Year of Publication

2014

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne A. Jensen

Clinical Mentor

Dr. Mollie Aleshire

Committee Member

Dr. Nancy Kloha

Abstract

Purpose: To determine current provider adherence to the 2010 ACOG Emergency Contraception (EC) guidelines, specifically by assessing provider EC counseling with patients at well-woman annual exam visits or during contraceptive counseling visits. A second aim of this study is to identify provider facilitators and barriers of EC discussion with patients.

Methods: Using a retrospective design, 90 medical records of patients presenting to a university clinic within the previous year were reviewed for the discussion of EC during annual exams or contraceptive counseling. Forty-five medical records were reviewed prior to implementation of the Ambulatory Electronic Health Record (AEHR) and forty-five medical records were reviewed after implementation of AEHR, which provided prompts for emergency contraception discussion. Following data collection, a focus group was conducted with the clinic providers to discuss study results, the 2010 ACOG EC guidelines, as well as facilitators and barriers that may encourage or prevent EC counseling in practice.

Results: There was no documentation of EC counseling for reproductive aged women in either paper or electronic medical records. The provider focus group demonstrated minimal knowledge of EC, as well as no knowledge of the EC guideline or the recommendation of counseling all women of reproductive age about EC.

Conclusion: There was no discussion of EC during clinic visits. Barriers identified by providers included a lack of provider knowledge, a language barrier with Hispanic patients, and EC cost, especially for the most at-risk populations. Facilitators identified included developing reminder systems to discuss EC with patients, such as using electronic prompts, utilizing an EC fact sheet, and placing EC posters throughout the clinic. Results were disseminated to clinic providers in an attempt to increase awareness, improve compliance to evidence-based guidelines, and improve outcomes, with the hope of reducing the number of unintended pregnancies.

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