CONTRACEPTIVE OPTIONS PRIOR TO EXAM (COPE) - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Tue, 02/07/2017

Rapid, easy access to contraception for young women is critical to preventing unintended pregnancy. This standardized procedure allows RNs to provide a 3 month supply of contraceptives to young women who do not have contraindications to use of hormonal contraception. Women at risk of pregnancy are also at risk of sexually transmitted infections. This procedure uses the opportunity of a discussion on contraception to educate,  assess, and  order testing for sexually transmitted infections for this at-risk patient group.

Procedure
Patient makes an appointment for a COPE visit with RN.
At time of scheduling appointment, patient support staff will direct patient to on-line or other resources for contraceptive education and STI Risk assessment. Patient is encouraged to use these resources in preparation for their COPE appointment. Patient support staff instructs patient to complete the on-line COPE medical history prior to the appointment.

At Appointment:
 RN reviews the medical history form, paying particular attention to the mandatory fields.
 Patients with a relative or absolute contraindication to hormone contraception are referred for a clinician visit. Barrier methods of contraception are reviewed and encouraged pending clinician visit.
 Patient with no contraindication to hormone contraception are educated on their contraceptive options
 RN takes patient’s vital signs. Blood pressure readings with systolic >120 or diastolic >80 at two readings separated by 30 minutes require referral to clinician for contraception.
 RN assesses risk for current pregnancy: date of LMP, SIC without protection since LMP, missed LMP. Pregnancy testing is ordered as indicated by assessment. Positive pregnancy test initiates Pregnancy protocol.
 RN reviews past GYN history, including past use of contraceptives, past pregnancy, STI history, and PAP history. RN generates request for past records as indicated in preparation for clinician visit.
 RN reviews contraceptive options with the patient, presenting all available options and giving the student the opportunity to ask questions, explore concerns, and discuss each option. Choice of contraceptive is made by the patient in consultation with the RN.
 A three month supply of the chosen contraceptive is ordered under standing orders from the Medical Director using the RN Standardized Procedure Medication list.
 Using the handout specific to the patient’s chosen contraceptive, the RN instructs patient on how and when to start the contraceptive, major and minor side effects of the chosen method, how long to use a back-up contraceptive, what problems to report to a clinician and any additional appropriate material included in the specific contraceptive handout.

Quick Start criteria: (see Algorithm link above):

Patients should be instructed to start their chosen contraceptive method on the day it is dispensed. The RN assesses pregnancy risk according to the algorithm attached. The patient is instructed to begin the method on the day of the appointment and to use a back-up contraceptive for the subsequent 7 days. If they have no menses at the end of the first month, they are to return to the office for an RN visit.
 RN reviews STI risk reduction, prevention and screening. If appropriate, STI testing is ordered. RN reviews the proper use of condoms and sources of affordable condoms.
 The patient is schedule for a Birth Control Visit or annual GYN exam with a clinician 12 weeks after starting the contraceptive. Women under 21 years of age are scheduled for a Birth Control Visit. Women 21 and older are scheduled for an Annual GYN exam.

Experience, Training and/or Education
 Current RN license
 Successful completion of UCSC Student Health Center orientation specific to this procedure.
    Evaluation of Competency

Initial Competency
 Observes experienced RN implementing this procedure at least three times
 Demonstrates successful use of this procedure under direct RN supervision at least three times.
 Submits a minimum of 5 chart notes demonstrating use of the procedure to the Clinic Director for review.

On-going Competency
Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center.

Scope of Supervision
No direct supervision required.
Clinician available as needed for questions or clarifications.

Criteria for Consultation/Referral
 Women over 35 are referred for clinician appointment to discuss contraception.
 Patients are referred for clinician evaluation prior to providing contraception if they have relative or absolute contraindications to use of contraception or if they have medical problems which might complicate their use of contraceptives. All the conditions on the COPE Questionnaire are relative and/or absolute contraindications for hormone contraception.
 Patients are referred for clinician evaluation prior to providing contraception if they have persistently elevated blood pressure readings (>120 Systolic and >80 Diastolic).
 RN consults with clinician to answer questions posed by the patient which the RN is not prepared to answer.
 RN consults with clinician for any contraceptive not on the RN Standardized Procedure Medication list. (see link)

Documentation
RN documents according to the standards delineated in the UCSC Student Health Policy on Documentation of Care