Citation

Burnhill MS. Clin. Obstet. Gynaecol. 1986; 13(1): 145-156.

Copyright

(Copyright © 1986, Elsevier Publishing)

DOI

unavailable

PMID

3709010

Abstract

Risk management, or quality assurance, in 1st trimester abortion service delivery, is unique in medicine for having developed a systematic set of actions to prevent or mitigate medical complications as well as consequences of fires, vandalism, harassment, bombings, job actions, and counseling and administrative crises. Risk management principles should be incorporated into facility design, staff selection, equipment selection and maintenance, physician hiring and monitoring, patient screening, regular review of protocols for medical emergencies, high-risk tissue examination. Types of medical crises include cardio-pulmonary collapse, hemorrhage, visceral injury, shock, seizure, and coma. Counseling crises imply suicide or homicide threat, acute psychosis, and reactions of other clients and visitors. Under administrative crises were listed fire, threats or acute bombing, arson, or assault, power or water failures, personnel shortage, harassment, and hostile media. All types of crises are handled by developing a plan of action, training staff, repeating training regularly, and conducting drills, feedback sessions, equipment checks, and designing in security. It should be expected that medical crises will occur on the average in 1/400 terminations, which amounts to one every 2-3 years for a small clinic, or 1-2 per month for a large one. All staff, including counselors, should be able to recognize destabilizing vital signs and to do cardio-pulmonary resuscitation. Appropriate alarm signals should be prearranged to transport the patient to hospital, without concern for personal ego damage, social disruptions, lack of hospital privileges, insurance, or cost. Equipment necessary to handle medical crises is listed, as are security measures to minimize administrative crises. An example of a severe drug reaction and its efficient handling, a result of pre-planning, is detailed.

Language: en