Effective Date: 
Wed, 09/01/2010
Wed, 01/10/2018
Wed, 01/10/2018

This procedure outlines the situations in which the RN may provide a contraceptive refill to patients without a clinician visit.
Three Month Contraceptive Recheck

  • Patients started on a hormonal contraceptive by a UCSC Student Health Center clinician, who have never taken a contraceptive before, receive a 3 month initial prescription. These patients are required to make an RN appointment in the third month for BP check and contraceptive review in order to receive a subsequent 9 month supply.
  • Review with the patient any concerns or questions they may have about their contraceptive.
  • Specifically ask how often they have missed their pill or forgotten to change their patch or their contraceptive ring.
  • Ask about breakthrough bleeding and other side effects.
  • Check blood pressure. If BP is >120 or >80 twice with 15 minutes between readings, refer for clinician evaluation.
  • Check patient weight. If weight has changed more than 10% up or down, refer for clinician evaluation.
  • If there are no concerns or abnormal vital signs, RN may refill contraceptive for an additional 9 month supply.

Contraceptive Refill prior to scheduled Annual GYN

  • A patient scheduled for a GYN exam who has run out of her contraceptive, but is still taking her current contraceptive pack may have a refill adequate to take her to the date of her GYN appointment.
  • If a patient has stopped her hormone contraceptive because she ran out of medication initiate the COPE standardized procedure.

Contraceptive Refill for Rx from another provider
RN assists patient to contact the original prescribing provider to have a prescription faxed or transferred to a local pharmacy. In some situations, the RN may use the COPE procedure to continue a contraceptive pending clinician appointment.

Experience, Training and/or Education

  • Current CA RN license
  • Completion of the UCSC Student Health Center orientation specific to this procedure

Evaluation of Competency
Initial Competency

  • Observes experienced RN using this procedure at least 3 times.
  • Demonstrates correct use of this procedure under direct RN supervision at least 3 times.
  • Submits a minimum of 5 additional chart notes demonstrating correct 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
Requires no direct clinician supervision

Criteria for Provider Consultation and/or Referral
Clinician referral is required prior to contraceptive refill for students with:

  • Any medication alert requires documented clinician consult.  The consulting clinician co-signs the visit note and the prescription is written in that clincians name.

  • elevated blood pressure,

  • greater than 10% change in weight,
  • abdominal pain, chest pain, new or different headaches, visual changes or severe leg pains (as delineated by the “ACHES” parameters)
  • RNs assessment that refill is not straightforward
  • RN consults with clinician for any contraceptive not on the RN Standardized Procedure Medication list.

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