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Implementing the Pregnancy Reasonably Excluded Guide (PREG) for Pre-Surgical Pregnancy Screening
Abstract Number: F3B-399
Abstract Type: Original Research
Objective: To evaluate the success of the Pregnancy Reasonably Excluded Guide (PREG) for pregnancy assessment prior to general surgery procedures to improve the consistency of screening.
Design: The PREG was designed to accurately and efficiently screen for pregnancy prior to procedures by directing appropriate urine or serum pregnancy testing. The process allows for adult reproductive-aged women to participate in a shared-decision-making model to decide whether testing is needed. The PREG checklist includes both traditional (e.g. menopause, hysterectomy, sterilization, known pregnancy) and World Health Organization supported (contraceptive use, last menses, timing of coitus with a man) testing exclusions. Women may also simply request a pregnancy test without answering questions. We report the adoption of the PREG process in a large general surgery practice that previously had no institutionalized pregnancy screening procedure. Rates of pregnancy testing before and after implementation were evaluated.
Method: Women aged 18-51 years undergoing elective general surgery were administered the paper PREG questionnaire on the day of surgery. Nursing verbally confirmed responses privately with each woman and initiated testing as indicated by the PREG protocol. If the woman or nurse felt the patient was unable to independently read and freely respond to the PREG checklist, the patient was directed to pregnancy testing. The system provided the nurse with an order for urine qualitative pregnancy testing, or serum testing in the event a urine sample was not possible. Data was collected for 3 months prior to PREG implementation and 4.5 months after implementation with the exclusion of a 2-week interval transition period. Administrative data identified qualifying women and lab data identified pregnancy tests. Quality review provided surveillance for positive tests and missed diagnoses of pregnancy.
Results: Before implementation, 777 women were listed for surgery and 66 received pre-procedure pregnancy testing (8.49% ranging from 8.2-8.8%). After implementation, 1038 women were listed with 185 tested (17.82% ranging from 11.3-22.4%). After implementation, all patients consistently had a pregnancy assessment documented in their record. In this cohort, no pregnancies were diagnosed on the day of surgery and no failures to diagnose pregnancy were identified. Implementation of the process did not affect the average time patients spent in the preoperative area.
Conclusions: The PREG process provides an efficient, consistent method of screening for pregnancy prior to surgery in adult reproductive-aged women. In the setting where no standardized pregnancy evaluation was present, the rate of testing increased with implementation. Data collection is ongoing in larger populations and various settings which may provide support for the consistency and accuracy of the PREG system.