miscarriage-what instructions/support do your pts get?

Altra, BSN, RN · Jun 27, 2013

I'll assume you meant *30,000 patients annually.

My first thought is that if patients are returning to your ED then they're either not clearly being directed to their OB/GYN for follow up care, or they're not going for whatever reason.

Do you think it's a lack of access to GYN care?

There may certainly be room for improvement in the d/c instructions ... but the ED is not the place that's going to exhaustively work up dysfunctional uterine bleeding. We can confirm pregnancy or absence of evidence of pregnancy, rule out or rule in a surgical emergency such as a ruptured ectopic pregnancy, make sure that blood counts are stable, make sure vital signs are stable, and control pain. Further diagnostics & care are really out of the ED realm.

Sassy5d · Jun 27, 2013

In epic, the provider can type in any extra's they would like, that's an option, to get their feedback.

The other day, I was trying to explain to a pt why they should establish, how we can't do test xyz and all they said was 'why'.. I really had to think about that.

At my place, we get a lot of girls who don't go to gyn, they return multiple times during their pregnancy.

Although I think the education may be helpful, I think we're gonna continue to see them, as we can't turn anyone away, and our 'office hours' are convenient. Not that I would want to turn them away.

Ask your social worker too, she may have pamphlets you can copy and hand out with ur instructions for grief ect

TooterIA · Jun 27, 2013

Whoops, I meant 3,000/month.

We tell these patients to establish care with a Ob/Gyn until we are blue in the face, and they just dont. As far as I know, if you call, you can get in for an appointment without problems.

Our providers very rarely type in their own info on EPIC.

Ciale · Jul 10, 2013

Great question. I just had my first threatened abortion patient the other day. When I came to dc her, I went over the instructions and she was shocked by the diagnosis (mainly because the doc never told her what it was) but also because she was very vigilant about her pre-natal care and overall health. She seemed very perturbed that I couldn't tell her why she was bleeding. Just to add onto this post, can anyone recommend some verbiage on how to explain this to a patient? I know that seems like an odd question, but I was really at a loss to come up with a decent way to explain it.

SweetMelissaRN · Jul 11, 2013

Great question. I just had my first threatened abortion patient the other day. When I came to dc her I went over the instructions and she was shocked by the diagnosis (mainly because the doc never told her what it was) but also because she was very vigilant about her pre-natal care and overall health. She seemed very perturbed that I couldn't tell her why she was bleeding. Just to add onto this post, can anyone recommend some verbiage on how to explain this to a patient? I know that seems like an odd question, but I was really at a loss to come up with a decent way to explain it.[/quote']
I always tell them that bleeding while pregnant is ALWAYS considered a threatened abortion because there was no direct cause for the bleeding. I also tell them the diagnosis sounds scarier than it actually is bc bleeding during pregnancy is fairly common, but we only have one diagnosis for that. Usually helps put them at ease

R!XTER · Jul 12, 2013

Great question. I just had my first threatened abortion patient the other day. When I came to dc her, I went over the instructions and she was shocked by the diagnosis (mainly because the doc never told her what it was) but also because she was very vigilant about her pre-natal care and overall health. She seemed very perturbed that I couldn't tell her why she was bleeding. Just to add onto this post, can anyone recommend some verbiage on how to explain this to a patient? I know that seems like an odd question, but I was really at a loss to come up with a decent way to explain it.

One of the docs I work with told me that he always explains to women who are miscarrying that the pregnancy would most likely not have resulted in a healthy baby, that it is the body's natural way of making sure she does not have an unhealthy child etc. Miscarriage is more painful emotionally than physically, so senstivity/compassion is important. I find a lot of women come in because they are under the impression that we can save the baby. It's very hard to explain that there's nothing we can do for them.