Pre-op procedures: Check all women for pregnancy?

SDS programs differ on need for global testing

Test for pregnancy in all cases? In some cases? Who makes the decision? These are just a few of the questions faced by outpatient surgery managers who are looking at pregnancy testing policies in terms of cost savings and patient safety. A survey conducted by The SurgiCenter of Baltimore in Owings Mill, MD, shows that 57% of the 171 respondents do routinely test all females of childbearing age for pregnancy; 81% of the respondents use a urine test to obtain results, and 83.5% conduct the test on the day of surgery.

The survey was conducted as part of the same-day surgery program’s evaluation of its own pregnancy testing policy, says Jerry Henderson, executive director of the program. "Our policy was ambiguous and subjective because it gave nurses and anesthesiologists the responsibility of determining a need for the test," she explains.

Although the center excluded women who had undergone hysterectomies or were menopausal, other factors such as different birth control methods and a partner’s vasectomy were not applied consistently to determine which patients required a pregnancy test, she says. After receiving the survey responses, input from physicians, and feedback from the nursing staff, the policy was changed to require a pregnancy test for all women of childbearing age, Henderson says.

Jane A. Kusler-Jensen, RN, MBA, CNOR, chair-elect of the Association of periOperative Registered Nurses’ Ambulatory Surgery Specialty Assembly (AORN) and director of surgical services for Aurora BayCare Medical Center in Green Bay, WI, has worked in same-day surgery programs that do not require a pregnancy test for all women.

"The decision would be made by the surgeon on a case-by-case basis," she says. The pre-op nurse and the anesthesiologist would ask all patients about the possibility of pregnancy, Kusler-Jensen explains. "If the patient was hesitant to answer, or indicated that there might be a possibility, the anesthesiologist would order the test," she adds. It was a very collegial decision, based on everyone’s level of comfort, she says.

Kusler-Jensen’s facility used a blood test, and results could be turned around in less than an hour by a laboratory next to the surgery center. Henderson’s program relies on a urine test that can be read by the program’s nurses. "The key is to reassure surgeons that testing all women will not delay the start of their procedures and will ensure patient safety," she says.

AORN addresses the pregnancy issue by recommending that all women of childbearing age be asked about the possibility of pregnancy and that a urine test should be performed preoperatively if they indicate there is a possibility1, says Ellen O’Connor, RN, CNOR, chair of the membership committee of AORN’s Ambulatory Surgery Specialty Assembly and staff nurse at the Women’s OR of Huntsville (AL) Hospital.

"Our hospital tests all women of childbearing age in our pre-op holding area with a urine specimen, and the nurse reads this result unless we have a specific order written by a physician that it is not necessary," she explains. "Our policy is the same for both in- and outpatient."

If you do test for pregnancy, be prepared to handle unexpected positive results, Kusler-Jensen suggests. Be sure that you know who will tell the patient about the pregnancy and whether the surgery will be cancelled, she explains. "In one center, we had two instances of teen-agers who had an idea that they might be pregnant but had not verified their suspicions," she says. Both times, the surgeon cancelled the procedures, which were elective, and offered to talk to the girl’s mother. Be prepared with referrals to agencies that offer social support for the patient if necessary, she adds.

You also should be prepared to handle the financial aspect of the pregnancy test if you require it for all women, Henderson says. "Insurance will usually pay for a test if it is part of an overall lab workup prior to the surgery day, but might refuse to pay for a test performed the morning of surgery in the surgery center," she says. "We’ve made the decision that we will continue to perform the pregnancy tests on everyone, even without reimbursement. No matter how much a pregnancy test costs, it will be less than the cost of a lawsuit if a baby is harmed by anesthesia during surgery."

Reference

1. Association of PeriOperative Registered Nurses. Ambulatory Surgery Principles and Practices: Standards and Recommended Practices for Ambulatory Surgery. Denver; 2001. 

Sources

For more information about pregnancy testing for same-day surgery patients, contact:

Jerry Henderson, Executive Director, The SurgiCenter of Baltimore, 23 Crossroad Drive, Suite 100, Owings Mill, MD 21117. Telephone: (410) 356-0300. Fax: (410) 356-0309. Web: www.surgicenterofbalt.com.

Jane Kusler-Jensen, RN, MBS, CNOR, Director of Surgical Services, Aurora BayCare Medical Center, P.O. Box 8900, Green Bay, WI 54308-8900. Telephone: (920) 288-4808. E-mail: jane.kusler-jensen@AuroraBayCare.com.

• Ellen O’Connor, RN, CNOR, Staff Nurse, Women’s OR of Huntsville (AL) Hospital. E-mail: ellencnor@hotmail.com.