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Nurses raise concerns with CQC over complex abortion training

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Nurses at a West Midlands women’s hospital that was rated “requires improvement” by inspectors have said they need more guidance and training to address the emotional needs of patients undergoing complex abortions.

During a visit to Birmingham Women’s Hospital NHS Foundation Trust by the Care Quality Commission in April, inspectors found areas of good care but noted concerns about its termination of pregnancy services.

“Several nurses across termination of pregnancy services expressed concerns to us as they had not received training that would equip them to deal with the physical and emotional aspects of advanced gestation abortions,” said the CQC’s report on the trust, published last week.

Nurses working in these services told inspectors they had “no agreed differential care pathways,” it added.

”Nurses… expressed concerns they had not received training that would equip them to deal with the physical and emotional aspects of advanced gestation abortions”

CQC report on Birmingham Women’s Hospital Foundation Trust

“They needed guidance in best practice and sensitive management care of a foetus where the patients’ emotional and psychological needs may significantly differ due to the reason for the decision to terminate the pregnancy,” said the report.

Nurses also told inspectors that the complex abortion care service staff did not “have a presence” on the ward and there was no written guidance for staff and no training plan.

The CQC said the organisation must “identify, monitor and mitigate all risks relating to developing the complex abortion service pathway”, in particular the impact on staff and patients of distressing elements of late gestation termination.

It must also provide training to ward staff caring for patients with complex abortions about the appropriate procedures for late gestation termination of pregnancy in cases where the foetus may be indicating signs of life, said the CQC.

Inspectors also found that neonatal staffing levels did not meet the British Association of Perinatal Medicine’s recommended nurse to patient ratio.

”[The trust must] identify, monitor and mitigate all risks relating to developing the complex abortion service pathway”

CQC report on Birmingham Women’s Hospital Foundation Trust

However neonatal staff worked extra hours to fill gaps on the staffing rota, “which ensured care and treatment was delivered in a timely manner”, said the report.

In surgery, gynaecology and termination of pregnancy services, staff felt there was little support from the central trust teams, such as those overseeing governance or nursing.

“During the junior doctors strike, staff complained of being unsupported practically with medical shifts and experienced difficulty gleaning information from the human resources department with shift rotas,” said the report.

In surgery and gynaecology services, inspectors observed several occasions where infection control practices were not followed.

In one case, a member of staff helped a patient with a wound drain and catheter, before serving patients at lunch - without cleaning their hands.

“We feel the rating of ‘requires improvement’ is an accurate reflection of where we currently are on our improvement journey”

Sarah-Jane Marsh 

However, overall, patients received care in a “visibly clean and suitably maintained environment”, the report concluded.

The trust was rated as “good” for being caring and safe, and “requires improvement” for being effective, responsive and well-led. The trust’s inpatient maternity service was rated as “outstanding”.

CQC chief inspector of hospitals, Professor Sir Mike Richards, said: “Our inspectors found that some improvements were needed at Birmingham Women’s NHS Foundation Trust but we also observed many areas of good care across several departments.”

Staff were committed and passionate about their work and proud of the services they offered to patients, he added.

Trust chief executive Sarah-Jane Marsh said: “We very much welcome our CQC report and feel the rating of ‘requires improvement’ is an accurate reflection of where we currently are on our improvement journey.”

Staff working in the trust’s complex abortion care service were due to receive specialist training, she said

“We will work tirelessly on the actions we need to put in place to ensure that all women get the services they deserve and feel confident that together we can achieve outstanding care for each and every woman we look after,” she added.

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Readers' comments (1)

  • How sad to be reminded of the emotional problems women are experiencing and sad that women are not informed of the physical and emotional effects of abortion,especially late terminations. It is bad too that staff are emotional affected. Can no one see that killing a child, inside or outside the womb is a very emotive thing? Can no one see what effects will be fore ever?. The grief and guilt that many be felt, especially if the woman cannot conceive another child at a later time. We need to give FULL advice of the risks to all concerned in terminations and help to women choose life rather than deathfor the babe in their womb

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