Miscarriage in the Emergency Department: A Guideline for Emergency Room Nurses in the Emotional Care of the Miscarrying Patient

Problem: Fifteen percent of all pregnancies end in miscarriage and many of the women experiencing a miscarriage will seek treatment in an emergency department. Those who seek care in the emergency department may receive adequate medical management, but the staff is ill-prepared to handle the emotional and psychosocial aspects of the miscarriage leading to patients feeling marginalized and that their loss is dismissed as unimportant. The purpose of this project was to create a guideline to assist nurses with the emotional needs of the patients who had a miscarriage in the emergency department, regardless of their access to a dedicated bereavement specialist. Methods: This project utilized a rural and an urban emergency department within an organization and identified what care was currently being provided, available resources, and what barriers exist to caring for this patient population. Using the identified information, a standard work guideline, miscarriage flowchart, and educational PowerPoint were developed. The miscarriage packet was created and contained the miscarriage flowchart, standard work, bereavement, discharge teaching tips, and necessary documents that were required by the healthcare organization and the State of Utah. The nursing staff was educated on the miscarriage packet and then the packet was implemented. A feasibility survey was developed and sent to emergency room nursing staff after one month of implementation of the miscarriage packet. The analysis of the feasibility survey evaluated whether the guideline assisted nurses with the emotional needs of their patient, required any changes or additions, and if it was feasible to implement it throughout the organization. Key Findings: In the emergency room, 90% of the nursing staff have cared for patients experiencing a miscarriage and 61.5% indicated barriers to providing care which included a lack of bereavement education. From the survey results, a Standard Work Guideline and a Miscarriage and Fetal Demise flowchart were developed and placed in a Miscarriage Packet. The Miscarriage Packet was implemented in the rural and urban emergency departments to increase the comfort levels of nursing staff when they were caring for patients experiencing a miscarriage. Conclusion: Providing education and the Miscarriage Packet within the emergency department simplified the complex process of caring for a patient with a miscarriage or fetal demise. The miscarriage packet allowed the nursing staff to focus on providing care for the patient rather than searching for necessary documentation and bereavement education allowed the nursing staff to provide emotional care without requiring access to a bereavement specialist. An unintended consequence of the project included delineation of the roles and responsibilities of the emergency department and the labor and delivery unit during a miscarriage or fetal demise. Eighty percent of surveyed staff indicated that they felt the Miscarriage Packet was feasible to implement throughout the entire organization without any changes to education or packet contents; however, 83% of surveyed staff did not take care of a patient experiencing a miscarriage or fetal demise while the project was being implemented. Further evaluation is needed to determine feasibility, usability, and acceptability of the miscarriage guideline and packet.