The majority of EPUs will be nurse-run, requiring very little input from a gynaecologist if appropriate protocols are created and adhered to. With the current emphasis on evidence-based practice and clinical governance to optimize patient care and reduce adverse events and risk incidents, clearly defined protocols are a prerequisite to the successful functioning of an EPU. This guarantees a consistent approach to all problems and becomes independent of staff turnover. Individual protocols for all early pregnancy complications should be compiled into a file and placed in every assessment room for reference. These protocols will include fine details such as dosage regimens and timings between visits. Protocols relating to referral criteria, initial assessment, management of miscarriage, ectopic pregnancies, pregnancies of unknown location, gestational trophoblastic disease and hyperemesis gravidarum should be developed and made available to all members of the early pregnancy team. The evidence for each protocol is stated at the end of each section and the date of compilation also stipulated. Protocols should be revised on an annual basis according to current NHS recommendations. A suggested series of protocols will be offered in the following chapters.
Women attending EPUs will not be able to absorb all the information relayed to them verbally and so rely upon written information to supplement and remind them of discussions that took place during the consultation. This written information also answers questions that may not have been considered at the time. Each type of early pregnancy problem has advice specific and appropriate to it that needs to be passed on to women. Given this, the creation of patient information leaflets for each early pregnancy complication can ensure women are informed of the underlying cause, what to expect now and what the future holds for them. This information can also be placed on the unit or hospital website for reference. Clear warning of symptoms/signs that require urgent action should also be found in such leaflets. The language should be clear, must avoid using medical jargon and explain medical terms clearly when necessary. Diagrams may help in explaining the problem more clearly, e.g. ectopic pregnancy. Contact numbers for the unit and numbers to call in the event of an emergency should be clearly outlined in every leaflet, especially those pertaining to pregnancies of unknown location or medical management of ectopic pregnancies. Women should know exactly who to contact and where to go in any given 24-hour period. Most hospital leaflets are now vetted and approved by a dedicated patient information services department. This should be done in consultation with them for clinical governance purposes.
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