DNP Scholarly Projects

Abstract

Project Title: Improving Same-day Access To Highly Effective Contraceptives In Middle Tennessee

Background and Rationale: Long-acting reversible contraceptives (LARC) are highly effective at preventing pregnancy at 99%. A two-visit protocol is a known barrier to access. The American College of Obstetricians and Gynecologists recommends same-day placement to increase access to LARC. A Step Ahead Middle Tennessee (ASA) is a non-profit organization partnered with Belmont University that provides free, long-acting reversible contraceptives. However, most ASA clinical partners offer services with a two-visit protocol, and there is no process to identify patient preference for same-day placement.

Purpose: The primary purpose of this phased quality improvement project was to facilitate timely same-day LARC placement for women who stated a clear preference for a single visit.

Project Design: The Institute for Healthcare Improvement (IHI) Model for Improvement was utilized as a framework for this QI project. Three key change ideas were implemented in April 2024. This included early identification of patient preference for same-day placement, adjustment of call script, intake forms, and addition of a post-appointment survey.

Outcomes: Between April and October of 2024, 57% (n=115) of clients opted for same-day placement. 43% (n=87) opted for a two-visit protocol. Timely reproductive care was provided regardless of patient preference, with all clients receiving their desired appointment in approximately one month.

Implications for Practice: Increased clinical capacity is an essential next step toward accommodating patient preference for same-day placement and ensuring timely access to the most effective contraception. Additionally, a cost-effectiveness analysis of a two-visit protocol versus same-day placement may support clinical workflow and scheduling changes.

References

ACOG Committee Statement No. 5: Increasing access to intrauterine devices and contraceptive implants (2023). Journal of Obstetrics and Gynecology, 141(4), 866-872. https://doi.org/10.1097/aog.0000000000005127

Bergin, A., Tristan, S., Terplan, M., Gilliam, M. L., & Whitaker, A. K. (2012). A missed opportunity for care: Two-visit IUD insertion protocols inhibit placement. Contraception, 86(6), 694-697. https://doi.org/https://doi.org/10.1016/j.contraception.2012.05.011

Stark, E. L., Gariepy, A. M., & Son, M. (2022). What is long-acting reversible contraception? JAMA, 328(13), 1362-1362. https://doi.org/10.1001/jama.2022.14239

Streaming Media

Date

Spring 4-14-2025

First Advisor

Dr. Morse

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

long acting reversal contraceptives; LARC; same day placement; two visit protocol

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