Background and Goal of Study: In April 2010 the National Patient Safety Agency (UK) issued an alert highlighting the deficit in preoperative pregnancy checking. They reported 42 unknown preoperative pregnancies, 3 resulting in post-operative abortions.
The alert recommends the following be in place by 28/10/10:
1. Pregnancy checking immediately pre-operatively
2. Recording the check on pre-operative documentation.
3. Robust reporting of incidents where pregnancy checks have not happened and any associated actions that may come from this.
Goal: To audit performance of pregnancy documentation against the standards set by the NPSA.
Materials and Methods: The first audit was performed in April and May 2010 after which a form was introduced for patients to self-report pregnancy status and consent for a pregnancy test. The reaudit was carried out in October 2010. In each audit data from 100 female patients aged 16-50 having non-gynaecological surgery was collected. We looked at documentation of whether the patient had been asked if they were pregnant in preassessment, pregnancy testing, LMP, contraception and whether all of this was done less than 5 days preoperatively.
Results and Discussion: The results showed that 62% of women were asked if they were pregnant in the first audit and 78% in the second. Documentation of pregnancy testing was 3% in the first audit and 9% in the second, LMP 62% in the first, 76% in the second, contraception 15% in the first and 49% in the second. 47% had their pregnancy check >5days preoperatively in the first audit, 52% in the second.
Recommendations being introduced following the second audit include changing the anaesthetic chart to add a section to prompt the anaesthetist to ask about pregnancy. Others being considered include adding pregnancy status to the WHO surgical checklist as well as introducing a universal pregnancy testing policy; however the cost and ethical concerns for the latter will need further review.
A clear definition of what a makes an adequate preoperative pregnancy status check would help in assessment and achievement of standards as well as reducing interhospital variability.
Conclusion: Preoperative pregnancy checking should have 100% compliance and by those standards our current systems fall short. Further improvement is expected following implementation of the new recommendations.
NPSA. Rapid response report. Checking pregnancy before surgery. NPSA/2010/RRR011. 28/4/2010.