Background Hyperemesis gravidarum occurs in less than 1% of pregnancies1 but causes significant morbidity and burdens inpatient gynaecology services. Best-practice advice is based on expert opinion as no national guidelines on management exist. This audit examined the management of women admitted with hyperemesis against hospital guidelines based on best-evidence expert advice.
Methods Women admitted with a diagnosis of ‘hyperemesis’ over a retrospective 6 month period were identified. Hospital guidelines on hyperemesis management were examined and 62 auditable data points identified. The medical records, discharge summaries, drug charts, and investigations of each admission were studied accordingly.
Results 108 admissions over six months were identified, accounting for 291 bed days. Average duration of admission was two days. A significant number of women were re-admitted more than once. Correct admission investigations (15–65%) were often missed. Ward-based monitoring (10–57%) and the provision of advice to patients (2–9%) was poor. Recommended medications were often omitted (12%) or misprescribed (8–43%).
Key Messages Multiple areas of weakness in management were identified. A route-cause analysis was performed and extensive changes to the guidelines were made, patient information leaflets were written and education of the MDT was undertaken as a result. A re-audit was planned to assess the impact of these interventions.
Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011 Jun 17;342:d3606. doi: 10.1136/bmj.d3606