posted in the paper and translation into best practices. Setting: The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. Implementation proved challenging due to an external disaster affecting the hospital. Participants/Subjects: The project was directed toward "champions" among nurses, doctors, care partners, chaplains, and social workers working in the ED. Three social workers, two ED nurses and a chaplain received the educational presentation in the first PDSA cycle. With the feedback of the first participants, the project will be brought to the ED unit council and continually worked on according to department needs with the participation of project "champions." Methods: The implementation method included introductions at shift and unit meetings and delivering an educational module to three social workers, two ED nurses and a chaplain. Using pre-existing materials and staff input, a PowerPoint presentation was created. A pre- and post-intervention questionnaire, and direct informal feedback was used for evaluation of the educational intervention. Results/Outcomes: Questionnaire results and feedback showed an increase in confidence and knowledge levels on and the need for pregnancy loss specific training. All questions showed a post-intervention change. Highest improvement results after education were in the areas of comfort and confidence with the presentation of remains, communication with family, and arranging interdisciplinary care. Implications: Given the positive response to this first PDSA cycle, the recommendation is to continue offering the presentation to ED personnel. ED staff have requested continued educational opportunities with an emphasis on how the guidelines can be applied in daily practice. Unit shared governance, and patient council feedback will also be sought and implemented.