Implementing Perinatal Bereavement Care in the Emergency Room · Webinar ‐Implementing Perinatal Bereavement Care in the ER Jill Wilke, BSN‐RN 7. ©2012, Gundersen Lutheran Medical

Webinar ‐ Implementing Perinatal Bereavement Care in the ERJill Wilke, BSN‐RN

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Implementing Perinatal Bereavement Care in the Emergency Room

©2012, Gundersen Lutheran Medical Foundation, Inc.

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Presenter

Jill Wilke, BSN, RNLead Educator and Nursing Systems Specialist

Bereavement Services

Gundersen Health System


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Contact/Clock Hours

Successful Completion

• Register for the webinar• Attend entire educational session• Complete and submit post-test • Complete and submit evaluation

Your contact/clock hour certificate will be emailed to you after you complete the evaluation and post-test.


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Conflict of Interest/Off Label Use

Speakers and planners have an employment relationship with Gundersen Lutheran Medical Foundation, Inc. We are a

provider of the program, but we do not endorse any commercial products in conjunction with this program. Off-

label use of any products will not be discussed.

Planning CommitteeRana Limbo, PhD, RN, PMHCNS-BC, FAAN Jill Wilke, BSN, RN Jennifer Linse, MSW, CAPSWDebbie Schulze, MDiv

Commercial SupportThere is no commercial support for this program.


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Objectives

• Describe how to collect data on the number of miscarriage patients that present to the ER

• Discuss the meaning of an “emotional emergency”

• List two ways to support a woman who leaves the ER to miscarry at home


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Step 1 - Determine the number of miscarriage cases seen in your ER and nationally


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• spontaneous abortion, threatened abortion, or miscarriage

• hemorrhage in early pregnancy

• bleeding during pregnancy

• ectopic or molar pregnancy

(Wittels, Pelletier, Brown, &Camargo, 2008)

70%Nationally vaginal bleeding in early pregnancy accounts for approximately 500,000 ED visits per year

1.6% of all ED visits


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Why Present to the ER?

• Fear

• Lack of access Lack of insurance/inability to pay

No primary care provider

Could not be seen in a timely manner

• Convenience

(Bacidore, Warren, Chaput, & Keough, 2009)


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Step 2 - Gain understanding of what the ER staff does in a shift


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The ER nurse works in a fast paced unit that cares for patients of any age with any disease process (Schneider, Hamilton, Moyer & Stapcyzynski, 1998).

• Sick children• Behavioral health patients• Drug/alcohol dependence

or overdose• Acute MI• Stroke • Trauma• Aneurysm• Orthopedic conditions• Sexual assault• Abdominal pain• Flu-like symptoms• Tooth and eye pain


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Step 3 - Identify interdisciplinary champions who recognize the need for improved care and will assist in staff education


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Step 4 - Begin education

• Appreciating what an emotional emergency is to a family


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“Loss of a Baby” - 75%vs.

“Part of Life” - 25%

(Limbo & Wheeler, 1986; Limbo & Kobler, 2010)


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Emotional Emergency

“If the staff viewed miscarriage as a death, then

maybe it would be taken more seriously.”


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Emotional Emergency

• The emotional impact of miscarriage is underappreciated by care providers (Lok & Neugebauer, 2007).

• Women and their families repeatedly report dissatisfaction with emotional support when cared for in the ER after a pregnancy loss (Covington & Rickabaugh, 2006).


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Step 5 – Utilize the power of the human story


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Katie’s Story


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.©2012, Gundersen Lutheran Medical Foundation, Inc.

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Step 6 – Standard of Care/Standard Operating Procedure


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Perinatal Death SOP©2012, Gundersen Lutheran Medical Foundation, Inc.

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Families appreciate being offered the opportunity for: A naming or blessing ceremony

Photographs (must have a signed consent)

Holding


Respectful Disposition

• Gundersen Health System has an annual burial service for all POC < 20 weeks

• Families who miscarry at home can return the container given to them for genetic testing or for the burial service

• Label the container as you would any other sample in your facility and have the family return the container

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Hospital Burial Service 24



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Step 7- Identify and Address Barriers


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Barriers

• Patient support in the waiting room

• Awkwardness during transport to and from ultrasound

• Who should provide written miscarriage information?

• Are literature and supplies given to patients with threatened miscarriages?

• Access to respectful disposition information for staff


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Triage and Waiting

Involve the Interdisciplinary Team


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Transport to and from US

Communication


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Written information

Social Worker or Nurse


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Threatened Miscarriage

• Ask

• Allow for family to come back

• Have a family member take information/package


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Instructions for Staff

• Website

• Intranet – death process

• Charge nurse notebook


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Conclusion

Seven Steps to Engage staff and implement perinatal bereavement in the ER

1. Determine the number

2. Gain understanding

3. Identify interdisciplinary champions

4. Begin education – appreciating emotional emergency

5. Utilize the power of the human story

6. Standard of Care/SOP

7. Identify and address barriers


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Questions?©2012, Gundersen Lutheran Medical Foundation, Inc.

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Thanks for joining us©2012, Gundersen Lutheran Medical Foundation, Inc.

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www.bereavementservices.org

Be sure to “Like” us

References

• Bacidore, V., Warren, N., Chaput, C., & Keough, V., A. (2009). A collaborative framework for managing pregnancy loss in the emergency department. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38, 730-738. doi: 10.1111/j.1552-6909.2009.01075.x

• Covington, D. & Rickabaugh, B. (2006). Caring for the patient with a spontaneous abortion. Journal of Emergency Nursing. (32) 6, 513-515.

• Limbo, R., & Kobler, K. (2010). The tie that binds: Relationships in perinatal bereavement. MCN, The American Journal of Maternal Child Nursing, 35(6), 316-321. [CE: 322-323].

• Limbo, R. K., & Wheeler, S. R. (1986). Women’s response to the loss of their pregnancy through miscarriage: A longitudinal study. Forum Newsletter, 10(4), 4-6.

• Wittels, K., A., Pelletier, A., J., Brown, D.,F., M. & Camargo, C., A. (2009). United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003. American Journal of Obstetrics & Gynecology, 523.e1-523.e6.


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Implementing Perinatal Bereavement Care in the Emergency Room · Webinar ‐Implementing Perinatal Bereavement Care in the ER Jill Wilke, BSN‐RN 7. ©2012, Gundersen Lutheran Medical

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