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Advice to the Profession: Induced Abortion Care

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What are the staffing requirements for abortion care premises?

Care in the OHP must comply with the National Association of PeriAnesthesia Nurses of Canada  Standards for Practice, including requirements for appropriate staffing, discharge of patients from recovery phases, documentation of care in the patient record, and appropriate discharge instructions.

In an abortion care premises, if the physician performing the procedure has determined that the patient is alert, oriented, and responsive to commands, and is deemed to no longer be sedated, it may be appropriate for a Registered Practical Nurse (RPN) to care for the patient in Recovery Phase 1 with the presence of a Registered Nurse (RN) onsite.

Where this is the case, an RN should only have one responsibility at a time (e.g. monitoring a patient during a procedure or monitoring a patient in recovery).

Are patients always required to be accompanied by an adult when leaving abortion care premises post-procedure?

It is the widely accepted practice in Ontario that patients who receive sedation, and in particular intravenous sedation, for a procedure are accompanied home by an adult when leaving the premises post-procedure. They also need to avoid driving a motor vehicle or operating complex machinery for 24 hours. Deviating from this standard can put patients and others at risk.

However, in the context of abortion care, there may be circumstances where requiring adult accompaniment could jeopardize access. In these circumstances, it may be appropriate for a patient to leave without adult accompaniment. Any decision to allow patients to leave without accompaniment needs to be weighed carefully by the physician, with patient safety as the primary consideration.

Physicians who make such exceptions will need to clearly document the circumstances, the instructions given, and arrangements made with the patient.

Patients will need to be given a 24-hour contact number for the clinic or a trained abortion provider on behalf of the clinic and encouraged to call this number first for any problems.

What other resources or guidelines do abortion care premises and providers need to be aware of?

The National Abortion Federation’s Clinical Policy Guidelines for Abortion Care sets out guidance for facilities to use in establishing their clinical policies. Abortion care providers need to be aware of the Standards set out in this document and comply with them where applicable.