Name of General Practice

Medicine Standing Order:
Emergency Contraceptive Pill (ECP) for women
Levonorgestrel tablet 1.5 mg  (Postinor™ )

Rationale:
To provide emergency contraception to women in general practice.

Organisation:
Name of general practice

Scope (the condition and patient group):
Women in general practice who have been assessed as meeting the criteria for ECP.

Medicine:
Levonorgestrel  (Postinor™ )

Dosage instructions for each medicine:
Levonorgestrel 1.5mg. A single dose (1.5mg) as soon as possible after coitus, preferably within 12 hours of unprotected sexual intercourse (UPSI) but no later than 72 hours.

Drug Interactions:
Medicines and herbal remedies that induce liver enzymes can reduce the effectiveness of Postinor™ [barbiturates, topiramate, phenytoin, carbamazepine, rifampicin, rifabutin, ritonavir and St John’s Wort]. Patients should be referred to a doctor or Family Planning for consideration of an additional dose of Postinor™ or an alternative contraceptive (e.g. copper IUD).

Adverse effects:
Nausea, lower abdominal pain, diarrhoea, vomiting, menstrual irregularities, fatigue, dizziness, headache, and breast tenderness.

  • Preferably take with food
  • Repeat administration if vomiting occurs within 3 hours of administration

See:  Postinor - New Zealand Formulary & Data Sheet http://nzf.org.nz/nzf_4249 ; http://nzf.org.nz/nzf_4245 & http://www.medsafe.govt.nz/profs/datasheet/p/Postinor-1tab.pdf 

Route of Administration: Oral

Indication/circumstances for activating the Standing Order:
Female clients requiring emergency contraception when any one, or more of the following indications have occurred within the previous 72 hours:

  • 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:

Contra-indications:  Pregnancy or suspected pregnancy

Person authorised to administers the Standing Order: Registered Nurse (RN)  names

Competency/training requirements for the person(s) authorised to administer:
R.N’s must attend a PHO approved education session on the programme, eligibility, standing orders and the medications involved in those standing orders. The R.N.’s must also have read and signed the policy on standing orders.

Countersigning and Audit:
RNs need to refer to their own general practices Standing Order Policy to annotate this. The below information relates to MAGPS ONLY and is provided as an example.

The duty G.P. must countersign all Standing Orders at the end of shift. This occurs by the following process:

  • Presenting a paper copy of the standing order / a prescription to the duty G.P. for countersigning.

Once this is countersigned scan the paper copy onto the patient’s notes and then place at the back of the Standing Order folder for audit purposes.

Definition of terms used:
G.P. - General Practitioner
R.N. - Registered Nurse

Name of Issuer:
Signature of Issuer:
Date:
Date of Issue:
Review date: