DEPO-PROVERA ADMINISTRATION

Effective Date: 
Mon, 01/02/2012
Revised: 
Wed, 01/14/2015
Policy: 

This policy clarifies the procedure for giving the injectable contraceptive Depo-Provera (Depo, DMPA).     The policy clarifies the procedure for patients who are late receiving their repeat Depo-Provera injections, allowing the nurse to provide on-going contraception by using the "quick start" algorithm (attached below).  This algorithm guides the nurse to assist women in need of on-going contraception who present after the standard 14 week (98 day) guideline for repeat injection.

Patient makes an appointment for Depo injection or is seen as a COPE RN visit. Nurse may administer Depo Provera in AIT, Same Day Clinic or by Nurse appointments

Equipment:

Injectable Contraceptive-Depo-Provera Patient Information Handout, HC266
Depo-Provera in a vial or pre-filled syringe containing 150mg DMPA per ml
21 or 23 gauge safety needle
A signed order from a Clinician at CSHC or per RN Standardized Procedure through the COPE or quick contraceptive refill procedure

 

Procedure: 

First Injection:

Assure that a signed order from a clinician at SHC is appropriately entered into the PNC medical record, or meets the criteria for COPE as per the UCSC RN Standardized Procedures.

A urine pregnancy test is done prior to the initial injection.  If it is positive, proceed with pregnancy test visit.  If it is negative, proceed with Depo injection process.

Patient reads Injectable Contraceptive handout and is given the opportunity to ask any questions or clarify any concerns.

The first dose of Depo-Provera is given according to the Quick Start Algorithm.

Following standardized nursing practice, nurse gives IM injection and documents in the EMR.

DMPA 150mg/1 ml is given in a single injection deeply in the gluteus maximus or deltoid muscle using a 21 or 23g needle.

Patient waits 15 minutes after injection and prior to leaving to be observed for possible local site allergic reaction.

Nurse instructs patient to use a back-up contraceptive method for one week and to schedule follow-up appointment for the next injection every 12 weeks.  If Depo initial injection was initiated via COPE, the follow-up injections require a clinician order.  The Nurse assists the student in arranging a clinican appointment if indicated for on-going orders.

Follow-up Injections:

Nurse reviews side effects and patient concerns with attention to change in periods. A pregnancy test will be repeated prior to the second injection. If negative, the nurse will administer the second injection.

Obtain weight and blood pressure.  If weight is up more than 10% or BP is >130/>90, refer for clinician evaluation.

Discuss STI risk and/or testing.  Order STI testing as indicated.  Review STI risk reduction as indicated.

Follow-up injections less than 14 weeks (98 days) from previous injection:

Give Depo-Provera per protocol.  No urine pregnancy testing is necessary after the second visit if seen within 14 weeks of prior injection.

Patient waits 15 minutes after injection to observe for allergic reaction.

Follow-Up injection More than 14 weeks (98 days) from previous injection:

With history of unprotected intercourse after 14 weeks, offer emergency contraception if appropriate. 

Obtain a urine pregnancy test if indicated.  If negative, reassure the patient that the hormone injection will not harm an unrecognized pregnancy.  If the student still wishes to proceed, give the Depo.

Instruct the patient to use a back-up method of birth control for 1 week following the injection. 

Schedule and emphasize a return visit in 3 weeks for repeat pregnancy test.

Create a reminder/future callback in EMR to call patient in 3 weeks to return for pregnancy test.

 

Key Points: 

Pregnancy tests are required prior to the first two injections and as needed if delay of greater than 98 days since prior injection.

Planned pregnancies are associated with improved health for both women and babies.  Every attempt should be made to provide appropriate contraception to avoid unintended pregnancy.  This guideline has been modified to facilitate on-going use of injectable contraception for women who fail to return as scheduled for repeat Depo-Provera injections. 

In addition, this protocol has been revised to remove the requirement that a woman sign a special consent to use this type of contraception.

In accordance with World Health Organization guidance, this protocol removes warnings about loss of bone mineral density in women using Depo Provera.  Longitudinal research suggests that this loss of bone mineral density is transient, returning to baseline when women stop using Depo.  The research also indicates that women using this form of contraception do not have more bone fractures than women who don't use this contraceptive.