Integrated Sexual Health Services MMPR012 CONTRACEPTIVE INJECTION PROTOCOL Page 1 f 8
Table f Cntents Why we need this Prtcl... 3 What the Prtcl is trying t d... 3 Which stakehlders have been invlved in the creatin f this Prtcl... 3 Any required definitins/explanatins... 3 Key duties... 4 The Medicines Management Cmmittee... 4 The Medical Directr... 4 Clinical Directr s... 4 ISHS staff... 4 Prtcl detail... 4 Client Attends Clinic / Venue... 4 Prviding Infrmatin fr Clients: Cntraceptin Injectin explained... 5 Administering the Cntraceptive Injectin... 5 Repeat / return visits... 6 Training requirements assciated with this Prtcl... 6 Mandatry Training... 6 Specific Training nt cvered by Mandatry Training... 6 Hw this Prtcl will be mnitred fr cmpliance and effectiveness... 6 Equality cnsideratins... 6 Dcument cntrl details... 8 Page 2 f 8
Why we need this Prtcl Integrated Sexual Health Services (ISHS) welcmes all clients and we respect all persnal beliefs and life chices. We aim t serve everyne equally and we wrk hard t eliminate any disadvantages faced in respect t gender, age ethnicity, disability, sexuality r any health inequalities. Carers/interpreters/chapernes are welcme t attend the cnsultatin at the request f the client. The trust is happy t prvide this service, althugh prir ntificatin may be required. ISHS will be prvided t meet the individual clients needs. The cntraceptive injectin cntains 150mg f Medrxyprgesterne Acetate. It is ver 99% effective. What the Prtcl is trying t d The purpse f this prtcl is t describe the prcess fr ISHS staff t prvide cntraceptive injectins within the clinics. It Fllws the Faculty f Sexual and Reprductive Healthcare Guidance Prgestgen- Only Injectable Cntraceptin (Updated June 2009) UK Medical Eligibility Criteria fr Cntraceptive Use (2009) NICE Guidance CG30 Lng Acting reversible Cntraceptin (Octber 2005) Specific Prduct Characteristics fr Dep Prvera NMC Standards fr Medicines Management Which stakehlders have been invlved in the creatin f this Prtcl ISHS prtcl grup MMC Any required definitins/explanatins NHFT - Nrthamptnshire Healthcare NHS Fundatin Trust MMC Medicines management Cmmittee FPA Family Planning assciatin FSRH Faculty f Sexual and Reprductive Healthcare NMC Nursing & Midwifery Cuncil LMP - Last menstrual Perid BP - Bld Pressure CVD Cardi Vascular Disease BMI Bdy mass Index Page 3 f 8
BMD Bne Mineral Density INP Independent nurse Prescriber Key duties The Medicines Management Cmmittee Will review and apprve the prtcl Is respnsible fr the implementatin and disseminatin f this prtcl The Medical Directr Is respnsible fr the disseminatin f this prtcl as apprpriate t their Clinical Directrs and Clinical Tutrs Clinical Directr s Are respnsible fr the disseminatin and implementatin f the prtcl in their service areas as apprpriate ISHS staff Are respnsible fr fllwing this prtcl when prviding cntraceptive injectins within the clinics Prtcl detail Client Attends Clinic / Venue Histry: Take a histry and dcument this in client Lilie recrd n histry new/histry review/ under 16 histry new template ensuring that valid cnsent is btained and dcumented. Minimum histry t be taken: Age LMP Plans fr children in the near future; Duratin f use f injectin t date; Family histry f Osteprsis Persnal medical histry: Exclude relevant medical histry (including liver disease, trphblastic disease, breast cancer, prphyria, abnrmal vaginal bleeding, SLE, CVD); Multiple risk factrs fr CVD including smking, diabetes, hypertensin; Risk factrs fr steprsis; Histry f severe depressin (requiring treatment r hspitalisatin); Any knwn allergies Page 4 f 8
Drug histry: Prescriptin/ver the cunter Examinatin: recrd BP, weight (in kg), height (in cms) and BMI Full cunselling shuld be given abut the risks f the Dep Prvera injectin and dcumented see FSRH Guidance (June 2009). Give the mst up t date FPA Cntraceptin Injectin leaflet. Injectin, Dep Prvera t be prescribed by dctr/inp and t be administered by a nurse wh has been deemed cmpetent t administer intramuscular injectins. Prviding Infrmatin fr Clients: Cntraceptin Injectin explained G thrugh the leaflet with the client making sure she understands the fllwing: Hw the injectin wrks Starting regime and timing f injectin at every 12 weeks Injectin site and risk f infectin at injectin site Hrmnal side effects: bleeding/amenrrhea, ability t tlerate side effects fr lifespan f injectin Pssible delay in return t fertility Safety: including effects n bne mineral density, an assessment if BMD risk and review f methd shuld be made every 2 years as per Faculty guidance. Benefits Safer sex (sexually transmitted infectin and ffer cndms) Advise t return befre scheduled appintment if any cncerns r side effect Administering the Cntraceptive Injectin Cmmence methd when pregnancy risk has been excluded r during 1 st 5 days f menstrual cycle Observe standard precautins fr infectin cntrl Check expiry date and recrd with batch number in client recrds. Shake the preparatin and give injectin intramuscularly int the upper uter quardrant f buttck. If very bese cnsider giving injectin in the Deltid muscle at dctr/nurses discretin. Advise client t make next appintment fr 12 weeks time. ( The injectin may be given between 10 & 14 weeks f previus injectin if patient cannt attend at 12 weeks). Explain she may return befre 12 weeks if experiencing any prblems r if she has any cncerns r develps majr illness and there is a change in their persnal, medical r family histry. Page 5 f 8
Repeat / return visits Review histry, (changes t medical histry, family medical histry), satisfactin with methd, new symptms and dcument in her recrds. Check bld pressure and weight at least annually. Late fr injectin refer t FSRH Prgestgen-nly injectable guidance June 2009 Training requirements assciated with this Prtcl Mandatry Training There is n mandatry training assciated with this prtcl. Specific Training nt cvered by Mandatry Training Ad hc training sessins based n an individual s training needs as defined within their annual appraisal r jb descriptin. All nurses and dctrs wrking under this prtcl will hld a relevant sexual and reprductive healthcare qualificatin Hw this Prtcl will be mnitred fr cmpliance and effectiveness The table belw utlines the Trusts mnitring arrangements fr this dcument. The Trust reserves the right t cmmissin additinal wrk r change the mnitring arrangements t meet rganisatinal needs. Aspect f cmpliance r effectiveness being mnitred Methd f mnitring Individual respnsible fr the mnitring Mnitring frequency Grup r cmmittee wh receive the findings r reprt Grup r cmmittee r individual respnsible fr cmpleting any actins Duties T be addressed by the mnitring activities belw. Prtcl prcess fllwed Audit f 50 patients recrds frm acrss the service Cnsultant fr Integrated Sexual Health Services Every 2 years ISHS prtcl grup. Service Lead grup. MMC ISHS prtcl grup Where a lack f cmpliance is fund, the identified grup, cmmittee r individual will identify required actins, allcate respnsible leads, target cmpletin dates and ensure an assurance reprt is represented shwing hw any gaps have been addressed. Equality cnsideratins Refer t MMP001 Cntrl f Medicines Plicy Page 6 f 8
Reference Guide FSRH 2009 The UK Medical Eligibility Criteria fr Cntraceptive Use www.fsrh.rg/pdfs/ukmec2009.pdf FSRH 2009 Prgestgen-nly Injectable Cntraceptin www.fsrh.rg/pdfs/ceuguidanceprgestgen OnlyInjectables09.pdf FSRH 2012 Drug Interactins with hrmnal cntraceptin www.fsrh.rg/pdfs/ceuguidancedruginteractinshrmnal.pdf Page 7 f 8
Dcument cntrl details Authr: Dr D Cusins Gill Black Apprved by and date: 15.11.16 Respnsible cmmittee: Medicines Management Cmmittee Any ther linked Plicies: MMP001 Cntrl f Medicines prtcl ICP002 standard precautin Prtcl Prtcl number: MMpr012 Versin cntrl: 1 Versin N. Date Ratified/ Amended Date f Implementatin Next Review Date 1 15.11.16 15.11.16 30.11.18 Review Reasn fr Change (eg. full rewrite, amendment t reflect new legislatin, updated flwchart, minr amendments, etc.) Page 8 f 8