Is EC available in your ED? If not, here's what to do

If a rape victim came to your ED asking how to prevent pregnancy, what would you tell her? The answer depends on which ED the woman came to for treatment, according to a study on the availability of emergency contraception (EC).

Researchers in Massachusetts contacted all the EDs in the state by telephone and asked a nurse or physician whether EC was available for a sexual assault victim. The study found that EC was not available in 15% of EDs, with an additional 5% saying that it was up to the individual physician.1

There are 40,000 visits to EDs for sexual assault each year, of which approximately 5% result in pregnancy.2 The study's findings show that access to EC is limited and that services for victims of sexual assault are inconsistent, says James A. Feldman, MD, one of the study's authors and an ED physician at Boston Medical Center.

"There are many implications for ED nurses," he says. "I was struck by how often the investigators reported that it was the ED nurse who worked to ensure that the mock patient would be provided with appropriate care." These actions included the suggestion to wait for a different shift if the physician on the current shift would not provide EC or the suggestion to go elsewhere if EC would not be available.

Massachusetts passes ED law

Massachusetts recently passed legislation requiring all EDs to provide information, offer and dispense EC to rape survivors. (For more information about the law's requirements, go to www.mass.gov/legis. Click on "Text of Senate Bills," enter "2165" and click on "Senate Bill, No. 2165.")

Feldman recommends the following:

  • Ensuring that an evidence-based protocol is developed to allow timely access to emergency contraception. "For women who survive sexual assault, there should be a very standard protocol for examination and evidence collection, ideally performed by a SANE [sexual assault nurse examiner]" says Feldman. However, for a woman who reports contraceptive failure, a pelvic exam should not be part of a routine EC protocol, he adds.
  • Providing timely care to sexual assault victims. "Patients should not have to wait extended times in the ED," says Feldman.
  • Including information about EC with other educational information given to patients in the ED, especially those who report unprotected intercourse or present with a concern about a sexually transmitted infection.

At Boston Medical Center, all sexual assault victims are flagged in the ED's electronic charting system as "Name: XXX, XXX" and "Chief Complaint: Trauma X" to protect the identity of the patient, says Patricia Mitchell, RN, ED nurse manager. All sexual assault victims are seen by the psychiatric nurse, who in turn contacts the SANE, says Mitchell.

"If there is no SANE nurse available, the psychiatric nurse takes care of the patient," she says. "All patients are offered EC."

Feldman points to a patient he recently cared for who had been raped and not informed about the option for EC. "She was forced by her mother to have the child and suffered lifelong psychiatric trauma a result of this," he says. "I believe that on this issue, ED nurses can make an important difference at the individual and societal level." (Editor's note: A decision is pending from the Food and Drug Administration on making emergency contraception available over-the-counter.)

References

  1. Temin E, Coles T, Feldman JA, et al. Availability of emergency contraception in Massachusetts emergency departments. Acad Emerg Med 2005; 12:987-993.
  2. La Valleur, J. Update in contraception: Emergency contraception. Obst Gyn Clinic 2000; 274:817-839.

Sources/Resource

For more information on emergency contraception in the ED, contact:

  • James A. Feldman, MD, Boston Medical Center, Department of Emergency Medicine, 818 Harrison Ave., Boston, MA 02118. Fax: (617) 414-5975. E-mail: jfeldman@bu.edu.
  • Patricia Mitchell, RN, Emergency Department, Boston Medical Center, 818 Harrison Ave., Boston, MA 02118. Telephone: (617) 414-4075. E-mail: pmitch@bu.edu.

A toll-free Emergency Contraception Hotline [(888) NOT-2-LATE] and the Emergency Contraception web site (http://not-2-late.com) are jointly sponsored by the Association of Reproductive Health Professionals (ARHP) and the Office of Population Research at Princeton (NJ) University. The hotline and web site are completely confidential, are available 24 hours a day in English and Spanish, and offer names and telephone numbers of providers of emergency contraception located near the caller's area in the United States and parts of Canada. The web site also is available in French and Arabic.