Emergency Contraception: A Primer for Pediatric Providers

Alana L. Clements; Alison Moriarty Daley

Disclosures

Pediatr Nurs. 2006;32(2):147-153. 

In This Article

Nurse Practitioners and Adolescent Access to Plan B

NPs are an important point-of-access to EC for adolescents. Therefore, providers seeing adolescents, in any setting, need to be knowledgeable and available to provide EC. Research has demonstrated that health care services provided to adolescents work best when they are tailored to meet the specific needs of this population. In particular, teens should be able to access all their health care needs (physical exams, acute visits, reproductive/contraceptive care) in one place and by a consistent provider. Services also need to be located where teens can access them confidentially, affordably, and in a manner that allows for frequent follow-up (Jessor et al., 1995; Kirby, 1997, 2001; Kissinger et al., 1997; Moriarty Daley, Sadler, Leventhal, Cromwell & Reynolds, 2004, 2005; Moriarty Daley, Sadler, Leventhal & Reynolds, 2005; Resnick et al., 1997, Rosen, Elster, Hedberg, & Paperny, 1997; Zabin, Hirsch, Smith, Street & Hardy, 1986). The NP should explain at each visit, very concretely, to all teens, male or female, how they would acquire EC if they were to have unplanned or unprotected sex. The added benefit of providing this information is that the teen is aware that the provider is available to discuss sexual activity, contraception, STIs, and any other concerns the teen may have regarding sex. Additionally, it increases the likelihood of one partner knowing about EC if unprotected sex should occur.

Written information on EC methods, circumstances under which its use would be beneficial, and how EC can be obtained quickly and easily can be given to adolescents in bags of condoms or made available in examination rooms to be taken in private. Literature available in the office or examination room may also serve as a conversation "starter" for some teens.

The provider may discover the need for EC during a visit for a physical examination, acute complaint or reproductive concern. The NP should be able to give the adolescent a prescription to be filled immediately following the visit or provide samples of Plan B or the appropriate dose of the estrogen-progestin method, taken from sample packs of OCPs (see Table 1 ) for teens who do not have insurance coverage. If the estrogen-progestin method is used, an anti-emetic (meclizine 25-50 mg) can be taken 1 hour prior to the administration of each dose. In addition, the NP needs to help the teen to decide a convenient time to begin the estrogen-progestin regimen so each dose is taken at a reasonable time, for example 8 p.m. and 8 a.m., not 2 p.m. and 2 a.m. NPs should instruct adolescents to call as soon as possible after unprotected sex has occurred for a prescription; calling the morning following unprotected sex is appropriate. Urgent calls at 3 a.m. are not necessary unless there are other concerns or issues, such as a sexual assault or abuse, that require immediate assistance from the provider. Prior to prescribing EC the provider should ask the teen a series of questions (see Table 3 ) and schedule a follow-up appointment.

Providers may elect to provide advanced prescriptions "just in case" for Plan B. This option is useful for teens that have elected to use condoms only as their method of contraception and those who are going away to school or moving and may not have established health care services at the new location. Ideally, a follow-up appointment should be made for all teens who have taken EC to discuss available contraceptive methods, the proper use of condoms, STIs, and to have a pregnancy test if they have not menstruated within 3 weeks after treatment (Cromwell, Moriarty Daley & Risser, 2004). A discussion should also be included about how and why Plan A, their contraceptive method, failed. A pelvic examination, including Pap smears (if appropriate), STI screening, and HIV counseling and testing should be offered to all female adolescents with a history of unprotected sexual activity. A review of the proper use of condoms, as well as a discussion with the teen on how to negotiate condom use with her partner, should also be included in the follow-up visit.

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