Further development of patient group directions for first time issue of
hormonal contraception by nurses
J.T. McVicker
Abacus Clinics for Contraception and Reproductive Health Care, North
Liverpool Primary Care Trust, Liverpool, UK
Introduction: For the past 10 years our service has actively
encouraged and supported our trained family planning nurses to work to an
extended role. The majority of nurses now issue first time and repeat hormonal
contraception to clients without the need for the client to be seen by a doctor.
Central to this way of working are the patient group directions (PGDs), a set of
guidelines setting the parameters within which the nurse may work independently
and highlighting issues which the nurse should discuss with a doctor before
proceeding. A framework of casenote review, regular feedback and clinical update
sessions as well as individual discussions with doctors provides ongoing support
and development. Working to the PGDs has proven very acceptable to the nursing
staff such that they have become highly competent in their extended role, so
much so that most now feel that they are actually restricted by the PGDs and
wish to develop further.
Objectives: We set out to review the current PGDs and identify areas
where they could be improved to further enhance the extended role of the nurse.
Methods: Formal group discussions were held at regular update meetings
to identify limitations within the current PGDs. Information was also gained
from informal one to one discussions.
Results: The main issue identified centred on the ‘out of licence’
use of hormonal contraceptive preparations. Although such use is common practice
in any modern contraceptive service it falls outside the nurses code of practice.
After reviewing the legislative situation we felt that we could include a number
of specific ‘out of licence’ uses within the PGDs thereby enabling the nurse
to proceed without discussion with a doctor.
Conclusions: The updated PGDs have been completed and have been
accepted and approved by the Primary Care Trust. Their continued use enables the
service to function more efficiently helping staff to develop further and
improve job satisfaction.
