1. 2014 Contraception Protocol Updates Nurse/MA Training All Sites March, 2014

2. Contraception Updates  Goals for this training Review new/updated set of contraception protocols Field questions and verify staff confident in performing contraception related visits.  Agenda Goals of Protocols What’s new & what’s changed Step by step review Expectations of Nurses, MAs, Providers Questions?

3. Key Goals  Prevent unplanned pregnancies.  Provide education to patients using EC or with unplanned positive pregnancies.  Improve patient access to same day contraception rx and education. Reduce missed opportunities to provide contraception!  Expand nurses abilities to conduct EC and Quick Start contraception visits independently or as quick co-visit.

4. Family of Contraception Protocols  P:\Clinical\Nursing Protocols\Section VI Contraception New: Sec 6.1 Quick Start Algorithm (RNs) Updated: Sec 6.2 Pregnancy Test (MAs & RNs) Updated: Sec 6.3 Emergency Contraception (RNs) New: Sec 6.4 Quick Start Pill/Patch/Ring/Injection Co-Visit (RNs) Updated: Sec 6.5: Depo Re-injection (MAs & RNs)

5. Expectations for MAs  MAs Perform Pregnancy Test & Depo re-injection visits; consult nurse as needed per protocol If pregnancy test positive; consult nurse or BHP for options counseling (script included). If pregnancy test negative; have nurse offer same day contraception options or pre-conception counseling. Clarified criteria for receiving Depo even if late; algorithm to review w/ nurse to ensure same day opportunity provided whenever possible. Sec 6.2 Pregnancy Test 12.30.2013.doc Sec 6.5 Depo Provera Re-Injection 12.30.2013.doc

6. Expectations for Nurses  Nurses Review new Algorithm  Sec 6.1 Quick Start Algorithm 12.30.2013.pptx Sec 6.1 Quick Start Algorithm 12.30.2013.pptx  Opportunities for use:  EC Visit  Concern for pregnancy/request for pregnancy test  Unhappy with current method  Confidential visits re: STDs, pregnancy, questions, etc  Goal is to help women leave with contraception the same day!

7. Expectations for Nurses  Nurses Perform Pregnancy Test & Depo Re-injection visits per protocol (per previous slide) Address and offer EC/quick start contraception needs as appropriate  Pills, patch, ring, Depo  Sec 6.3 Emergency Contraception 12.30.2013.doc Sec 6.3 Emergency Contraception 12.30.2013.doc For patients desiring quick start contraception, perform assessment using questionnaire & present to provider for co- visit to  Sec 6.4 Quick Start Pill Patch Ring Injection 12.30.2013.doc Sec 6.4 Quick Start Pill Patch Ring Injection 12.30.2013.doc  Review history form  Prescribe appropriate method  Recommend follow-up if needed Solicit feedback from providers to improve co-visits

8. Expectations for Providers  Providers Expect pregnancy visits & EC visits to flip into co-visits for quick start of contraception. If unfamiliar with quick start protocol (current recommendations for providing same day contraception to women), please review. Goal is to provide contraception TODAY whenever possible (do not require updated PAP or STI testing to prescribe). Provide feedback to nurses to improve quality and efficiency of teamwork in co-visit.

9. What about STI Testing?  E.g. Gonorrhea, Chlamydia, RPR, HIV  NOT required for contraception start  CDC recommends yearly Chlamydia testing for all sexually active women under the age of 25 and HIV testing ages 13-65 at least once & annually for those with risk factors (unprotected sex)  Clinica protocols for GC/Chlamydia direct nurse to add STI screening tests for patients with positive results  Hints on how to initiate these conversations with patients  Link to Linda’s doct: How to handle the patient with a positive chlamydia result.docxHow to handle the patient with a positive chlamydia result.docx

10. Questions?  Coding Hints Pregnancy Test Only: MA Visit Emergency Contraception: RN Visit (99211); submit to supervising physician (Pt’s PCP) for review Quick Start Pill/Patch/Ring/Injection: Co-visit; provider will bill Depo Re-injection: MA Visit