Download Policy for Pregnancy Testing Prior To Surgery of Young People

Pregnancy Testing Before Planned Surgery in young
people under 18 years of age
V2.0
10th March 2016
Table of Contents
1.
Introduction ..................................................................................................................... 3
2.
Purpose of this Policy/Procedure .................................................................................... 4
3.Scope .................................................................................................................................. 4
4. Definitions / Glossary .......................................................................................................... 4
6.
Standards and Practice ................................................................................................... 6
7.
Dissemination and Implementation ................................................................................. 1
8.
Monitoring and effectiveness ........................................................................................... 1
9.
Updating and Review ...................................................................................................... 2
Equality Impact Assessment ............................................................................................... 2
Appendix 1. Governance Information ..................................................................................... 3
Appendix 2. Initial Equality Impact Assessment Form ............................................................ 5
Summary
The possibility of pregnancy should be considered in all relevant female patients
before surgery which could pose risks to mother or foetus. Therefore Pre-operative
pregnancy testing should be carried out in all females between the ages of 12 years
and 55 years.
1.
Introduction
1.1. The possibility of pregnancy should be considered in all relevant female patients
before surgery which could pose risks to mother or foetus.
1.2. Offering pregnancy testing to females less than 18 years of age needs to be
undertaken in a sensitive and confidential manner and may lead to safeguarding
children concerns.
1.3. In some instances, the need to share information may need to override the duty of
confidentiality.
1.4. There is evidence that some treatments can carry the risk of spontaneous
abortion, prematurity and intrauterine growth restriction.
1.5. Patient history of menstrual period, contraception, sexual activity and the
possibility of pregnancy could be unreliable.
1.6. In order to reduce the risk to any unborn foetus/baby, it has been agreed that all
females 12 to 55 years should be routinely be offered a pregnancy test in the 24
hours prior to surgery being undertaken under general anaesthetic.
1.7. This will be obtained on the day of operation.
1.8. Written information about this test should be given to the patient and parents as
far in advance as possible, such as when surgery is agreed at out-patients, or when
the young person attends for pre-operative assessment so that the patient and/or
parents can have any relevant discussion between themselves and any outside
agencies and take appropriate action prior to admission.
1.9. If a previously unknown pregnancy is detected, the risks and benefits of surgery
can be discussed with the patient.
1.10. If a previously unknown pregnancy is detected, the appropriate Safeguarding
Children actions can be instigated.
1.11 .This policy states the responsibilities of the multidisciplinary team when caring for
females of 12 to 18 years of age who are to undergo an anaesthetic. It conforms to
guidelines and documents as identified within Appendix 1: Governance Information
1.12. This version supersedes any previous versions of this document.
2. Purpose of this Policy/Procedure
2.1. The purpose of this policy is to outline the Trust policy for Pregnancy Testing
prior to Surgery of Young People less than 18 years of age and to protect the
child/young person from the risk of undergoing surgery when pregnant.
2.2. To assist staff in the process of offering pregnancy tests and dealing with
safeguarding children issues that may arise from that process.
2.3. To ensure that any information collected from the young person and
parent/carer follows a standardised format, which is agreed by the multidisciplinary
team.
2.4. To ensure that appropriate action is taken if a positive pregnancy test result is
discovered in the 12 – 18 year old female according to statutory obligations.
3. Scope
3.1. This policy applies to all staff members, and their line managers who are
involved with the management of females of 12 to 18 years who are to undergo
anaesthesia.
4. Definitions / Glossary
4.1. POA – Pre Operative Assessment – a clinic where the pre-operative needs of
patients are identified and initial actions and investigations are performed to identify
risk and outline care to be provided during the forthcoming hospital stay.
4.2. OPD – Out Patient Department – an initial assessment clinic where the young
person is reviewed by a consultant on the referral from General Practitioner. From
this OPD clinic, the young person is listed for procedure requiring an anaesthetic.
5. Standards and Practice
5.1. Role of Managers
Line managers are responsible for:
Ensuring staff receive appropriate training
5.2. Role of Individual Staff
To ensure they are aware of the policy
5.3. Staff who are involved in the management of females of 12 to 18 years are
required to follow this policy and be clear with regard to their individual roles and
responsibilities within the process.
5.4. Role of the Consultant Medical Staff and Medical Team
The consultant staff and those to whom they delegate duties:
Must discuss with the parents and young person the reason for their admission to
hospital/contact with the service, the treatment involved and likely outcome including the
need for anaesthetic.
Will be responsible, in consultation with other members of the multidisciplinary team,
for deciding which professionals need to be involved in the management of females of 12 to
18 years who require an anaesthetic.
Anaesthetist must ascertain that the pregnancy status has been clarified prior to giving
anaesthetic
Should inform the female of 12 to 18 years who requires an anaesthetic a test is
performed to ascertain pregnancy status.
5.5. Role of Nursing Staff
The Nursing Staff involved in management of females of 12 to 18 years are responsible for:
At pre-operative assessment clinic (POA), or at time of admission if not attending POA
clinic clearly document accurate information relating to the 12 –
18 year old female menstrual cycle. This information will form the basis of decision regarding
the need for a pregnancy test on day of anaesthetic.
At pre-operative assessment clinic, or at time of admission if not attending pre op
assessment clinic, should provide an information sheet: Pregnancy Testing Before Planned
Surgery.
On the day of admission ask the patient to provide a specimen of urine to enable a
pregnancy test to be carried out according to RCHT Pregnancy Testing Protocol (2010)
Be responsible for documenting that the pregnancy test has been performed and
document the result of the test in the medical notes.
6. Standards and Practice
6.1. Most young people under the age of 18 years will have an interest in sex
and sexual relationships.
6.2. All staff coming into contact with children and young people have a duty to
safeguard and promote their welfare and should know what to do if they have
concerns.
6.3. Cases of underage sexual activity are likely to raise difficult issues and should
be handled particularly sensitively.
6.4. This means when offering routine pregnancy testing prior to surgery, the
reason for it should be explained in a sensitive and confidential way, but it will have
to be made clear to the young person that if sexual activity is disclosed, that
absolute confidentiality cannot be guaranteed, as there may be circumstances
where the needs of the young person can only be safeguarded by sharing
information with others (Working Together to Safeguard Children 2010)
6.5. Age 13 years and under: A child under 13 years is not legally capable of
consenting to sexual activity. Any offence under the Sexual Offences Act (2003)
involving a child aged under 13 years is very serious and should be taken to
indicate that the child is suffering, or is likely to suffer, significant harm (Working
Together to Safeguard Children 2010).
These cases should always be
discussed with a nominated child protection lead in the organisation.
6.6. Over 13 – 16 years olds: Sexual activity with a child under 16 years is an
offence. Where it is consensual it may be less serious in cases than if the child
were under 13 years, but may have serious consequences for the welfare of the
young person. Consideration should be given in every case of sexual activity
involving a child aged 13-15 as to whether there should be a discussion with other
agencies and whether a referral should be made to children’s social care.
6.7. 16 – 18 year olds: Sexual activity with 16 – 18 year olds may involve harm or
the risk of harm, although it is unlikely to be an offence.
6.8
The process of offering pregnancy testing to under 18 year olds
6.8.1 Written information is given as far in advance as possible to the patient
and parents such as when surgery is agreed at out patients, when the young
person attends for pre-operative assessment or when prior to obtaining
consent for the operation in the Emergency Department.
Patient being
admitted on the day of surgery are asked to provide a sample of urine on
arrival to the ward/unit.
6.8.2 When the young person is admitted to the ward or Emergency
Department, they must be asked if menstruation has commenced. Pregnancy
test should be performed in all cases.
6.8.3 The patient and parents are asked if they are aware that RCHT
pregnancy testing as a routine on all pubertal females. If they are not,
why pregnancy testing is offered as part of routine procedure prior
should be explained to the young person and accompanying adult in
manner.
undertake
the reason
to surgery
a sensitive
6.8.4 Informed consent must be obtained prior to pregnancy testing being carried
out and documented in medical notes.
6.9 Cases where consent for pregnancy testing is obtained:
6.9.1 Lot/Batch number of test and the result should be recorded in the
medical notes and in t he peri-operative document pre op checklist with the
batch number and the result
6.9.2 If the result is negative, pre-operative procedure should be continued.
6.9.3If the result is positive, pre-operative procedure should be discontinued and
the relevant surgeon informed immediately and a discussion with the
Safeguarding team should be initiated. For additional guidance, reference should
made to www.SW.CPPorg.uk http://www.swcpp.org.uk/. A referral to the Genito-Urinary- Medicine
Clinic should be made and discussed with the young person (Appendix 4).
6.11 Cases where consent for pregnancy testing is refused:
6.11.1If consent for pregnancy testing is refused by the parent or young person,
the possible dangers to the young person’s health should be discussed in a
sensitive manner
6.11.2Where possible the issue should be discussed with the young person on
their own
6.11.3If pregnancy testing is still refused, this should be discussed with the
relevant surgeon and written refusal to consent obtained from the parent and
young person. The parent or young person should sign the peri-operative
document checklist if the pregnancy test is declined.
6.12 All cases:
6.12.1At all stages the young person should be reassured that this is a
routine procedure for all pubertal females.
6.12.2A record of the pregnancy test result or refusal to consent to the test
must be made in the young persons’ medical record. In cases where the result
is positive, steps should be taken to deal with the issues that arise, together
with discussion with Safeguarding Children team, which should be recorded.
7. Dissemination and Implementation
7.1. Ward and Department Managers are responsible for ensuring adequate
dissemination and implementation of the policy within their own areas.
7.2. All managers will be aware of the contents of the policy and will ensure that
their staff have read and understood the procedures and processes related to the
management of pregnancy testing prior to anaesthetic for all 12 to 18 year old
female patients.
8. Monitoring and effectiveness
Element to be
monitored
Lead
Tool
Frequency
Reporting
arrangements
Acting on
recommendations
and Lead(s)
Completion of documentation
Recording of pregnancy test results
Timeline of documentation for all interactions with young
person
Ward Manager or designated deputy
An agreed audit tool developed by the Directorate, to include all
elements as described above.
An agreed audit tool developed by the Directorate, to include all
elements as described above.
Audits will be reported via the Divisional Audit and Guidelines
meeting in the Directorate. Action plans, incidents and
complaints related to discharge and transfer will be brought back
to the directorate via Clinical Governance meetings.
Reports should be discussed at the appropriate Operational Board
Reports should be discussed at the appropriate Operational
Board,
with any high risk areas highlighted and action plans developed to
address any gaps identified.
Change in
practice and
lessons to be
shared
Lessons will be shared with all the relevant stakeholders by
Presentation at Child Health audit and guidelines meetings and via
Child Health risk management newsletter. Following liaison with
relevant stakeholders, any required changes to practice will be
discussed at Directorate Clinical Governance meetings, prior to
being reflected in this policy and implemented clinically.
9. Updating and Review
9.1. This policy will be reviewed by the author at least every 3 years reflecting
changes in legislation as necessary.
This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the
'Equality, Diversity & Human Rights Policy' or the Equality and Diversity
website.
Royal Cornwall Hospitals NHS Trust is committed to a Policy of Equal
Opportunities in employment. The aim of this policy is to ensure that no
job applicant or employee receives less favourable treatment because
of their race, colour, nationality, ethnic or national origin, or on the
grounds of their age, gender, gender reassignment, marital status,
domestic circumstances, disability, HIV status, sexual orientation,
religion, belief, political affiliation or trade union membership, social or
employment status or is disadvantaged by conditions or requirements
which are not justified by the job to be done. This policy concerns all
aspects of employment for existing staff and potential employees.
Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
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Appendix 1. Governance Information
Document Title
Policy for pregnancy testing prior to surgery of
young people under the age of 18 years of age
Date Issued/Approved:
March 2016
Date Valid From:
March 2016
Date Valid To:
March 2019
Directorate / Department
responsible (author/owner):
Yvette Williams; Tabitha Fergus
Contact details:
01872 253911
Brief summary of contents
Policy and guidance for the management of 12 to
18 year old females who require pregnancy testing
prior to anaesthetic
Suggested Keywords:
Pre surgery pregnancy testing
Target Audience
RCHT

PCH
CFT
KCCG
Executive Director responsible
for Policy:
Medical Director
Date revised:
March 2016
This document replaces (exact
title of previous version):
Policy for Pregnancy testing prior to surgery of
young people under the age of 18 years of age
Paediatric practice development forum
Sexual Health Hub
Safeguarding Children’s Team
Audit and guidelines
Approval route (names of
committees)/consultation:
Divisional Manager confirming
approval processes
Tim Mumford
Name and Post Title of additional
signatories
None
Name and Signature of
Divisional/Directorate
Governance Lead confirming
approval by specialty and
divisional management meetings
Signature of Executive Director
giving approval
Publication Location (refer to
Policy on Policies – Approvals
and Ratification):
Document Library Folder/Sub
Folder
{Original Copy Signed}
Name:
{Original Copy Signed}
Internet & Intranet
Paediatrics
Page 3 of 14

Intranet Only
Links to key external standards
GOSH
Related Documents:
DoH: Working Together to Safeguard
Children (2010)
DoH: Information Sharing: Pocket Guide
(2008)
Responsibilities of Doctors in Child
Protection Cases with regard to
Confidentiality (2004)
The Sexual Offences Act (2003) DoH: NSF
for Children and Young People and
Maternity Services (2004) Children Act
(2004)
RCHT Pregnancy Testing Protocol
(2010)
NSPA Rapid Response Report.
NSPA/2010/RRR011
Training Need Identified?
No
Version Control Table
Date
1st
October
2012
10th
March
2016
Version
No
Summary of Changes
V1.0
Initial Issue
V2.0
2nd Issue minor no changes.
Changes Made by
(Name and Job Title)
Ann Houlston
Ward manager then
Yvette Williams
Yvette Williams
Delegated
to Yvette
Tabitha Fergus
Williams Willisam
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy on Document Production. It should not be altered in any way without the
express permission of the author or their Line Manager.
Page 4 of 14
Appendix 2. Initial Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to
as policy) (Provide brief description): Policy for pregnancy testing prior to surgery of young
people under the age of 18 years of age
Directorate and service area:
Is this a new or existing Policy?
Directorate and service area: Nursing
Existing
Midwifery and Allied Health Professional
Name of individual completing
Telephone: 01872 253911
assessment: Yvette Williams
This policy has been developed to support Trust staff in the
1. Policy Aim*
management
of pregnancy testing prior to anaesthetic in the
Who is the strategy /
12 to 18 year old female patient.
policy / proposal /
It is a requirement of NPSA Rapid Response Report
service function
NPSA/2010/RRR011 to have in place a policy that meets the needs
aimed at?
specific to this group.
2. Policy Objectives*
To ensure the safe management of 12 to 18 year old females who
require an anaesthetic.
3. Policy – intended
Outcomes*
Safe management of 12 to 18 year old females who require
an anaesthetic.
4. *How will you
measure the
outcome?
5. Who is intended to
benefit from the
policy?
6a) Is consultation
required with the
workforce, equality
groups, local interest
groups etc. around
this policy?
Annual audit of documentation
RCHT staff and 12 to 18 year old female patients
Nursing Staff
Consultant
Anaesthetists
Consultant Surgeons Consultant
Gynaecologist
Consultant Sexual Health
Children’s Services Integration Group
Paediatric Practice Development Forum
b) If yes, have these
*groups been
consulted?
C). Please list any
groups who have
been consulted about
this procedure.
7. The Impact
Please complete the following table.
Are there concerns that the policy could have differential impact on:
Equality Strands:
Age
Yes
yes
No
Rationale for Assessment / Existing Evidence
All female patients from 12 to 55
years require pre-anaesthetic pregnancy testing
Page 5 of 14
Sex (male, female, trans-
no
gender / gender
reassignment)
Race / Ethnic
communities /groups
no
Disability -
no
Learning disability, physical
disability, sensory impairment
and mental health problems
Religion /
other beliefs
no
Marriage and civil
partnership
yes
All female patients from 12 to 55 years require pre
anaesthetic pregnancy testing
Pregnancy and maternity
yes
Sexual Orientation,
yes
All female patients from 12 to 55 years require pre
anaesthetic pregnancy testing
All female patients from 12 to 55 years require pre
anaesthetic pregnancy testing
Bisexual, Gay, heterosexual,
Lesbian
You will need to continue to a full Equality Impact Assessment if the following have been
highlighted:
 You have ticked “Yes” in any column above and
 No consultation or evidence of there being consultation- this excludes any policies
which have been identified as not requiring consultation. or
 Major service redesign or development
Nox
8. Please indicate if a full equality analysis is recommended.
Yes
9. If you are not recommending a Full Impact assessment please explain why.
Signature of policy developer / lead manager / director
Y.williams
Names and signatures of
members carrying out the
Screening Assessment
Date of completion and submission
March 2016
1.
2.
Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa,
Truro, Cornwall, TR1 3HD
A summary of the results will be published on the Trust’s web site.
Signed __Y.Williams/ T.Fergus_____________
Date ___March 2016_________
Appendix 4 -Sample of leaflet given to children and young people.
Page 6 of 14
Appendix 3- Sample of Information given to children and
young people.
Pregnancy testing before planned surgery
When you come into hospital for your operation you will be asked to give a urine sample
for a pregnancy test on the morning of the operation. This is something hospitals all
across the country are doing and specifically has been recommended as a way of
enhancing safety.
Why am I being asked to do this?
Pregnancy testing before surgery is recommended for all female patients aged 12 –
55 years of age. It has no relation to any individual’s circumstances.
I am sure I’m not pregnant. Must I have the test?
Nobody is compelled to have a pregnancy test. If you decide not to be tested you will
be asked to sign a note to say that you have made that decision. This may be the
obvious thing to do for some people such as those who have had a hysterectomy. We
would recommend that even people confident about their contraception check with a
pregnancy test.
Why is it important?
The very early stage of pregnancy, maybe even before the pregnancy has been
recognised, is the time when an embryo may be most vulnerable to ill effects of
medicines, X-rays and anaesthetics. Operations on the abdomen and pelvis can directly
affect the womb and even operations (or occasionally complications) on other parts of
the body may involve medicines that can affect pregnancy.
If I’m pregnant, will my operation be cancelled?
Pregnancy is just one factor in your decision to have an operation. If you are pregnant
you should talk to the doctors looking after you about whether there are any additional
risks involved with your operation. You will be able to decide together whether you
should go ahead, consider another treatment or delay treatment.
I don’t think this is right for my daughter
We hope you will understand that it is better to test every female patient of child
bearing age rather than discriminate by asking personal questions, especially for very
young patients.
When girls are mature enough to understand and weigh up information to help them
make decisions, they can (legally) determine their health care even when not yet 16
years of age. Therefore if a young patient under the age of 16 is having an operation she
will often be asked to either have a pregnancy test or sign herself that she does not want
to do so (and takes responsibility for that decision). If it is not appropriate for her to do so
herself, the person with parental responsibility who signs the consent form would also be
asked to consent to pregnancy testing.
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