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Table of Contents

Key Objectives

Provide patients with information about their procedure and collect information from the patient before their appointment to reduce clinic time and to support patient empowerment.

Outcome measures

Equip patients with the information they need before their appointment, also providing the tools they need to interact digitally rather than relying on face to face consultations.

Current Baselines

The patient arrives at the clinic. Information is explained to the patient and the nurse goes through a questionnaire/checklist with the patient, appointments aren’t being efficient and patients are having long waiting times.

Workflow

...

Coil fitting checklist care plan

...

Expand
titleExample care plan template code for Coil fitting checklist Care Plan HTML

<div class="form-inline">

<style media="screen">

.form-group {width: 100%; !important}

ul {list-style:inherit; margin-left: 15px;}

.cp_whiteBox_orange {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid #FEC001;}

.cp_whiteBox_red {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid red;}

.cp_colorBox {background-color: #ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

</style>

<div class="cp_colorBox">

<h2>Coil fitting checklist - for intrauterine devices (IUD) and intrauterine systems (IUS)</h2>

<p>Please complete this checklist to ensure that we are able to fit your coil at your booked

appointment. This checklist will also provide you with some important information about

having a coil fitted.</p>

</div>

<div class="cp_colorBox">

<p>Please watch the video below or read <a href="https://www.contraceptionchoices.org " target="_blank">the contraception

Choices website</a> before completing this form.</p>

<div class="embed-responsive embed-responsive-16by9">

<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/bn9BTOrABa4 " allowfullscreen="true"></iframe>

</div>

</div>

<div class="cp_colorBox">

<p>Please tick the boxes to confirm that you have understood and are ready to book your coil fitting appointment:</p>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I have watched the video above on coils or I have read the <a href="https://www.contraceptionchoices.org " target="_blank">contraception

Choices website</a> or I already have an IUD/IUS and am familiar with this contraception method</p>

<input type="radio" id="cp_q1yes" name="cp_q1" value="yes"> Yes</input>

<input type="radio" id="cp_q1no" name="cp_q1" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I am using an effective method of contraception and haven't had any problems eg burst condom, missed pills, IUD overdue for change.</p>

<input type="radio" id="cp_q2yes" name="cp_q2" value="yes"> Yes</input>

<input type="radio" id="cp_q2no" name="cp_q2" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I have not had unprotected sex (or used the withdrawal method) since my last period.</p>

<input type="radio" id="cp_q3yes" name="cp_q3" value="yes"> Yes</input>

<input type="radio" id="cp_q3no" name="cp_q3" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that it is not safe to insert an IUD/IUS if I might be pregnant.</p>

<input type="radio" id="cp_q4yes" name="cp_q4" value="yes"> Yes</input>

<input type="radio" id="cp_q4no" name="cp_q4" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I will make sure that I have eaten on the day of the appointment. (You may also wish to take an over-the-counter

painkiller 30 minutes before your appointment.)</p>

<input type="radio" id="cp_q5yes" name="cp_q5" value="yes"> Yes</input>

<input type="radio" id="cp_q5no" name="cp_q5" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that an IUD/IUS is more than 99 per cent effective (less than 1 in 100 chance of pregnancy).</p>

<input type="radio" id="cp_q6yes" name="cp_q6" value="yes"> Yes</input>

<input type="radio" id="cp_q6no" name="cp_q6" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that there is a small risk (1 in 1,000) that the IUD/IUS might go through (perforate)

my womb or cervix when it is put in. If this does happen, the IUD/IUS may have to be removed surgically.</p>

<input type="radio" id="cp_q7yes" name="cp_q7" value="yes"> Yes</input>

<input type="radio" id="cp_q7no" name="cp_q7" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that there is a 1 in 20 chance of the device falling out.</p>

<input type="radio" id="cp_q8yes" name="cp_q8" value="yes"> Yes</input>

<input type="radio" id="cp_q8no" name="cp_q8" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that there is a small risk of infection (1 in 100) in the first 20 days following insertion of a device.</p>

<input type="radio" id="cp_q9yes" name="cp_q9" value="yes"> Yes</input>

<input type="radio" id="cp_q9no" name="cp_q9" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I know that a copper IUD will make my periods slightly heavier, longer and more painful.</p>

<input type="radio" id="cp_q10yes" name="cp_q10" value="yes"> Yes</input>

<input type="radio" id="cp_q10no" name="cp_q10" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I know that an IUS will make my periods much lighter but causes erratic bleeding and spotting in the first few months of use.</p>

<input type="radio" id="cp_q11yes" name="cp_q11" value="yes"> Yes</input>

<input type="radio" id="cp_q11no" name="cp_q11" value="no"> No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I do not believe I am at risk of sexually transmitted infections (STIs) or I have been tested negative recently for

Chlamydia / Gonorrhoea. Risk factors for STI are having a new partner in the last 3 months or more than one partner

in the last year - we recommend you have a negative test before the procedure. Order yours at

<a href="https://www.friskywales.org " target="_blank">Frisky Wales</a></p>

<input type="radio" id="cp_q12yes" name="cp_q12" value="yes"> Yes</input>

<input type="radio" id="cp_q12no" name="cp_q12" value="no"> No</input>

</div>

</div>

</div>

Sub-dermal implant insertion checklist care plan

Key Objectives

Provide patients with information about their procedure and collect information from the patient before their appointment to reduce clinic time and to support patient empowerment.

Outcome measures

Equip patients with the information they need before their appointment, also providing the tools they need to interact digitally rather than relying on face to face consultations.

Current Baselines

The patient arrives at the clinic. Information is explained to the patient and the nurse goes through a questionnaire/checklist with the patient, appointments aren’t being efficient and patients are having long waiting times.

...

Expand
titleExample care plan template code for Sub-dermal implant insertion Care Plan HTML

<div class="form-inline">

<style media="screen">

.form-group {width: 100%; !important}

ul {list-style:inherit; margin-left: 15px;}

.cp_whiteBox_orange {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid #FEC001;}

.cp_whiteBox_red {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid red;}

.cp_colorBox {background-color: #ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

</style>

<div class="cp_colorBox">

<h2>Sub-dermal implant insertion checklist</h2>

<p>Please complete this checklist to ensure that we are able to fit your implant at your booked

appointment. This checklist will also provide you with some important information about

having an implant inserted.</p>

</div>

<div class="cp_colorBox">

<p>Please watch the video below or read <a href="https://www.contraceptionchoices.org " target="_blank">the contraception

Choices website</a> before completing this form.</p>

<div class="embed-responsive embed-responsive-16by9">

<iframe class="embed-responsive-item" src="https://www.youtube.com/embed/opnXt3m2Nno " allowfullscreen="true"></iframe>

<p>(courtesy of Worcestershire Health and Care NHS Trust)</p>

</div>

</div>

<div class="cp_colorBox">

<p>Please tick the boxes to confirm that you have understood and are ready to book your implant insertion appointment:</p>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I have watched the video above on implants or I have read the <a href="https://www.contraceptionchoices.org " target="_blank">contraception

Choices website</a> or I already have an implant and am familiar with this contraception method</p>

<input type="radio" id="q1yes" name="q1" value="yes">Yes</input>

<input type="radio" id="q1no" name="q1" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I am using an effective method of contraception and haven't had any problems eg burst condom, missed pills, IUD/Coil or Implant overdue for change</p>

<input type="radio" id="q2yes" name="q2" value="yes">Yes</input>

<input type="radio" id="q2no" name="q2" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I have not had unprotected sex (or used the withdrawal method) since my last period.</p>

<input type="radio" id="q3yes" name="q3" value="yes">Yes</input>

<input type="radio" id="q3no" name="q3" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that an implant is more than 99 per cent effective (less than 1 in 1000 chance of pregnancy).</p>

<input type="radio" id="q4yes" name="q4" value="yes">Yes</input>

<input type="radio" id="q4no" name="q4" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that the Implant may alter my bleeding pattern, and that I may experience no bleeding,

or have irregular bleeding especially in the first few months.</p>

<input type="radio" id="q5yes" name="q5" value="yes">Yes</input>

<input type="radio" id="q5no" name="q5" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that medications such as some of those used to treat epilepsy, HIV and TB, and the

complementary medicine St John's Wort, may make the Implant less effective</p>

<input type="radio" id="q6yes" name="q6" value="yes">Yes</input>

<input type="radio" id="q6no" name="q6" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I understand that if a new Implant is inserted outside of day 1-5 of the menstrual cycle, it is not

effective for 7 days and I should use another method of contraception, such as condoms.</p>

<input type="radio" id="q7yes" name="q7" value="yes">Yes</input>

<input type="radio" id="q7no" name="q7" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>If there is a risk of pregnancy at the time my implant is fitted I should do a pregnancy

test at 4 weeks after the insertion</p>

<input type="radio" id="q8yes" name="q8" value="yes">Yes</input>

<input type="radio" id="q8no" name="q8" value="no">No</input>

</div>

<div class="cp_colorBox" style="background-color: #f7d5e0;">

<p>I do not believe I am at risk of sexually transmitted infections (STIs) or I have been tested

negative recently for Chlamydia / Gonorrhoea. Risk factors for STI are having a new partner in

the last 3 months or more than one partner in the last year. Order a free test at

<a href="https://www.friskywales.org " target="_blank">Frisky Wales</a></p>

<input type="radio" id="q9yes" name="q9" value="yes">Yes</input>

<input type="radio" id="q9no" name="q9" value="no">No</input>

</div>

</div>

</div>

Contraceptive Pill Checklist care plan

Key Objectives

Provide patients with information about their procedure and collect information from the patient before their appointment to reduce clinic time and to support patient empowerment.

Outcome measures

Equip patients with the information they need before their appointment, also providing the tools they need to interact digitally rather than relying on face to face consultations.

Current Baselines

The patient arrives at the clinic. Information is explained to the patient and the nurse goes through a questionnaire/checklist with the patient, appointments aren’t being efficient and patients are having long waiting times.

Workflow

  1. Admin: calls patient offering appointment and PKB

  2. Admin: creates an appointment and adds care plan into PKB

  3. PKB: notifies patient about appointment and care plan are in their record

  4. Patient: fills in informed questionnaire care plan before the appointment

  5. Patient: attends appointment for contraceptive pill advice and prescription

  6. Professional: reviews answers in the care plan

  7. Professional: prescribes the contraceptive pill

  8. Professional: team-based messaging available to the patient for follow up instructions and questions

...

Evaluation

  • Reducing phone calls and contacts

  • Patient reduce coming back in for more contraception

  • The ability for patients to contact the team if they have any issues after starting the contraceptive pill

  • Women able to track symptoms in relation to the contraceptive pill

  • Record weight

  • Record BP when they get it checked at the GP

  • Library of different contraception options

...