Appendix C. Detail on criteria for audit of the use of fluid-filled thermal balloon and microwave endometrial ablation techniques for heavy menstrual bleeding

Appendix C. Detail on criteria for audit of the use of fluid-filled thermal balloon and microwave endometrial ablation techniques for heavy menstrual bleeding

Possible objectives for an audit

An audit on the treatment of women with heavy menstrual bleeding (HMB) could be carried out to ensure the following, when surgery is considered appropriate for the management of the condition

  • Thermal balloon endometrial ablation (TBEA) and microwave endometrial ablation (MEA) are being offered as treatment options.

  • Women with HMB are involved in the choice of treatment.

Possible patients to be included in the audit

An audit on the treatment of women with HMB could be carried out on women referred for surgical Measures that could be used as a basis for an audit

Measures that could be used as a basis for audit

The measures that could be used in an audit of TBEA and MEA are as follows.

Criterion

Standard

Exception

Definition of terms

1. The woman is offered TBEA and MEA as treatment options

100% of the women in the audit.

A. The woman has contraindications for TBEA and MEA as follows:

For TBEA:

(1) the woman's uterine cavity is large or irregularly shaped or

(2) the woman has a latex allergy (for Thermachoice) or

(3) the woman has had uterine surgery that has left a scar where the uterine wall is less than 8 mm thick or (4) the woman has had a classical caesarean section.

For MEA:

(1) the woman has had uterine surgery that has left a scar where the uterine wall is less than 8 mm thick or (2) the woman has had a classical caesarean section

Clinicians will need to agree locally on how the offer of the option of TBEA and MEA is documented for audit purposes.

A large uterine cavity is > 10 cm from the internal os to the fundus for Cavaterm and > 12 cm in length for Thermachoice.

'Classical caesarean section' means that the procedure was done with a vertical midline incision in the upper segment of the uterus.

2. The woman and the clinician responsible for treatment decide jointly on the choice of treatment for HMB after an informed discussion of

a. the woman's desired outcome of the treatment and

b. the relative benefits of all the treatment options and the adverse events associated with them and

c. the clinical condition, anatomical suitability and preferences of the woman.

100% of the women in the audit

None

terms

Clinicians will need to agree locally on all other treatment options and the adverse events associated with them and on how an informed discussion is documented for audit purposes.

The clinician responsible for treatment is ordinarily the specialist gynaecologist.

For 2a, desired outcomes could be normal reduced bleeding or complete cessation of menstrual bleeding.

A locally based audit on HMB also could include measures related to previous drug treatments for HMB and to appropriateness of the use of hysterectomy.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

  • Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

  • x 100

  • Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.