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

The request was successful.

Katharine Tylko-Hill

Dear The Rotherham NHS Foundation 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

Freedom-of-Information (THE ROTHERHAM NHS FOUNDATION TRUST), The Rotherham NHS Foundation Trust

 

Dear Katharine

We are writing to acknowledge receipt Tuesday, 2 April 2019 of your
request for information under the Freedom of Information Act 2000.  Your
request has been assigned the following reference number 4725 please could
you quote this reference number in any future correspondence relating to
your request.

We will endeavour to respond to your request at the earliest opportunity
within the statutory 20 working day (30 April 2019) time limit subject to
the following constraints:

(a) The Freedom of Information Act 2000 defines a number of exemptions,
which may prevent the release of the information you have requested. If
any of the exemption categories apply, the information will not be
released to you and we will advise you accordingly, including your rights
of appeal.

(b) If the information you have requested contains reference to a third
party, we will consult with them prior to making a decision on whether to
release the information to you.  

Further information is also available from the Information Commissioner
at:

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

SK9 5AF

Telephone: 0303 123 1113

Website: [1]www.ico.org.uk

If we can be of any further assistance in the meantime, please do not
hesitate to contact us.

Yours sincerely

 

Freedom of Information Office

The Rotherham NHS Foundation Trust

 

 

show quoted sections

Freedom-of-Information (THE ROTHERHAM NHS FOUNDATION TRUST), The Rotherham NHS Foundation Trust

Dear Katharine

 

Further to our email below, please note due to a miscalculation which
excluded bank holidays the correct statutory 20 working day time limit
date is 2 May 2019.

 

Yours sincerely

 

Freedom of Information Office

The Rotherham NHS Foundation Trust

 

 

From: Freedom-of-Information (THE ROTHERHAM NHS FOUNDATION TRUST)
Sent: 02 April 2019 14:22
To: Katharine Tylko-Hill
Cc: Freedom-of-Information (THE ROTHERHAM NHS FOUNDATION TRUST)
Subject: 4725 FOI - Re: Hysteroscopy/Biopsy

 

 

Dear Katharine

We are writing to acknowledge receipt Tuesday, 2 April 2019 of your
request for information under the Freedom of Information Act 2000.  Your
request has been assigned the following reference number 4725 please could
you quote this reference number in any future correspondence relating to
your request.

We will endeavour to respond to your request at the earliest opportunity
within the statutory 20 working day (30 April 2019) time limit subject to
the following constraints:

(a) The Freedom of Information Act 2000 defines a number of exemptions,
which may prevent the release of the information you have requested. If
any of the exemption categories apply, the information will not be
released to you and we will advise you accordingly, including your rights
of appeal.

(b) If the information you have requested contains reference to a third
party, we will consult with them prior to making a decision on whether to
release the information to you.  

Further information is also available from the Information Commissioner
at:

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

SK9 5AF

Telephone: 0303 123 1113

Website: [1]www.ico.org.uk

If we can be of any further assistance in the meantime, please do not
hesitate to contact us.

Yours sincerely

 

Freedom of Information Office

The Rotherham NHS Foundation Trust

 

 

show quoted sections

Freedom-of-Information (THE ROTHERHAM NHS FOUNDATION TRUST), The Rotherham NHS Foundation Trust

1 Attachment

 

 

Dear Katharine                                   

 

Thank you for your request for information dated 2 April 2019 under The
Freedom of Information Act 2000 (the FOI Act).

 

Decision:

 

The Rotherham NHS Foundation Trust does hold the information that you have
requested and has decided to release the information requested;

 

Your request: Our response:

   
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? 1.a)   Yes

b) Have your hysteroscopy managers read the following  
statement – Y/N?
 
[1]https://www.rcog.org.uk/en/guidelines-re...
b)      Yes
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/? a)   No
N b) under regional anaesthetic – Y/N? c) with IV
sedation? Y/N? b)   No

  c)   No
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? a)   No

  b)   No

c)   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 – Y/N? Yes

 
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? a)   No

  b)   No

 
6. Does your hysteroscopy department send all its  
patients the RCOG’s Patient Information Leaflet,
published on its website - Y/N? No
[2]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? Yes.  This will be
reviewed within
  the next 2 months
8. If your hysteroscopy department uses its own Patient Yes
Information Leaflet, please may I have a link to it?
Please see
  attached
9. Does the leaflet include ALL the key points listed  
(below) by the RCOG – Y/N? –
Yes
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.
 
• You may feel pain or discomfort during OPH. It is
recommended that you take pain relief 1–2 hours before Yes
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.
Yes
• You may choose to have the hysteroscopy under general
anaesthetic. This will be done in an operating theatre,  
usually as a day-case procedure.
Yes
• 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
No
 
 

 

Yes

 

We hope the above information satisfies your request

 

If you consider that your request for information has not been properly
handled or if you are otherwise dissatisfied with the outcome of your
request, you can try to resolve this informally with the person who dealt
with your request.

 

If you remain dissatisfied, you may seek an internal review within The
Rotherham NHS Foundation Trust of the issue or the decision. A senior
member of the Trust’s staff, who has not previously been involved in
collating the response to your request, will undertake that review.
Requests for an internal review must be submitted within two months of the
date of receipt of this response and should be addressed to:  The Freedom
of Information Office [3][email address]

 

 

If you are dissatisfied with the outcome of any internal review conducted
by the Trust, you may complain to the Information Commissioner for a
decision on whether your request for information has been dealt with in
accordance with the FOI Act. The Information Commissioner can be contacted
at:

 

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

SK9 5AF

 

Telephone: 0303 123 1113

Website: [4]www.ico.org.uk

 

Copyright Notice:

 

We would like to take this opportunity to remind you that information
disclosed under the Freedom of Information Act is still protected by
copyright laws. The disclosure does not give you ‘the applicant’ the right
to breach the copyright of the copyright holder.

 

Any information provided is the property of The Rotherham NHS Foundation
Trust and subject to Intellectual Property and Database Rights.   Any
commercial application or use of this information will be subject to the
provisions of the Re-use of Public Sector Information Regulations 2005.
This means that if you wish to re-use the information provided for
commercial purposes for any reason you must ask us for permission to do
so.

 

The information provided to you from The Rotherham NHS Foundation Trust
should not be used to construct a database for direct marketing purposes
and unsolicited emails infringing the copyright in the material provided
or otherwise processed in contravention of the rights of the named
individuals under the Data Protection Act unless you have our explicit
permission separate to this FOI request.

 

To do so you will need to apply to:

The Rotherham NHS Foundation Trust

Moorgate Road

Rotherham

South Yorkshire

S60 2UD

 

Or via e-mail at:  [5][email address]

 

 

Yours sincerely

   

Freedom of Information Office

The Rotherham NHS Foundation Trust

 

 

 

 

show quoted sections