Jamie - great idea to have guielines on such subjects. Also may well be of
benefit to establish how one's department complies with such guidelines at
the same time you set them, through audit, or you may end up proving that
something IS worth doing and at the same time find that it is not being done
despite your guidelines, say for reasons such as lack of staffing or staff
time at Triage or use of "agency" staff who are not familiar with all the
information you have worked hard to gather and formulate.
I think you might do well to separate the issue of who needs Beta-HCG from
the A&E point of view and the X-ray point of view. As far as radiology - you
already have a few replies on the list and the Royal College of Radiologists
has more advice (see web site).
A completely different matter is the question of abdo pain and the need for
testing, but I believe the list's very positive reply is already in clear
view (although there will be more replies on this, I bet). Recent OSCE
presentations and, before that, my own teaching and learning experiences
have taught me that you should treat this test in SOME WAYS as you do taking
a blood pressure or a pulse at triage. In some countries in many departments
ALL PATIENTS have some routine vitals done - without question or exception.
I beleive, as others have already stated, that you will miss a few ectopics
otherwise. And one is enough...
And, furthermore, you will have everyone pointing a finger at you for
missing such a classical non-classical presentation...
You also have to wonder how often overweight female post-ictal patients may
be diagnosed with something other than eclampsia if no-one checked their HCG
and they did not realise (or were unable to tell) they were pregnant...
There are MANY other such presentations, of course.
You might wish to find out whether there are any local factors involved in
your department. Some are weary of the financial cost of every female having
her B-HCG tested. (Please calm down anyone who just jumped up to tell me how
much more costly it would be to miss out an ectopic - I know). Other
departments have problems staffing enough nursing posts to provide
staff-time to appropriately assess and deal with triage indicators. You may
find the same people who wish to find ways of avoiding doing B-HCG also have
problems with their triage/assessment areas coping with doing other
observations the usefulness of which are NOT in doubt - if this is the case
where you work, then you may find people don't appreciate the conclusions
you will undoubtely reach in this matter. Still, I am sure this will not
deter you in your search.
drydok
>From: Francis Andrews <[log in to unmask]>
>Before writing your guidelines, read the confidential enquiry into
>maternal deaths available on the department of health website. Read
>also the ones from previous years. A&E appears in everey report. I
>quote from the latest report: 'It is essential that GPs, and other
>clinicians including staff in Accident and Emergency Departments
>consider the diagnosis of ectopic pregnancy in any woman of
>reproductive age who complains of abdominal pain. The clinical
>presentation is often not "classical". Gastrointestinal symptoms,
>notably diarrhoea and painful defecation, may be prominent in ectopic
>pregnancy. BetahCG testing should be considered in any woman with
>unexplained abdominal pain whether or not she has missed a period or
>had abnormal vaginal bleeding.'
>
>In other words, if you don't want women dying from ectopic pregnancy
>having been sent home from A&E, then make sure All women with
>abdominal pain in your department get bHCG testing-otherwise one day
>you'll be sued.
>
>The guidelines on X-rays and pregnancy can be found in the Royal
>College of Radiologist's Guidelines on using the X-ray depatment-ask
>your local radiologist for a copy.
>
------------------------------------
Had an interesting discussion with my manager yesterday
>on the use of pregnancy testing (BhCG) in the department. There
>currently seems to be an unwritten policy that all female patients of
>child bearing age should have a pregnancy test if they present with
>abdominal pain. Is this the policy of other departments? Also we
>seem to be getting more female patients sent back from X-Ray for
>request for pregnancy test prior to X-Ray. How do list members feel
>about this? What did we do before BhCG testing? I would be
>interested to hear some responses as I am trying to write some
>guidelines for the use of BhCG tests in the A&E department. Thank you
>in advance.
> >
> > Jamie Forde
> > Staff Nurse
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