2/12/2018 1 Women`s Health Symposium February 9 th , 2018 1 France Morin, RN, BScN, MScN Perinatal Consultant Champlain Maternal Newborn Regional Program (CMNRP) At the end of this session, you will be able to: • Describe the methodology used to develop the new evidence- based recommendations. • Provide an overview of the new evidence-based recommendations. • Apply the recommendations in your practice when caring for families experiencing an early pregnancy loss in the Emergency Department. • Discuss current services available for early pregnancy losses in tertiary hospitals within our region. 2 1. Project Overview 3 4 • Develop recommendations for ED healthcare providers and staff regarding the provision of compassionate care to patients presenting with a confirmed early pregnancy loss (less than 20 weeks gestation). • Develop tools / reference materials for ED health care providers and staff • Early pregnancy loss: < 20 weeks gestation - Recommendations may be applicable to other settings that care for late pregnancy loss and infant death • Out of Scope: medical management, educational materials 5 • While 25,000 patients in Ontario attended an ED experiencing a pregnancy loss in 2015, this however represents less than 1% of ED all visits – ED healthcare providers and staff may not have a lot of experience dealing with pregnancy loss. • The medical management of pregnancy loss may be familiar practice, however, the way in which psychological and emotional support should be provided is not. • Significant barriers include inexperience with, and the lack of knowledge of perinatal bereavement care strategies and communication skills. 6
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1. Project Overvie · • Pregnancy Loss and Infant Death Alliance (PLIDA) • Sands –Stillbirth and Neonatal Death Charity 14 • Policies, brochures and any materials currently
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2/12/2018
1
Women`s Health Symposium
February 9th, 20181
France Morin, RN, BScN, MScNPerinatal Consultant
Champlain Maternal Newborn Regional Program (CMNRP)
At the end of this session, you will be able to:
• Describe the methodology used to develop the new evidence-
based recommendations.
• Provide an overview of the new evidence-based
recommendations.
• Apply the recommendations in your practice when caring for
families experiencing an early pregnancy loss in the
Emergency Department.
• Discuss current services available for early pregnancy losses in
tertiary hospitals within our region.
2
1. Project Overview
3
4
• Develop recommendations for ED healthcare providers and
staff regarding the provision of compassionate care to
patients presenting with a confirmed early pregnancy loss
(less than 20 weeks gestation).
• Develop tools / reference materials for ED health care
providers and staff
• Early pregnancy loss: < 20 weeks gestation
- Recommendations may be applicable to other settings that care
for late pregnancy loss and infant death
• Out of Scope: medical management, educational materials
5
• While 25,000 patients in Ontario attended an ED
experiencing a pregnancy loss in 2015, this however
represents less than 1% of ED all visits – ED healthcare
providers and staff may not have a lot of experience
dealing with pregnancy loss.
• The medical management of pregnancy loss may be
familiar practice, however, the way in which psychological
and emotional support should be provided is not.
• Significant barriers include inexperience with, and the lack
of knowledge of perinatal bereavement care strategies and
communication skills.
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2/12/2018
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Name Title/ Position Organization
Doreen Day Senior Program Manager Provincial Council for
Maternal and Child Health
Olha Lutsiv Program Analyst Provincial Council for
Maternal and Child Health
France Morin Perinatal Consultant Champlain Maternal
Newborn Regional Program
Laura Zahreddine Masters of Nursing Candidate Health Quality Ontario
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The Project Team was supported by an Expert Advisory Panel.
Role of the Expert Advisory Panel included:
• Guiding the development of the recommendations/ materials
• Providing content expertise
• Providing feedback on the recommendations and materials created
• Acting as a liaison between the project team and experts in the field, when required
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Name Title/ Position Organization Sonia Baruzzo Social Worker (Obstetrics); Patient Advisor The Ottawa Hospital
- Canadian Perinatal Programs Coalition (CPPC) Listserv
- Maternity Care Discussion Group (MCDG) Listserv
- Canadian Association of Perinatal and Women’s Health
Nurses (CAPWHN) Listserv
- BestStart Listserv
- ER and OB Social Workers and Educators across Ontario
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Objective: to better understand the experience of families who
had received care for an early pregnancy loss in an ED
Approach:
• mixed quantitative and qualitative online survey
• distributed via Facebook, Twitter, PCMCH website
• survey open for 2 weeks in March
• Eligibility:
- ectopic pregnancy or pregnancy loss <20 weeks in the last 12 months
- received care for the pregnancy loss in an ED in Ontario
• thematic analysis of qualitative data
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N = 52 participants
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East (e.g., Ottawa, Kingston, Peterborough)
Greater Toronto Area (e.g., Toronto, Peel)
North (e.g., Thunder Bay, Sudbury, Parry Sound)
West (e.g., London, Hamilton, Waterloo, Niagara, Brant)
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2/12/2018
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0
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The themes that emerged about what families want, include:
• Empathy –acknowledgement of feelings of loss and emotional pain; extra sensitivity in communication, language (e.g., “baby”), and overall provision of care (e.g., ultrasound)
• Information – options and risks/benefits (e.g., D&C); what to expect and next steps; follow-up care
• Referrals – social worker, spiritual care, mental health services, support groups
• Timeliness – communication of diagnosis; frequent checks/ not being left unattended for long period of time
• Privacy– not being forced to wait for the diagnosis in the main waiting area; privacy
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3. Recommendations
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28 Recommendations:
1. Environmental Considerations (1)
2. Communication Strategies & Considerations (5)
3. Cultural, Religious & Spiritual Considerations (1)
4. Informational Needs (4)
5. Psychological Needs & Supports (5)
6. Memories & Mementoes (3)
7. Disposition of Fetal Remains (5)
8. Discharge Considerations & Follow-up (3)
9. Training & Support of Healthcare Providers and Staff (2)
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Recommendations are available on the PCMCH website (http://www.pcmch.on.ca/health-care-providers/maternity-care/pcmch-