|
 |
Pharmacists interested in providing injectable contraception in the pharmacy must identify a local family planning clinic/ health clinic/ physician with whom they can partner. Once a collaborative relationship has been established, pharmacists receive training in injection technique in order to provide Depo-Provera injections in the pharmacy. Pharmacists receive a $12 reimbursement for each injection service from Pharmacy Access Partnership-Public Health Institute for state insured low-income patients.
Click on the following links to find information on:
IC Guidelines and Procedures
IC Program Policies and Procedures (PDF-16K)
Objective
Provide patients that have a prescription for an injectable contraceptive (Depo-Provera) with the option of pharmacy access to both the drug and administration of the contraceptive injection as delineated in this guideline.
Approved Contraceptive Injection
The contraceptive injection listed in Table 1 can be administrated by authorized pharmacists/pharmacies under prescription from the prescribing provider/authorizing health care facility in accordance with the guidelines listed below.
Policy and Procedure
1. The authorizing health care provider will:
- Conduct contraceptive options counseling.
- Screen the patient for contraindications for contraceptive injection use.
- Provide method specific instructions for use.
- Administer the initial contraceptive injection.
- Offer the option of pharmacy access to patients that have received their initial injection from the prescribing provider or are established injectable users.
- Write a prescription for the injectable contraceptive that shall include the date of the most recent injection administered by the prescriber and the date of the next injection.
- Provide general information on the new “re-supply” service at participating pharmacies.
2. The pharmacist will:
- Be knowledgeable about the techniques for injection of medications, assessment and management of contraceptive injection patients, patient-sensitive counseling techniques, legal issues pertaining to the provision of contraceptive services to minors, STI/HIV prevention/diagnosis/treatment, and serving with victims of sexual abuse.
- Provide services, including written materials, education, and counseling, in a manner that is culturally, linguistically and educationally appropriate for the patient.
- Refer patients as appropriate to the authorizing health care facility or prescribing provider for side effects or complications related to the injectable contraceptive or for ongoing reproductive health and contraceptive care that may include but is not limited to STI/HIV counseling, testing or treatment, pregnancy testing, or evaluation of contraceptive method related conditions.
- Refer patients as needed to other community resources. Refer all sexual assault victims to appropriate local resources.
- Provide injectable contraceptive patients with the following information:
- A. Contraindications to use
- B. Instructions for use
- C. Minor and serious side effects associated with use
- D. Timing of menses and bleeding patterns
- E. Impact on return to fertility after discontinuation
- F. Injectable contraceptives do not protect against STI/HIV
- G. Re-injection schedule
- Obtain and document the following information prior to administration of the injection:
- A. Date of previous injection
- B. Date of last menstrual period
- C. Patient complaints and side effects
- D. Presence of contraindications for continuation
- E. Drug name, dose, and lot number
- F. Date of injection and administration site
- G. Date range for re-injection
- H. Referrals initiated
- Immediately notify the prescribing provider/authorizing health care facility of serious adverse events/side effects related to the contraceptive injection among patients receiving services under these guidelines. No further injections will be administered without instructions from the prescribing provider/authorizing health care facility if serious side effects are present. If the pharmacist cannot reach the prescribing provider/authorizing health care facility, the pharmacist will refer the patient for appropriate care.
- Provide proper storage and handling of injectable contraceptives.
- Administer the contraceptive injection to women that present for injection within the identified time frame and do not have contraindications to continued use.
- Provide the patient with written documentation that identifies the interval for re-injection.
- Advise patients that present for re-injection at a time that is greater than the maximum allowable to:
- A. Use a back up method of birth control.
- B. Consider emergency contraception if she has had otherwise unprotected intercourse after the time re-injection was due and within the last 120 hours.
- C. Refer to the prescribing provider/authorizing facility for evaluation prior to administration.
| Authorizing Provider: |
|
|
| Printed Name |
Title |
|
| Signature |
Date |
|
| Organization/Affiliation |
| Authorizing Pharmacist: |
|
| Printed Name |
License # |
|
| Signature |
Date |
|
| Contact Phone |
Fax |
| Pharmacy where service will occur: |
|
| Store name |
Pharmacy License # |
|
| Street |
City |
|
| County |
Zip |
|
| Phone-Public |
Phone-Professional |
Table 1. Injectable Formulation and Dosage
| Formulations |
Dosage and
Administration |
Timing of Administration |
How supplied |
Storage |
Medroxy-
progesterone
acetate 150 mg
injectable
suspension
Brand name:
Depo-
Provera®
Contraceptive Injection |
Dosage: 1 mL
Administration:
Deep (Z-track)
intramuscular
injection in the
deltoid or gluteal
muscle
Note: Do not
rub injection
site after
administration. |
Every 3 months, not to exceed 13 weeks since the previous injection |
1mL vials and 1mL prefilled syringes of sterile aqueous suspension;
Note: Multi-dose vials of Depo-Provera do NOT contain the suspension strength contraception dose. |
Controlled room temperature of 68°-77°F. Protect from freezing
Shake vigorously just prior to injection to ensure uniform suspension of drug.
|
Table 2. Specific Counseling Points
| Formulations |
Patient Counseling |
Medroxy-progesterone acetate injectable suspension, 150 mg
Brand name:
Depo-Provera |
Do not rub injection site after receiving injection; this may reduce the duration of contraceptive efficacy by hastening absorption.
Return for next reinjection before 13 weeks.
|
Table 3. Adverse Reactions
| Formulations |
Serious Adverse Reactions
to Injection |
Immediate Management |
Other Adverse Reactions |
Medroxy-progesterone acetate injectable suspension, 150 mg
Brand name:
Depo-Provera |
Anaphylactic and anaphylactoid reactions have been reported on rare occasions. |
Institute appropriate therapy, using emergency equipment.
Call 911 for transport to emergency facility. |
In a few instances, there have been undesirable results at the site of injection, such as residual lump, change in color of skin, or sterile abscess. |
Pharmacist Requirements
Checklist for IC Pharmacy Requirements (PDF-20K)
Pharmacist Check List of Requirements for the Injectable Contraceptive Program
| General |
 |
We have written policies and procedures for administering injection services, including patient notification in the event of a drug recall. |
|
We have an arrangement to dispose of medical waste (i.e. needles). |
|
We have a system for the secure storage and easy retrieval of medical records (other than prescriptions). |
|
Clinical staff administering injections will be attired in appropriate protective/ professional dress (e.g., lab coat). |
|
Both the pharmacy store and the pharmacist(s) who will provide injections are licensed to practice with the State of California. |
|
All the pharmacists who will provide IC injections have professional liability insurance. |
| Pharmacy Layout and Equipment |
|
The IC injection service area ensures patient privacy. |
|
The IC injection service area has adequate space to provide injection services safely and comfortably. |
|
The IC injection service area has appropriate equipment, including client and pharmacist chairs for the consultation. |
|
The IC injection service area is professional in appearance, with minimal personal or unrelated professional effects. |
|
An emergency medical kit readily accessible (including stethoscope with blood pressure cuff and syringes pre-filled with epinephrine and diphenhydramine). |
| Training |
|
All pharmacists who will provide IC services have successfully completed a recognized injection training program covering intramuscular injections. |
|
All the pharmacists who will provide IC injections have completed training in management of Injectable Contraceptive patients. |
|
There will always be someone present who has current basic CPR training when IC injections are given. |
Training
Online Training Program:
A distant learning program is available. This continuing education program Incorporating the Administration of Injectable Contraceptives into a Pharmacy-Based Practice has been developed in collaboration with the CPhA Educational Foundation. Contact
for access to the training program.
Live Training Program:
Pharmacy Access Partnership and California Pharmacists Association (CPhA) provide occasional live trainings on injectable contraception for pharmacists. This clinical training includes IC patient management and injection technique.
Special Training Requests:
Special IC training can be arranged for pharmacists who wish to participate in Health Step, the IC Demonstration Program. If you are interested in training, and participating in Health Step, please contact Pharmacy Access Partnership at (510) 272-0150 or e-mail us at
.
|
|
