Issued: 01/12/2011 Review date: 01/12/2012
Medicine Standing Order Title Progesterone Only Emergency Oral Contraception
Rationale: In a rural GP clinic there are times when an authorised prescriber is not available and in order for patients to access
care a registered nurse using standing orders is the best option.
Organisation/clinic: Church Street Surgery Opotiki
Scope: To enable registered nurse working in the clinic to treat patients aged 12 and over who are
sexually active and at risk of pregnancy.
Medicine/s: Levonorgestrel (Microval, microlut) , Norethisterone (noriday) Desogestrel
(cerazette)
Dosage instructions for each medicine: 1500 micrograms single dose.
Adverse effects - Nausea, lower abdominal pain, diarrhoea, vomiting, Menstrual irregularities, Fatigue, dizziness,
headache, Breast tenderness.

Preferably take with food

Repeat If vomiting occurs within 3 hours of administration,
Route of administration: Oral
Indication/circumstances for activating the standing order:
Female clients aged 12 yrs or older requiring emergency contraception when any one, or
more of the following indications have occurred within the previous 120 hours:
Unprotected Sexual Intercourse (UPSI).
Failed barrier method of contraception.
Questioned oral contraceptive cover or late Depo-Provera.
Sexual assault abuse.
Recent teratogen use.
Back up contraception required.
Precautions and exclusions that apply to this standing order:
Any client who has Category WHO 4 contra-indications is reviewed by the issuer or the client’s own GP .
Contraindications : Category WHO 4 (Do not Use) Pregnancy (although no researched effects on fetus).Proven
severe allergy to Levonorgestrel or constituents. Active acute porphyria. WHO Category 3
(Caution/Counselling) Current Active severe liver disease. Enzyme inducing medication (see attached table)
WHO category 2 (Broadly Useable)Current breast cancer / in remission , Trophoblastic disease with elevated
HCG, Current VTE , Inflammatory bowel disease.
Persons authorised to administer the standing order:
Registered nurses
Competency/training requirements for the person(s) authorised to administer:
Prior to administering POC under this standing order the registered nurse is required to undergo the in-house training on
the policy ,procedure and documentation requirements for this standing order.
In addition the registered nurse may undertake Family Planning and Sexual health training.
A record of this training will be kept.
Countersigning and audit
Countersigning by the issuer is required within 7 days of use of this standing order
Definition of terms used in standing order:
POC – Progesterone only Oral Contraception
Additional information: Follow protocols as attached
Signed by issuer:
Name:
Date:
Title: medical practitioner
Signed by management:
Name:
Date:
Title:
Signed by nurses working with Standing Order
Name/s :
Date:
This Medicine Standing Order is not valid after the review date.
Instructions For Use With Enzyme-Inducing Medication
Drug type that can
reduce efficacy
Approved names
Clinical Implications
Antitubercle
Rifampicin
Rifabutin
Barbiturates
Phenobarbitones
Carbamazepine
Phenytoin
Primidone
Topiramate
Oxcarbazepine
Griseofulvin
Ritonavir
Nevirapine
Double dose
Anticonvulsants
Antifungal
Protease
inhibitors +
other antiretroviral
agents
Miscellaneous
St John’s Wort
Tacrolimus
Modafinil
Bosentan
(pulmonary
hypertensive drug)
Warfarin
As above
As above
As above
As Above
Check INR – refer to Medical Officer
NB. The following anticonvulsants are not enzyme inducers:
•
Sodium Valporate (Epilim)
•
Clonazepam (Rivotril)
emergency contraceptive pill (ECP) protocol
1. Check if client has had unprotected sexual intercourse in previous 120 hrs.
(If >120 hours see doctor). Refer to Family Planning / own GP if wants emergency IUCD
fitted. Also exclude any possibility of pregnancy (on basis of LMP and previous unprotected
intercourse during this cycle).
2. Explain how ECP works, failure rate and possible effect on timing of next period. If multiple
UPI since LMP discuss when greatest risk and even whether to give.
3. Give Postinor – one tablet stat. Discuss what to do if vomiting occurs.
Contraindications
-
pregnancy
previous allergy to progesterones or ECP
acute porphyria
severe vomiting or diarrhoea
Discuss with Doctor if any of the above
-
enzyme inducing drugs ( see table )
4. Discuss ongoing contraceptive needs. Offer condoms and consider commencing on
the COC if appropriate. Ask client to return for pregnancy test and further discussion
of contraception if not already established in 3 weeks. If absolutely unable to attend,
may give pregnancy test and instructions to do in 3 weeks. Advise re attending
earlier if experiences marked abdominal pain. Give information leaflet
5. Discuss possible need for sexually transmitted infection screen. STI screen in 3 weeks
recommended
6. Countersigning is to be completed by issuer ( set a task in Medtech )
emergency contraceptive protocols
E C P Check List
Document the following in the client’s notes
Last Menstrual Period (LMP)
Menstrual Cycle
Unprotected Sexual Intercourse (UPSI)
Previous ECP and any problem
No. of times since LMP
Medication/ allergies known
Pregnancies
Type of ECP
Any Coercion
Past Contraception
Alcohol Involvement
On-going contraception needs
Use of condoms
Procedure if ECP is not retained/vomiting
of ECP
STI’S
FP pamphlet ECP provided
Information on Postinor provided
Future Strategies
Countersigning is to be completed by the
issuer ( set a task in medtech )
Encourage client to discuss personal
health and contraception needs with
family/ caregiver/whānau especially if
under 16 yrs