Effect of a Quality Improvement Initiative on Procedural Abortion Pain and Anxiety Using a Standardized Patient-Focused Sedation Options Counseling Guide.

OBJECTIVE: To evaluate the effect of a quality improvement initiative on procedural abortion pain and anxiety using a standardized patient-focused sedation options counseling guide. STUDY DESIGN: We developed and implemented a patient-focused sedation options counseling guide for use across three reproductive health centers in Maine, New Hampshire, and Vermont. To evaluate the effect of the initiative, pain (0-10) and anxiety (0-5) scores were abstracted from the electronic health record for all patients who obtained procedural abortions with moderate sedation through 18 weeks of gestation (N = 362). A six-month pre/post implementation analysis was conducted examining pain and anxiety scores. To analyze differences in pain and anxiety while controlling for covariates, a hurdle model was fit with maximum intraoperative pain scores, and Poisson regression was fit with maximum full procedure anxiety scores as the outcomes of interest. RESULTS: The proportion of patients reporting no pain increased from 13.0% to 22.7% with the use of the counseling guide (p = 0.03). The median maximum intraoperative pain score decreased from 5 to 4. In the unadjusted model, use of the counseling guide decreased the odds of patients reporting any intraoperative pain by 49% (odds ratio (OR): 0.51, 95% confidence interval (CI): 0.27-0.91). The odds ratio was similar after adjustment for covariates (OR: 0.52, 95% CI: 0.26-1.04). Use of the counseling guide showed no significant effect on anxiety. CONCLUSION: We saw a reduction in procedural abortion pain after the implementation of the counseling guide. This adjunct to established pain management options is a simple improvement on current practice.