Modernising Abortion Services

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Modernising Abortion Services.
Nurse/Midwife Led Provision

• Alison Jones, Consultant Nurse Sexual Health
  Teenage Pregnancy
• Pontypridd
  Rhondda NHS Trust
• 28 June 2007

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Objectives

• Introduction
• Developing nurse/midwife roles
• Opportunities challenges

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Globally

• Over ¼ of worlds population live in countries
  where abortion is strictly prohibited
• 19,000,000 Women have unsafe abortions annually
• 70,000 Women die each year from unsafe abortions
• 1 in 3 British Women will have an abortion

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In Wales, England Scotland abortion can be
carried out providing that 2 registered medical
practitioners agree that

• Up to 24 weeks
• The continuance of the pregnancy would involve
  risk greater than if the
• pregnancy were terminated to the physical or
  mental health of the
• pregnant woman or any existing children in her
  family
• (ii) With no gestational limit
• If termination is necessary to prevent grave
  permanent injury to the mental or physical health
  of the pregnant woman
• There is a risk to the life of the pregnant woman
  greater than if the pregnancy were terminated
• There is substantial risk that if the child were
  born it would suffer from such physical or mental
  abnormalities as to be seriously handicapped
• (Abortion Act 1967, amended by the Human
  Fertilisation Embryology Act 1990)

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• Note
• Parliamentary debate July 2005 upheld the 24 week
  gestational limit.
• Doctors attending the BMA conference June 2005
  supported maintaining the limit by 31.

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Statistics (Wales Eng)

• Abortions increased by 0.4 2004-05
• Teenage abortion rates unchanged
• 89 of abortions carried out under 13wks, less
  than 2 over 20 weeks (unchanged for 10 years)
• 84 abortions were funded/carried out by the NHS
• (fpa fact sheet, August 2006, publisher Sexual
  Health Direct, London)

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Modernising abortion services - national policy
context

• All Wales Sexual Health Strategy 2006
• Designed to Deliver (Wanless, 2000)
• RCOG Guidelines

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Modernising abortion services locally

• Working together multi professional,
  multi-organisation
• Identifying the need for change
• Organisational support
• Risk assessment, professional legal liability
• Clearly specified purpose, roles
  responsibilities

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Principles of Nurse / Midwife Role Development

• focused on empowering nurses/midwives to develop
  knowledge skills for the benefit of patient
  care.
• avoiding ad hoc acquisition of technical skills
  or inappropriate delegation of unpleasant/unwanted
  tasks by other professional groups.

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Nurse/Midwives Responsibilities

• Nurses work within the Abortion Act when they
• accept delegated instructions from a registered
• medical practitioner carry out treatment in
• accordance with his/her directions

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Areas of nurse/midwife role development

• Ultrasound assessment of gestational age
• Pre post abortion counselling
• Administration of abortificants
• Discharging patients
• Vaginal/speculum examination
• Assessment for provision of contraception
• Obtaining consent for abortion procedures

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Obtaining consent for abortion procedures
..exceptions

• Under 16 unaccompanied by an adult with parental
  responsibility
• The woman does not understand the procedures
• The woman is unsure
• The woman has bleeding / pelvic pain
• A medical condition that is contraindicated
• The nurse/midwife deems it unsafe

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Areas of nurse/midwife role development ..
Competency Framework

• Identifies qualifications, experience training
  Registered Nurses Midwives require to enable
  competent safe practice
• Provides methodology to quality assure through
  assessment audit

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Modernisation.. developing a dedicated service

• Specified referral process
• Developing enhancing expertise
• Responsive to individual needs
• Easily accessible for ongoing care
• One stop shop / community settings
• Speedier initial consultation
• One to one holistic assessment
• sexual health perspective
• High levels patient satisfaction
• Positive effects on other services

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Challenges.

• Primary legislation
• Interface between primary secondary care
• Cutting edge. Expect the unexpected ..
• Sustainability

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Checklist for service development

• Working together!
• Clear identification of need
• Policy statement, protocols procedures
• Education training package
• Assessment theoretical practical
• Audit
• Identifying acting on clinical incidents
• Maintenance of competence
• Identifying opportunity for continued development

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Thank you

• Alison Jones
• Pontypridd Rhondda NHS Trust
• Alison-g.jones_at_pr-tr.wales.nhs.uk
• 01443 443443 ext 4246