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Transcript of 1. Project .• Pregnancy Loss and Infant Death Alliance (PLIDA) •...

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.

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1. Project Overview

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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

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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

Nadine Duhil-Enns Midwife Family Midwifery Care

Josh Gohl Registered Nurse (Emergency Department); Patient Advisor Guelph General Hospital

Batya Grundland Family Physician; Maternity Care Lead for Family Practice Obstetrics Women's College Hospital

Terri Irwin Director, Quality Standards Health Quality Ontario

Kate MacWilliams Registered Nurse (Emergency Department); Clinical Educator St. Josephs Health Centre Toronto

Barbara Matteucci Founder of Butterfly Run Quinte; Doula; Patient Advisor Butterfly Run Quinte

Howard Ovens Emergency Physician, Chief of Department of Emergency Medicine Sinai Health System

Gareth Seaward Obstetrician (Maternal-Fetal Medicine Specialist); Vice-Chair of Quality

Improvement and Patient Safety in Department of Obstetrics and Gynaecology

Sinai Health System

Elaine Senis Social Worker (Emergency Department) St. Michael's Hospital

Lindsey Sutherland Family Physician (Primary Care, Obstetrics, Emergency Medicine, Hospital

Medicine)

Chatham-Kent Health Alliance

Heather Tempest Registered Nurse (Labour and Delivery, Early Pregnancy Clinic) North York General Hospital

Melissa Theriault Nurse Practitioner (Emergency Department) Hpital Montfort

Jackie Thomas Obstetrician/ Gynecologist; Founder of Early Pregnancy Clinic Sinai Health System

Catherine Varner Emergency Physician Sinai Health System

Ashley Waddington Obstetrician/ Gynecologist (Early Pregnancy Clinic) Kingston Health Sciences Centre

Jo Watson Nurse Practitioner; Operations Director of Women & Babies Program;

Director of Pregnancy and Infant Loss Network (PAIL)

Sunnybrook Health Sciences Centre

Arthur Zaltz Obstetrician/ Gynecologist; Chief of Department of Obstetrics & Gynecology

and Women & Babies Program

Sunnybrook Health Sciences Centre

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2. Methodology

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1. Literature Review

2. Current Practice Review

3. Patient Engagement Survey

4. Expert Advisory Panel Consensus

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Databases: PubMed, CINHAL, EMBASE, Cochrane Library

Literature obtained from communications and outreach to the field

Qualitative and quantitative studies, position statements from professional organizations, evidence based

practice guidelines

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Total of 142 Articles

Total of 142 Articles

16 Records WITH

Emergency Room

16 Records WITH

Emergency Room

Pregnancy Loss

Pregnancy Loss

BereavementBereavement

EmpathyEmpathy

126 Records WITHOUT Emergency

Room

126 Records WITHOUT Emergency

Room

Pregnancy Loss

Pregnancy Loss

BereavementBereavement

EmpathyEmpathy

Examples of guidelines used:

National Perinatal Association (NPA)

The National Institute for Health and Care Excellence (NICE)

The Society of Obstetricians and Gynaecologists of Canada (SOGC)

Queensland Clinical Guidelines (QCG)

American College of Obstetricians and Gynaecologists (ACOG)

Canadian Paediatric Society (CPS)

Pregnancy Loss and Infant Death Alliance (PLIDA)

Sands Stillbirth and Neonatal Death Charity

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Policies, brochures and any materials currently used in EDs were sought out through outreach to:

- LHIN Leads

- TC LHIN ED Leads

- PCMCH Maternal Newborn Advisory Committee (MNAC)

- Canadian Perinatal Programs Coalition (CPPC) Listserv

- Maternity Care Discussion Group (MCDG) Listserv

- Canadian Association of Perinatal and Womens 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

2/12/2018

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0

7

7

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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-

strategies-and-initiatives/early-pregnancy-loss-emergency-department/)

4. Tools and Resources

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2/12/2018

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1. Summary of Recommendations

2. Bereavement Checklist

3. Communication Strategies for Breaking Bad News

4. Communicating with Families Experiencing a Pregnancy Loss

5. Bereavement Package and Mementoes

6. Normal Grief Response

7. List of Pregnancy Loss Resources for Families and Healthcare

Providers

8. Discharge Teaching for Patients Experiencing an Early

Pregnancy Loss

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27 28

29 30

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31 32

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Recommendations and tools are available on

the PCMCH`s website:

www.pcmch.on.ca

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5. Dissemination

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1. Social Media Facebook, Twitter, PCMCH

Website

2. Conferences (CAPWHN)

3. ED LHIN Leads

4. Professional Associations

5. Regional Maternal Child Networks

6. Obstetrical and ED Educator List Serve

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2/12/2018

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6. Implementation

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The MOHLTC has supported the Pregna