Retrospective data audit reviewing pre-operative pregnancy testing in women of childbearing age compared to NICE guidelines

Pregnancy testing in all women of childbearing age should be performed pre-operatively to ensure there is no case of unknown pregnancy, which could potentially be affected by anaesthesia and/or surgical intervention by causing miscarriage, intrauterine growth restriction or low birth weight [1] Hammersmith hospital is a busy tertiary referral centre with a high turnover of complex surgical procedures We reviewed retrospective data to conclude if the Trust adequately documented pre-operative pregnancy test results as set out by the National Institute for Health and Care Excellence (NICE) guidelines [2] Methods Retrospective review of case notes of women aged 16-49 attending for surgery between 04/12/2019 and 30/12/2019 pre-COVID Statistical analysis was performed using Microsoft Excel 2010 Results One hundred and six notes were collected We excluded ERCP procedures as pregnancy would be confirmed by ultrasound prior to surgery Analysis of the results showed that 93% of the procedures were elective of which the majority were from gynaecology, renal, ear-nose-throat (ENT) and hepatobiliary specialties The majority of gynaecology procedures were hysteroscopies Compared to the NICE guidelines, only 79% had a documented conversation regarding their pregnancy status, 6% had written consent for a urine test, and 59% had had their pregnancy test documented Fig 1 shows the patients who had a documented pregnancy test Of the patients with a documented pregnancy test, four of the patients had no preceding conversation or given consent for the test It was also found that for two patients who tested positive on their test, the anaesthetist had not had a conversation regarding the effects of anaesthesia with the patient Discussion Our audit shows inadequate consent and documentation of patients' pregnancy status when considering NICE guidance We propose to alter our peri-operative WHO checklist to include confirmation of pregnancy status at sign in and to offer an education cycle for nurses, anaesthetic assistants and anaesthetists with regards to pre-operative tests and NICE guidance We aim to re-audit the data prospectively following our interventions