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Abstract

Background: Clinical pathways in emergency departments (ED) are designed to standardize patient care and reduce variability in clinical practice. In a rural hospital setting, the ED management of RhoGAM administration in pregnant patients with vaginal bleeding varied by provider with no standard of care achieved. This approach raised concerns about potential patient safety issues.

Methods: In response, the local emergency department medical director, in conjunction with local perinatal providers developed a clinical pathway to standardize care and optimize RhoGAM administration. The clinical pathway was implemented to the local ED providers over a three-month period. Retrospective chart review for Type and Screen and RhoGAM administration was conducted over the implementation period.

Results: Over a three-month period, 54 charts of patients presenting with vaginal bleeding and pregnancy were reviewed. Of these, 27 patients had a positive pregnancy test while 23 had a negative test and 4 did not have testing performed. Blood typing and screening were either completed or previously documented for nearly all patients, with 29 new type and screen results returned. Only one Rh-negative patient received RhoGAM, and administration was based on appropriate clinical criteria. Weekly chart reviews confirmed adherence to the pathway, and targeted education was provided in cases of deviation. Overall, the pathway improved appropriate RhoGAM administration and ensured evidence-based utilization in the local ED.

Conclusion: Implementation of a clinical pathway for RhoGAM administration in the local ED has the potential to standardize care for Rh-negative pregnant patients and improve appropriate RhoGAM administration.

Keywords: Clinical Pathways, Emergency Department, RhoGAM, Rh-negative

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