Risk management in pregnancy termination

Abstract

This chapter reminds those who provide abortion services that crises are inevitable in the medical, counselling and administrative areas of the facility. After more than 10 years of providing safe, legal abortions, the author notes that the different types of crises that occur are already known and that it is possible to prepare for them. Indeed, it is necessary to prepare for a crisis before it occurs. The essence of crisis management is to: (a) identify each possible crisis and prepare a plan to cope with it, (b) train personnel to avert and/or manage a crisis, and to be sure that this training is carried out at appropriate intervals to provide sufficient trained staff at all times and (c) have on hand an up-to-date, adequate stock of the appropriate supplies and equipment to deal with medical and other emergencies. Four crisis management 'dicta' are given: Prepare yourself, your personnel, and your facility to be able to handle crisis. When a medical crisis, as listed, has occurred, the patient should be rapidly transported to the hospital and observed there for a suitable period of time. A medical crisis must be treated as the life-threatening event that it is, regardless of personal ego damage, social disruptions and/or financial considerations. The more personnel trained in cardiopulmonary resuscitation, the better.

PIP: Risk management, or quality assurance, in 1st trimester abortion service delivery, is unique in medicine for having developed a systematic set of actions to prevent or mitigate medical complications as well as consequences of fires, vandalism, harassment, bombings, job actions, and counseling and administrative crises. Risk management principles should be incorporated into facility design, staff selection, equipment selection and maintenance, physician hiring and monitoring, patient screening, regular review of protocols for medical emergencies, high-risk tissue examination. Types of medical crises include cardio-pulmonary collapse, hemorrhage, visceral injury, shock, seizure, and coma. Counseling crises imply suicide or homicide threat, acute psychosis, and reactions of other clients and visitors. Under administrative crises were listed fire, threats or acute bombing, arson, or assault, power or water failures, personnel shortage, harassment, and hostile media. All types of crises are handled by developing a plan of action, training staff, repeating training regularly, and conducting drills, feedback sessions, equipment checks, and designing in security. It should be expected that medical crises will occur on the average in 1/400 terminations, which amounts to one every 2-3 years for a small clinic, or 1-2 per month for a large one. All staff, including counselors, should be able to recognize destabilizing vital signs and to do cardio-pulmonary resuscitation. Appropriate alarm signals should be prearranged to transport the patient to hospital, without concern for personal ego damage, social disruptions, lack of hospital privileges, insurance, or cost. Equipment necessary to handle medical crises is listed, as are security measures to minimize administrative crises. An example of a severe drug reaction and its efficient handling, a result of pre-planning, is detailed.