Consultations involving oral contraceptive pill checks; is documentation and prescribing optimal?

Problem

Oral contraceptive pills (OCP) are frequently prescribed in general practice consultations. Practitioners are aware of the side effects and risks of incorrect OCP prescribing. Safe prescribing of OCPs are guided by the UK Medical Eligibility Criteria (UKMEC). Failure to take these criteria into consideration when prescribing can affect patient safety. Poor documentation of any consultation may have legal implications. It is important that the prescriber is aware of the key risk factors and investigations required prior to prescribing an OCP and more importantly, that there is evidence that these safety checks have been documented. This study set out to establish whether patients are being prescribed an OCP in concordance with UKMEC criteria and whether legally binding documentation when prescribing OCPs is optimal. The use of an OCP prescription pro forma is reviewed.

Approach

Using Vision software, all women coded for being prescribed an OCP (293 patients) in a small general practice were selected. UKMEC criteria were selected and the documented consultation of a randomly proportional sample size of women were analysed. Using the UKMEC criteria, a pro forma was designed.This was distributed to practitioners to complete when consulting and prescribing OCPs.

Findings

147 consultations involving an OCP prescription were analysed. The mean age of women prescribed an OCP was 27 (range 15-50) years. 61% were prescribed a combined OCP, the remainder were prescribed a progesterone only OCP. Only 77% of women had their blood pressure recorded during the consultation in which an OCP was prescribed. In 16% of consultations, side effects from OCP were noted. 28% of women were asked if they had symptoms of migraine or headache. 1% were asked about mood changes. 58% had a weight recorded. 22% were asked about a history of thrombosis. A smoking history was obtained in 49% of consultations. The smear status was recorded in 11% of eligible women. A history of cancer was asked in 37% of patients. 0 patients were assessed in a manner fulfilling all of the key UKMEC criteria. In patients with adequately recorded information, the correct OCP was prescribed. Practitioners found the OCP prescription pro forma simple and quick to complete. An OCP prescription pro forma resulted in 98% of all fields being recorded.

Consequences

These results highlight the pitfalls in the documentation of consultations involving OCPs. In patients with poorly recorded documentation, it is difficult to ascertain whether the safest OCP is being prescribed. The OCP pro forma was well received by practitioners. The initial results from the OCP pro forma are encouraging in ensuring legally binding documentation of OCP risks as well as promoting safe prescribing of OCPs. A re-audit of the OCP pro forma is advised and planned for next year.