Margaret Hull

Date of Award


Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chair

Susan Alexander


Medical records--Data processing, Women--Health and hygiene, Self-care (Health), Pessaries


Pelvic floor dysfunction is a significant quality of life concern. Use of a pessary, a vaginal support device, may improve symptoms associated with this condition. While pessaries are an effective and low-risk management of the problem, complications can occur. Little data exists to define recommendations for follow-up to reduce complications. This quality improvement study was completed in two steps. A baseline evaluation was completed to determine the complication rate among pessary users within an urogynecology practice at a large tertiary care center. Via a retrospective chart review, data collected included kept and missed appointments, use or nonuse of local estrogen, development of complications, and self-management versus clinician management of the device. Part two involved the implementation of a tracking system utilizing the electronic health record. With the help of health IT personnel, monthly lists were generated to track patients who received a pessary, patients who missed pessary maintenance appointments, and patients who developed the complication of vaginal erosion secondary to pessary use. Upon receipt of monthly lists, the project developer and clinic staff contacted patients who missed the follow-up appointments to offer a new appointment. This strategy ensured that patients were not lost to follow-up and received the care needed with pessary use. Baseline statistics indicated a 3.8% pre-tracking and 10.9% tracking rate of complications. No associations were noted among this cohort regarding age, scheduled first follow-up appointments, and missed first follow up appointments. However, the total number of missed appointments improved over time (28.5 % among pre-tracked patients and 12.7 % among tracked patients). The tracking system worked and indicated a robust system can capture missed erosions, create consistency in care, and possibly reduce the development of more serious complications.



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