Outpatient hysteroscopy/biopsy - RCOG/BSGE 2018 statement on Pain Control and Patient Choice

The request was successful.

Katharine Tylko-Hill

Dear The Princess Alexandra Hospital NHS Trust,

Under the Freedom of Information Act please may I have answers to the following questions. This request is to audit implementation of the RCOG/BSGE statement about choice and pain-relief in hysteroscopy.

1. a) Have your hysteroscopists read the following statement issued by the RCOG in December 2018 - Y/N?
b) Have your hysteroscopy managers read the following statement – Y/N?
https://www.rcog.org.uk/en/guidelines-re...
The British Society for Gynaecological Endoscopy published this statement in December 2018:
"Diagnostic hysteroscopy is a commonly performed investigation; it is safe and of short duration. Most women are able to have the procedure in an outpatient setting, with or without local anaesthesia, and find it convenient and acceptable. However, it is important that women are offered, from the outset, the choice of having the procedure performed as a day case procedure under general or regional anaesthetic. Some centres are also able to offer a conscious sedation service in a safe and monitored environment. It is important that the procedure is stopped if a woman finds the outpatient experience too painful for it to be continued. This may be at the request of the patient or nursing staff in attendance, or at the discretion of the clinician performing the investigation."
________________________________________

2. Please are ALL your hysteroscopy patients from the outset routinely offered the choice of having hysteroscopy as a day case procedure a) under GA – Y/N? b) under regional anaesthetic – Y/N? c) with IV sedation?

3. Do your hysteroscopy consent forms contain tick-boxes to enable a patient to choose a) GA – Y/N? b) regional anaesthesia – Y/N? c) IV sedation – Y/N?

4. Have all your outpatient hysteroscopy teams received written instruction to monitor the patient throughout the procedure, to ask if she is experiencing pain, and to stop if the patient asks or is showing signs of severe pain or distress – Y/N?

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS pain-scores a) as hysteroscope passes through the cervix – Y/N, b) at biopsy – Y/N?

6. Does your hysteroscopy department send all its patients the RCOG’s Patient Information Leaflet, published on its website - Y/N? https://www.rcog.org.uk/en/patients/pati...

7. Does your hysteroscopy department intend to start using the RCOG leaflet – Y/N? If so, in which month/year?

8. If your hysteroscopy department uses its own Patient Information Leaflet, please may I have a link to it?

9. Does the leaflet include ALL the key points listed (below) by the RCOG – Y/N?
Key points
• Outpatient hysteroscopy (OPH) is a procedure carried out in the outpatient clinic that involves examination of the inside of your uterus (womb) with a thin telescope.
• There are many reasons why you may be referred for OPH, such as to investigate and/or treat abnormal bleeding, to remove a polyp seen on a scan or to remove a coil with missing threads.
• The actual procedure usually takes 10–15 minutes. It can take longer if you are having any additional procedures.
• You may feel pain or discomfort during OPH. It is recommended that you take pain relief 1–2 hours before the appointment.
• If it is too painful, it is important to let your healthcare professional know as the procedure can be stopped at any time.
• You may choose to have the hysteroscopy under general anaesthetic. This will be done in an operating theatre, usually as a daycase procedure.
• Possible risks with hysteroscopy include pain, feeling faint or sick, bleeding, infection and rarely uterine perforation (damage to the wall of the uterus). The risk of uterine perforation is lower during OPH than during hysteroscopy under general anaesthesia

Yours faithfully,

Katharine Tylko-Hill

FOI (RQW) Pr Alexandra Hosp Tr, The Princess Alexandra Hospital NHS Trust

Dear Ms Tylko-Hill,

Thank you for your email received 01/04/19. Under the Freedom of Information Act 2000 we are required to provide a response within 20 working days following the first working day of receipt.

You can expect to receive a response on 29/04/2019 however your request will be processed as soon as possible. We will advise you if we do not hold the information or if it falls within one of the exemptions laid down in the act.

Your request has been given the reference number FOI 19-181. Please use this in all future correspondence regarding this request.

We will contact you if we require any further clarification.

Kind regards

FOI team

The Princess Alexandra Hospital NHS Trust

show quoted sections

FOI (RQW) Pr Alexandra Hosp Tr, The Princess Alexandra Hospital NHS Trust

1 Attachment

Dear Ms Tylko-Hill,

 

I am writing to confirm that the Princess Alexandra Hospital NHS Trust has
now completed its search for the information which you requested on
01/04/19 and can respond as follows:

 

1. a) Have your hysteroscopists read the following statement issued by the
RCOG in December 2018 – No, some were unaware of the statement so this has
now been circulated

b) Have your hysteroscopy managers read the following statement – No, as
above

[1]https://www.rcog.org.uk/en/guidelines-re...

The British Society for Gynaecological Endoscopy published this statement
in December 2018:

"Diagnostic hysteroscopy is a commonly performed investigation; it is safe
and of short duration. Most women are able to have the procedure in an
outpatient setting, with or without local anaesthesia, and find it
convenient and acceptable. However, it is important that women are
offered, from the outset, the choice of having the procedure performed as
a day case procedure under general or regional anaesthetic. Some centres
are also able to offer a conscious sedation service in a safe and
monitored environment. It is important that the procedure is stopped if a
woman finds the outpatient experience too painful for it to be continued.
This may be at the request of the patient or nursing staff in attendance,
or at the discretion of the clinician performing the investigation."

________________________________________

 

2. Please are ALL your hysteroscopy patients from the outset routinely
offered the choice of having hysteroscopy as a day case procedure a) under
GA – Yes b) under regional anaesthetic – Yes c) with IV sedation - No?

 

3. Do your hysteroscopy consent forms contain tick-boxes to enable a
patient to choose a) GA – No b) regional anaesthesia – No c) IV sedation –
No

 

4. Have all your outpatient hysteroscopy teams received written
instruction to monitor the patient throughout the procedure, to ask if she
is experiencing pain, and to stop if the patient asks or is showing signs
of severe pain or distress – No – not written instructions

 

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS
pain-scores a) as hysteroscope passes through the cervix – No, b) at
biopsy – No? Verbal done only for pain and procedure stopped if needed

 

6. Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website - No?
[2]https://www.rcog.org.uk/en/patients/pati...

 

7. Does your hysteroscopy department intend to start using the RCOG
leaflet – Yes If so, in which month/year Now we are aware of its
availability by July 2019

 

8. If your hysteroscopy department uses its own Patient Information
Leaflet, please may I have a link to it? Attached

 

 

9. Does the leaflet include ALL the key points listed (below) by the RCOG
– No?

Key points

• Outpatient hysteroscopy (OPH) is a procedure carried out in the
outpatient clinic that involves examination of the inside of your uterus
(womb) with a thin telescope. Yes

• There are many reasons why you may be referred for OPH, such as to
investigate and/or treat abnormal bleeding, to remove a polyp seen on a
scan or to remove a coil with missing threads. No

• The actual procedure usually takes 10–15 minutes. It can take longer if
you are having any additional procedures. Whole procedure 15 – 20 minutes

• You may feel pain or discomfort during OPH. It is recommended that you
take pain relief 1–2 hours before the appointment. Abdominal cramping or
period like pain.  Pain relief 20 min prior to appointment

• If it is too painful, it is important to let your healthcare
professional know as the procedure can be stopped at any time. No.  This
is verbalised throughout the procedure

• You may choose to have the hysteroscopy under general anaesthetic. This
will be done in an operating theatre, usually as a daycase procedure. No.
Verbal only

• Possible risks with hysteroscopy include pain, feeling faint or sick,
bleeding, infection and rarely uterine perforation (damage to the wall of
the uterus). The risk of uterine perforation is lower during OPH than
during hysteroscopy under general anaesthesia Partially included

 

If you have any queries about this response please do not hesitate to
contact us. Please remember to quote the reference number above in any
future communications.

 

If you are not happy with the service you have received in relation to
your request and would like to make a complaint or request a review of our
decision you should write to: The Chief Executive, The Princess Alexandra
Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX.

 

If you are not content with the outcome of your complaint you may request
a decision from the Information Commissioner. Generally, the ICO cannot
make a decision unless you have exhausted the complaints procedure
provided by the Princess Alexandra Hospital NHS Trust.

 

You can contact the ICO at: The Information Commissioners Office, Wycliffe
House, Water Lane, Wilmslow, Cheshire, Sk9 5AF.

 

Kind regards

 

FOI Team

The Princess Alexandra Hospital NHS Trust

 

 

From: Katharine Tylko-Hill
[[3]mailto:[FOI #565414 email]]
Sent: 01 April 2019 13:57
To: FOI (RQW) Pr Alexandra Hosp Tr
Subject: Freedom of Information request - Outpatient hysteroscopy/biopsy -
RCOG/BSGE 2018 statement on Pain Control and Patient Choice

 

Dear The Princess Alexandra Hospital NHS Trust,

 

Under the Freedom of Information Act please may I have answers to the
following questions. This request is to audit implementation of the
RCOG/BSGE statement about choice and pain-relief in hysteroscopy.

 

1. a) Have your hysteroscopists read the following statement issued by the
RCOG in December 2018 - Y/N?

b) Have your hysteroscopy managers read the following statement – Y/N?

[4]https://www.rcog.org.uk/en/guidelines-re...

The British Society for Gynaecological Endoscopy published this statement
in December 2018:

"Diagnostic hysteroscopy is a commonly performed investigation; it is safe
and of short duration. Most women are able to have the procedure in an
outpatient setting, with or without local anaesthesia, and find it
convenient and acceptable. However, it is important that women are
offered, from the outset, the choice of having the procedure performed as
a day case procedure under general or regional anaesthetic. Some centres
are also able to offer a conscious sedation service in a safe and
monitored environment. It is important that the procedure is stopped if a
woman finds the outpatient experience too painful for it to be continued.
This may be at the request of the patient or nursing staff in attendance,
or at the discretion of the clinician performing the investigation."

________________________________________

 

2. Please are ALL your hysteroscopy patients from the outset routinely
offered the choice of having hysteroscopy as a day case procedure a) under
GA – Y/N? b) under regional anaesthetic – Y/N? c) with IV sedation?

 

3. Do your hysteroscopy consent forms contain tick-boxes to enable a
patient to choose a) GA – Y/N? b) regional anaesthesia – Y/N? c) IV
sedation – Y/N?

 

4. Have all your outpatient hysteroscopy teams received written
instruction to monitor the patient throughout the procedure, to ask if she
is experiencing pain, and to stop if the patient asks or is showing signs
of severe pain or distress – Y/N?

 

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS
pain-scores a) as hysteroscope passes through the cervix – Y/N, b) at
biopsy – Y/N?

 

6. Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website - Y/N?
[5]https://www.rcog.org.uk/en/patients/pati...

 

7. Does your hysteroscopy department intend to start using the RCOG
leaflet – Y/N? If so, in which month/year?

 

8. If your hysteroscopy department uses its own Patient Information
Leaflet, please may I have a link to it?

 

9. Does the leaflet include ALL the key points listed (below) by the RCOG
– Y/N?

Key points

• Outpatient hysteroscopy (OPH) is a procedure carried out in the
outpatient clinic that involves examination of the inside of your uterus
(womb) with a thin telescope.

• There are many reasons why you may be referred for OPH, such as to
investigate and/or treat abnormal bleeding, to remove a polyp seen on a
scan or to remove a coil with missing threads.

• The actual procedure usually takes 10–15 minutes. It can take longer if
you are having any additional procedures.

• You may feel pain or discomfort during OPH. It is recommended that you
take pain relief 1–2 hours before the appointment.

• If it is too painful, it is important to let your healthcare
professional know as the procedure can be stopped at any time.

• You may choose to have the hysteroscopy under general anaesthetic. This
will be done in an operating theatre, usually as a daycase procedure.

• Possible risks with hysteroscopy include pain, feeling faint or sick,
bleeding, infection and rarely uterine perforation (damage to the wall of
the uterus). The risk of uterine perforation is lower during OPH than
during hysteroscopy under general anaesthesia

 

Yours faithfully,

 

Katharine Tylko-Hill

 

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