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

The request was successful.

Katharine Tylko-Hill

Dear Royal Cornwall Hospitals 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 (ROYAL CORNWALL HOSPITALS NHS TRUST), Royal Cornwall Hospitals NHS Trust

Dear Ms Tylko-Hill

FREEDOM OF INFORMATION ACT 2000 - INFORMATION REQUEST Ref:  5827

Thank you for your request for information as detailed below (if I have
misunderstood any part of your request, please let me know as soon as
possible, otherwise I shall continue to retrieve the information as
outlined):

 

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?

[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? 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?
[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?

 

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.

 

Your request was received on  18^th March 2019 and I am dealing with it
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In the meantime, please do not hesitate to contact me if you have any
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Yours sincerely

 

Jemma Dunstan

Information Governance Team

 

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FOI (ROYAL CORNWALL HOSPITALS NHS TRUST), Royal Cornwall Hospitals NHS Trust

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Dear  Katharine Tylko-Hill

 

FREEDOM OF INFORMATION ACT 2000 - INFORMATION REQUEST Ref:  5827

Your request for information has now been considered and the response is
attached.

 

If you have any queries or concerns then please do not hesitate to contact
me (please remember to quote the reference number above in any future
communications).

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Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ or
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Generally, the ICO cannot make a decision unless you have exhausted the
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The Information Commissioner can be contacted at:

Information Commissioner's Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

SK9 5AF

 

Telephone: 0303 123 1113 or 01625 54 57 45

[3]www.ico.gov.uk

 

Yours sincerely

Jemma Dunstan 

 

Please note with immediate effect, the RCHT Freedom of Information email
address has changed to [4][Royal Cornwall Hospitals NHS Trust request email]  I would be most grateful if
you could please update your records to ensure that any future
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