The use of an integrated care pathway for evidence-based practice and clinical governance in abortion care

Abstract

The aim of the study was to assess the effectiveness of an integrated care pathway (ICP) for delivery of evidence-based practice in abortion care. All women re-admitted after an abortion had their records audited for adherence to national and local guidelines using information in the ICP and general gynaecology case notes. A total of 100 women were re-admitted into the gynaecological wards of hospitals in Hull and East Riding of Yorkshire after an abortion, between January 2000 and December 2006. Out of 8,476 medical or surgical induced abortions undertaken at 14 weeks gestation or under, the overall readmission rate was 1.2%. The ICP showed that 97% of women had chlamydia screening prior to the abortion; all women had a contraceptive discussion and 43% left using a long-acting reversible method of contraception (LARC). However, data outside the care pathway was not documented, and hence the standard of care given on readmission was difficult to locate and variable in quality. The ICP clinical record is demonstrated to be a useful tool for high quality record-keeping and ensuring all patients receive the same standard of pre-assessment care. Although this service has an acceptably low-risk profile in terms of re-admission, we propose the addition of a re-admission episode to the current ICP to further enhance clinical care post-abortion.

Keywords:

• Abortion
• audit
• contraception
• integrated care pathway
• LARC
• post-abortion care

Acknowledgements

The authors would like to thank Mrs Mary Crabtree and staff, Clinical Audit Unit Hull Royal infirmary for their contribution to the planning of the audit and staff; the Maternity Unit of the Women and Children's Hospital for their helpful comments on the audit outcomes and triage form documentation. We would like to particularly thank Dr Anne Webb for useful comments on drafts of the paper.

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Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.