The dreaded pregnancy test

NurseVoldemort, BSN, RN · Jun 22, 2011

OK here what i do not get the last time I was in the ER they walk in and told me they where going to do a pregnancy test, I told them there was no way in #### I that I could be pregnet , WHY because I cannot have kids , have an IUD to try to stop my bleeding , and Oh I am a virgin !!!!! and I did not want one and and did not want to pay $150 .00 for one I did not need .
At this point they first froze in place because of the virgin thing and then I was told it did not matter that it was mandatory !!!

Well believe it or not... Patients lie... A LOT!

So, we can't just take someones word for it... and BTW - I know THREE women PERSONALLY that got prego with TWINS with an IUD in place.... IT wouldn't mean a lot to me either... I'd still do it! I'm not concerned about your cost, I'm concerned about my license... Sorry but that's just how it is.

NurseVoldemort, BSN, RN · Jun 22, 2011

Likely because the mIU sensitivity for dollar store brands is a lot less than others. You could be waiting an extra week or more to be testing "with confidence" compared to more sensitive (and thus more expensive) tests.

Actually - the $1 ones I bought for myself, are 10 mIU, the First Response are 25mIU... so IT's MORE sensitive AND cheaper! People just think like you do... so they THINK that it's more accurate because no one wants to take the time to research or read a #$&%ing label! All you're paying for on the expensive ones are the nice plastic covering as compared to a flimsy peice of cardboard (Alot like the urine dip sticks in the ED)

brillohead, ADN, RN · Jun 23, 2011

How does an IUD help stop bleeding?

The Mirena IUD may cause amenorrhea in some women.

Actually, I'd word it a lot differently than "may cause" - in actuality, the Mirena will often (not always, but more often than not) result in amenorrhea. Of a dozen friends who have used it, 11 stopped getting their period and the 12th had a drastic reduction in her period (like going from almost-hemorrhaging prior to Mirena to heavy-spotting after Mirena).

For those not familiar with it, it's impregnated (no pun intended!) with levonorgestrel, which is released into the uterus over the course of 5+ years. (It's only licensed for 5 years by the FDA, but I've had mine for 8 years now and still no periods.)

Roy Fokker, BSN, RN · Jun 28, 2011

Roy's ED preceptor's rule: "All females of child bearing age are assumed to be pregnant until proven otherwise".

Therefore: "If you're a female of child bearing age, pee in a cup".

I've personally had one case of "immaculate conception" - and once is enough. Believe me, the amount of paperwork I had to do for that one incident converted me.

How can they not know?

Well denial is a biggie.

And also sometimes, things just work out that way: I knew this girl when I was in nursing school. Who suddenly found out she was 8 months pregnant and was contracting. Through her tears she realized that it must've happened at "that party" ... the same one where she couldn't remember where she went or how she got home [i.e. drugged and raped] Uncomplicated labor, healthy baby - but she had to drop out of her engineering program because of her new responsibilities.

Everywhere I have worked, even the appearance of the slightest suggestion that care would be better provided elsewhere before the medical screening exam has been considered an EMTALA no-no.
Seriously -- this is a BIG deal, and it drives a great deal of ER operations.

Which is why questions about insurance etc. are asked after triage and pt. registration is a two step process.

cheers,

ErinBSN · Jul 4, 2011

Off subject but I have a quick story (rant) about this. My sister who was pregnant and out of state went to a hospital for pregnancy complications. The hospital she went too had no L&D but she had no way of knowing that....she just googled the nearest hospital and went there. So, she sees the triage nurse waits about 10 min to be seen and is promptly told they can do nothing for her but transfer her to the hospital about 3 blocks away. My sister (very upset at this point for having to wait to be seen at a hospital who could do nothing for her but transfer her) throws a royal fit that no one informed her she was at a facility that could not handle this type of emergency and that she wasted precious time waiting (in the time it took for her to register, and see the triage nurse she could have walked to the other hospital) to be told that nothing could be done for her there. Then about a month later when she got the bill another fit ensued. I can't say I blame her why couldn't the triage nurse have told her that there was no L&D there? After many angry phone calls and threat of legal action my sister got out of paying the bill....I have never worked in the ED and I am from a very small town so my understanding of this is pretty limited but the whole ordeal just seemed so nonsensical to me.

We have no L&D in my ED. We're ambulatory, we have no surgery, no respiratory nothing. We don't have vents. if someone codes, we bag until we can get them transferred. We were told that we still fall under EMTALA. So, if someone comes in and I say, We don't have L&D here, we could be sited for a violation. We can say and do say "If there is a complication with the pregnancy that requires L&D and further evaluation you will be transported via ambulance to the closest facility with L&D capabilities" The majority of the patients say "Okay" Once in a while people will go No, I'm leaving than they go in as either LWBS or elopement and we no charge them.

I feel bad for your sister, but Unfortunately it's a catch 22. We have a delivery kit and a warmer. If we HAD to, we could deliver. Just like we get a patient in having a STEMI we initiate treatment and get them transported for Cath Lab at another hospital ASAP.

One of our other facilities is just like us and accepts ambulances. We are not at this time. It is up in the fence if we would. From what I am understanding Ambulatory ED's are the new wave of emergency medicine and it's supposidly kicking in across the country. I've been here almost 5 years. I came from a busy ED, I like where I'm at but I think we get a tad complacent, we don't expect the trauma to walk through, the MI's the strokes, the laboring patients. It happens more and more. We're starting to see drop and dash trauma (such as we just found this guy and he's got a bullet in his arm) but for the most part we're pretty cut and dry easy things.

So While I feel bad for your sister, I just have to defend the ED, as it's not always so straight forward, there is not always a clear answer to why things are done, but unfortunately regulations have to be followed.

Also, if the triage nurse eyeballed (triaged etc, ) the patient and they were in no distress, it's all any triage nurse can do. Sometimes unfortunately our first impression is not always right.

mwboswell · Jul 5, 2011

Agreed. DH is a rad tech, and he gets to ask the uncomfortable questions all the time to girls with their moms there. Moms usually get pretty upset and think he's a pervert. Fortunately, DH is very diplomatic and explains quickly WHY they have to do a UPT on a 9-year-old. But he had one former co-worker who worded the question badly (co-worker was also male): "So, have you had sex?" Mom didn't like that one so much; she thought it was a pick-up line.
We standardly test every female who has reached puberty age, unless she is critical and cannot wait for a UPT. We never ask if they're a virgin, partially because it seems that some people don't get basic biology. My roommate in college, for example, did not account for the fact that there are highly-motivated swimmers who will take advantage of any opportunity to fertilize. :smackingf

Ditto - same goes for the O.R.

No neg preg in a cup - no surgery, period.

caregiver1977 · Jul 10, 2011

So a few days ago...pt checks in during the middle of a very busy day... Her CC: "Need pregnancy test"
The MD (a non-nonsense doc) goes in to see the pt. Conversation as follows:
Doc: Do you smoke?
Pt: Yes
Doc: Do you have cigarettes now?
Pt: Yes
Doc: Then you have the money to go to the dollar store and get a pregnancy test. I'll get your discharge papers ready.
Love it!

I know this is old, but she could get a free test at her local crisis pregnancy center (they usually advertise in the classifieds or their number is in the phone book). Heck, if you get the people to like you at your local state health department (or give them a sad enough story) they will do it free. :idea:

Good grief Charlie Brown! :uhoh3:

caregiver1977 · Jul 10, 2011

Likely because the mIU sensitivity for dollar store brands is a lot less than others. You could be waiting an extra week or more to be testing "with confidence" compared to more sensitive (and thus more expensive) tests.

Many of those good, more expensive test at your local drug store is about $8 to $10 bucks. As chronically broke as I am I can afford that.

Maybe these people want an official test from a health care facility so they can have it with their Medicaid paperwork? Even then they could STILL go to the health dept. or a crisis pregnancy center.

SneakySnake · Jul 10, 2011

We can say and do say "If there is a complication with the pregnancy that requires L&D and further evaluation you will be transported via ambulance to the closest facility with L&D capabilities" The majority of the patients say "Okay" Once in a while people will go No, I'm leaving than they go in as either LWBS or elopement and we no charge them.
So While I feel bad for your sister, I just have to defend the ED, as it's not always so straight forward, there is not always a clear answer to why things are done, but unfortunately regulations have to be followed.
Also, if the triage nurse eyeballed (triaged etc, ) the patient and they were in no distress, it's all any triage nurse can do. Sometimes unfortunately our first impression is not always right.

I hope it didn't come across as me bashing the ER! I think the above quote is great too and a good way to handle it. I am actually glad to have an answer and I have shared this thread with her.

2bnurseforce1 · Jul 10, 2011

Love it. I work in a ED and see that type of stuff all the time, I wish the doctors at my hosptial would tell them that.

lrobinson5 · Jul 10, 2011

I know this is old, but she could get a free test at her local crisis pregnancy center (they usually advertise in the classifieds or their number is in the phone book). Heck, if you get the people to like you at your local state health department (or give them a sad enough story) they will do it free.
Good grief Charlie Brown!

I wouldn't recommend anyone to a crisis pregnancy center. I would definitely point them towards a planned parenthood. They have actual counselors that listen to you, not wave propaganda in your face and shame you in to a decision.

Although point taken, don't go to an ER and waste emergency resources. There are a dozen places you can go, all you need to do is google it or open a phonebook.