Miscarriage Management

MM-TI Miscarriage Management Training Initiative Training Outline:

Preparing the Physical Plant to Provide Outpatient Miscarriage Management Services

This exercise is valuable to prepare staff for integrating outpatient miscarriage management at their site. As the trainer, you will facilitate a discussion that documents how your staff will provide care to patients who elect surgical management of their miscarriage. Staff "maps out" what happens from the time a patient calls with her concern until she is discharged from care. It can be very helpful for staff to understand the steps involved, identify systems that are in place, and what is still needed to insure patient-centered care.

Goal To identify all steps to integrate outpatient miscarriage management at your site.

Objectives At the end of the training, participants will be able to:

 List the steps in providing outpatient miscarriage management care from phone call to discharge and follow-up

 Describe staff roles in providing miscarriage management

 Identify systems currently in place

 Identify gaps in service

Time: 15 minutes

Materials  Flip Chart paper and markers

Trainer Tip  This is a very helpful exercise, it takes time to walk through each step however it can provide valuable information as well a ‘bonding’ experience as the group solves problems together.

 Recommend having a facilitator and a note taker.

 The sample documentation of a clinic’s miscarriage management flow below provides an overview of what the outcome of this exercise may look like.

 This exercise may serve as a Needs Assessment. Identifying the needs is helpful as the team works together to integrate services you do not need to have all the answers.

Miscarriage Management-Training Initiative Johnson-May, VanDerhei, Wallace Time & Task Trainer Notes

Introduction Introduce Training by reviewing the goals and objectives. 5 minutes  Sample Script: We are going to walk through each step of caring for a patient that is experiencing an early miscarriage. We will start when she calls our clinic and identify who is involved and what happens. Please begin to think about every aspect of care including appointment making, preparing the procedure room, the procedure itself, recovery, and aftercare. We’ll generate a list that will help us identify what we have in place and what our gaps are.

Facilitated  This works best if one person facilitates the discussion and one person acts as a scribe. discussion of  patient care Encourage participation from everyone on the team.  10 minutes Ask for clarification and as many details for each step as possible.  See sample below for outline of items to include

Review  Review the information collected and check with participants for clarification or missing information. 5 minutes  Compile the results of this exercise for use as a Needs Assessment.

Sample Taking a patient from beginning to end –

1. Call to scheduler 2. Appointment made same day with Provider. 3. Patient checks in at front desk and the MA that is working with the Provider is notified 4. Patient roomed, vitals, pregnancy test, information re: bleeding/pain, set up for pelvic 5. Provider talks with patient 6. Provider does ultrasound 7. Dx of miscarriage based on protocols 8. Provider informs patient of miscarriage and options 9. If patient requests procedure she is scheduled per guidelines (need to develop – discussion was that slots would be available on certain days or flexible scheduling, what Providers would be available) 10. Pre-appointment instructions given, Rx for pre-op medications given 11. Information on what to do if care is needed prior to scheduled appointment 12. Consents – consider signing consents during consult 13. Contraception – discussed at consult or on day of procedure 14. Rh testing @ consult or day of procedure?

Day of Procedure

Miscarriage Management-Training Initiative Johnson-May, VanDerhei, Wallace 1. Patient picks up prescription prior to checking in 2. Patient checks in and is roomed by MA 3. Partners are welcomed to be in procedure room. They will be given clear instructions regarding where to sit, etc. 4. Procedure room will have blankets, heating pad, head sets for music 5. Consents completed (if not done at pre-op, consents will need to be completed prior to any pre-op medications) 6. In the procedure room: Provider and MA 7. MA has set up instruments on mayo stand 8. Vital signs 9. MA role is to support patient and assist Provider 10. POC will be examined in the lab, nothing sent to pathology unless indicated 11. MA recovers patient–heating pad, juice, etc. 12. Ultrasound post procedure if indicated 13. If patient requests to see POC, the Provider would prepare POCs and show to patient.

Post Procedure 1. Answer questions 2. Referral for counseling if indicated 3. Reassurance 4. Follow-up appointment in two weeks 5. Patient leaves with post-op instructions, prescription for pain management 6. Debrief with staff and team to include a review of delivery systems, what worked and what could we improve on, staff emotional reactions to experience. Billing Coding, DSHS, Private Insurance, etc. - there was not time to discuss in detail.

Miscarriage Management-Training Initiative Johnson-May, VanDerhei, Wallace