1. Modernising Abortion Services……………. Nurse/Midwife Led Provision Alison Jones, Consultant Nurse Sexual Health & Teenage Pregnancy Pontypridd & Rhondda NHS Trust 28 June 2007

2. Objectives Introduction Developing nurse/midwife roles Opportunities & challenges

3. Globally Over ¼ of worlds population live in countries where abortion is strictly prohibited 19,000,000 Women have unsafe abortions annually 70,000 Women die each year from unsafe abortions 1 in 3 British Women will have an abortion

4. In Wales, England & Scotland abortion can be carried out providing that 2 registered medical practitioners agree that: (i) Up to 24 weeks: The continuance of the pregnancy would involve risk greater than if the pregnancy were terminated to the physical or mental health of the pregnant woman or any existing children in her family (ii) With no gestational limit: If termination is necessary to prevent grave permanent injury to the mental or physical health of the pregnant woman There is a risk to the life of the pregnant woman greater than if the pregnancy were terminated There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped (Abortion Act 1967, amended by the Human Fertilisation & Embryology Act 1990)

5. Note: Parliamentary debate July 2005 upheld the 24 week gestational limit. Doctors attending the BMA conference June 2005 supported maintaining the limit by 3:1.

6. Statistics (Wales & Eng) Abortions increased by 0.4% 2004-05 Teenage abortion rates unchanged 89% of abortions carried out under 13wks, less than 2% over 20 weeks (unchanged for 10 years) 84% abortions were funded/carried out by the NHS (fpa fact sheet, August 2006, publisher: Sexual Health Direct, London)

7. Modernising abortion services - national policy context All Wales Sexual Health Strategy 2006 Designed to Deliver (Wanless, 2000) RCOG Guidelines

8. Modernising abortion serviceslocally Modernising abortion services locally Working together: multi professional, multi-organisation Identifying the need for change Organisational support Risk assessment, professional & legal liability Clearly specified purpose, roles & responsibilities

9. Principles of Nurse / Midwife Role Development  focused on empowering nurses/midwives to develop knowledge & skills for the benefit of patient care.  avoiding ad hoc acquisition of technical skills or inappropriate delegation of unpleasant/unwanted tasks by other professional groups.

10. Nurse/Midwives Responsibilities Nurses work within the Abortion Act when they accept delegated instructions from a registered medical practitioner & carry out treatment in accordance with his/her directions

11. Areas of nurse/midwife role development Ultrasound assessment of gestational age Pre & post abortion counselling Administration of abortificants Discharging patients Vaginal/speculum examination Assessment for & provision of contraception Obtaining consent for abortion procedures

12. Obtaining consent for abortion procedures ……..exceptions Under 16 unaccompanied by an adult with parental responsibility The woman does not understand the procedures The woman is unsure The woman has bleeding / pelvic pain A medical condition that is contraindicated The nurse/midwife deems it unsafe

13. Areas of nurse/midwife role development …….. Competency Framework Identifies qualifications, experience & training Registered Nurses & Midwives require to enable competent safe practice Provides methodology to quality assure through assessment & audit

14. Modernisation….. developing a dedicated service: Specified referral process Developing & enhancing expertise Responsive to individual needs Easily accessible for ongoing care ‘One stop shop’ / community settings Speedier initial consultation One to one holistic assessment ‘sexual health’ perspective High levels patient satisfaction Positive effects on other services

15. Challenges…….  Primary legislation  Interface between primary & secondary care  ‘Cutting edge’. Expect the unexpected ……..  Sustainability

16. Checklist for service development Working together! Clear identification of need Policy statement, protocols & procedures Education & training package Assessment – theoretical & practical Audit Identifying & acting on clinical incidents Maintenance of competence Identifying opportunity for continued development

17. Thank you Alison Jones Pontypridd & Rhondda NHS Trust Alison-g.jones@pr-tr.wales.nhs.uk 01443 443443 ext 4246