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

The request was successful.

Katharine Tylko-Hill

Dear Lancashire Teaching Hospitals 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 (LTHTR), Lancashire Teaching Hospitals NHS Foundation Trust

Dear Katharine,

Thank you for your request for information submitted under the Freedom of
Information Act.

In order for the trust to help with your request clarification is required
on the below point/s:

There is a problem with the link you provided for question 6, please can
you confirm the below is the leaflet you are referencing in your request?

[1]https://www.rcog.org.uk/en/patients/pati...

Once clarification has been received we will be able to advise on a date
for our response.  If no clarification has been received after 2 months
your request will be closed.

Regards,

Freedom of Information Office
Lancashire Teaching Hospitals NHS Foundation Trust
c/o The Medical Director’s Office
Royal Preston Hospital
Sharoe Green Lane
Fulwood, Preston, PR2 9HT
Email : [email address]
www.lancsteachinghospitals.nhs.uk
@LancsHospitals
Excellent care with compassion

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Katharine Tylko-Hill

Dear Freedom of Information (LTHTR),

Yes, that's the correct link, thank you.

Yours sincerely,

Katharine Tylko-Hill

Hodson Sam (LTHTR), Lancashire Teaching Hospitals NHS Foundation Trust

1 Attachment

Dear Katharine,

Thank you for your request for information submitted under the Freedom of
Information Act.  I can confirm that the trust does hold the information
requested, please see our response below & details of the review procedure
attached should you be dissatisfied with the handling of your request.

FOI Request 6394

1. a) Have your hysteroscopists read the following statement issued by the
RCOG in December 2018 - Y/N? Trust response: Yes
b) Have your hysteroscopy managers read the following statement – Y/N?
Trust response: Yes

[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 – Y/N? Trust response: No
b) under regional anaesthetic – Y/N? Trust response: Yes using local
anaesthetic.
c) with IV sedation? Trust response: No.

3. Do your hysteroscopy consent forms contain tick-boxes to enable a
patient to choose
a) GA – Y/N? Trust response: No. The Trust use consent form three, for
patients whose consciousness is not impaired.
b) regional anaesthesia – Y/N? Trust response: N
c) IV sedation – Y/N? Trust response: 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? Trust response: There is a standard
operating procedure document in place, that is currently being
re-validated . This includes instructions re- pre- and post-operative
observations and includes advise re pain management.

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS
pain-scores Trust response: N

a) as hysteroscope passes through the cervix – Y/N, Trust response: As the
patients advocate, the nurse will observe/ support and reassure patients
during the procedure. Should the patient find the procedure too
uncomfortable, it is then stopped and patients are listed for GA.
b) at biopsy – Y/N? Trust response: As above

6. Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website -
[2]https://www.rcog.org.uk/en/patients/pati...
- Y/N? Trust response: The trust sends our own leaflets which were adapted
from the above.

7. Does your hysteroscopy department intend to start using the RCOG
leaflet –
Y/N?

If so, in which month/year?
Trust response:  No, the trust is currently updating it’s own leaflet
which will incorporate the RCOG guidance.

8. If your hysteroscopy department uses its own Patient Information
Leaflet, please may I have a link to it?
Trust response: *currently under review
[3]https://www.lancsteachinghospitals.nhs.u...

9. Does the leaflet include ALL the key points listed (below) by the RCOG
– Y/N?
Key points
Trust response:  No

• 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.

Regards,

Freedom of Information Officer
Lancashire Teaching Hospitals NHS Foundation Trust
c/o The Medical Director’s Office
Royal Preston Hospital
Sharoe Green Lane
Fulwood, Preston, PR2 9HT
Email : [email address]
www.lancsteachinghospitals.nhs.uk
@LancsHospitals
Excellent care with compassion
       
Ranked #1 NHS Clinical Digital Maturity Index Acute rankings June 2018
  

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