First Time Clients

Reception and registration

The client should be warmly welcomed by the reception clerk, who obtains the client’s name and other demographic information in order to fill in the front sheet of the client record. The demographic portion of the record is filled in by the reception clerk, or the client, if he/she is willing to do so.

Verification of identification

Clients would be asked for legal form of identification; passport, National Insurance number, driver’s license. If no form of identification is available at this first encounter, the client should be asked to bring it at the next visit.

Record Number

New clients would be assigned a Public Health Information System (PHIS) number, which would be written on all pages of the client record and the clients “passport”. For those clients making first visits for Family Planning Reproductive Health, but who are not new to the Department of Public Health, their PHIS number would be used.

Flow of Clients

Clients would be seen on a first come, first served basis. Each client would be given a number indicating the order in which she would be seen. Flags would be attached to the records to signify the purpose of the visit.

• Pink- First timer.
• Blue - Return for method.
• Red - Return for repeat treatment, return for physical only, return for results.

Efforts should be made to accommodate identified high risk clients out of turn, to ensure that they do not leave without receiving service for example, adolescents and inmates of various facilities: Detention Centre, girls, boys and women’s Homes.

Once the client is registered, the client should be given directions to proceed to the bathroom to pass urine for testing, and then to the weighing room for weight and height measurement, then to have a seat in the waiting area and listen for his/her name to be called. These instructions should be in written form, handed to the client on a card and reinforced verbally at each point of the contact with health care providers during the encounter.

The Interview

The client will be seen by a nurse who will inquire as to the purpose for the client’s visit and source of referral – self, other person or agency. The client should be counseled in the following:

• Contraceptive methods.
• Safer sex and prevention of STIs.
• Breast self examination (women).
• Self Testicle examination (men).
• HIV pre-test counseling.

Screening

• Blood pressure.
• Weight.
• Height.
• Urinalysis.

The following investigations should be ordered for on all regardless of the purpose for the visit.

Lab Investigation

• Haemoglobin.
• Blood group and Rhesus if not known.
• Sickle Cell if not known.
• Venereal Disease Research Laboratory (VDRL).
• Human Immunodeficiency Virus (HIV) (written consent should be obtained following pre-test counseling).
• Hepatitis B.
• Rubella Titre.
• Pap Smear.
• Endocervical Smear (Gonorrhoea and Chlamydia).
• Prostate Specific Antigen (PSA).

Examination

A Physician, Nurse Practitioner, or Nurse with additional training/certification in performing pelvic examination should conduct a thorough physical assessment of the client at this visit, inclusive of breast examination and pelvic exam. Screening for cervical cancer and gonorrhoea and chlamydia is done at this time. For male clients, a digital rectal examination should be done for those over 40 yrs.

Prescription of Contraceptive Method

The client’s choice of method should be discussed again at this time and any contraindications identified. The method is prescribed by a physician or nurse practitioner. On Family Islands, in absence of a physician or nurse practitioner, the Registered Nurse, Nurse Midwife, who is aware of contraindications and side effects of various methods, (previously trained in family planning/ reproductive health locally or internationally) may prescribe a method.

Dispensing

Oral contraceptive methods – dispense 3 to 6 months supply. Record the amount given in the records and the control card.

• Injectable - Depo Provera – give every 12 weeks
• Noristerat – give every 8 weeks
• Mesigyna – give every 4 weeks (28 days)
• Condoms – give liberal supplies with instructions/demonstrations

Discharge

The client is given an exit interview by the nurse, who reiterates the instructions on how to take the method, possible side effects, etc. and gives the client the opportunity to ask any unanswered questions.

The client is given a 3 week appointment to return for results of investigations. Stress to the client, the importance of keeping this appointment. Tell him/her that in the event he/she does not return and the results are abnormal, the clinic staff would contact him/her.

The client is given another appointment to return for her method as follows:

• Oral Contraceptive Methods – give 3-6 month appointment according to the amount of cycles given.
• Injectable – Depo Provera – give 11 week appointment
• Noristerat – give 7 week appointment
• Mesigyna – give 28 day appointment
• Condoms – return as often as necessary

Write the date of the appointment in the client’s passport, the appointment book and index/control card.

Documentation

• Family Planning Client Record
• PHIS Encounter form
• Client Take Home Record (passport)
• Appointment Book
• Daily activity register

Return Visits

Reception and registration

The client should be warmly welcomed by the reception clerk, who obtains the client’s name. The reception clerk will review the demographic information with the client and update as necessary. Clients who have not previously presented a form of identification would be asked for it and if not available at this time, reminded to bring it at the next visit.

Flow of Clients

Clients would be seen on a first come, first served basis. Each client would be given a number indicating the order in which she would be seen. Flags would be attached to the records to signify the purpose of the visit:

• Blue - Return for contraceptive method.
• Red - Return for repeat treatment, Return for physical only, Return for results.

Efforts should be made to accommodate identified high risk clients out of turn, to ensure that they do not leave without receiving service, for example, adolescents and inmates of various facilities: Detention Centre, girls, boys and women’s Homes, etc.

Once the client is registered, the client should be given directions to proceed to the bathroom to pass urine for testing, and then to the weighing room for weight and height measurement, then to have a seat in the waiting area and listen for his/her name to be called. These instructions should be in written form, handed to the client on a card and reinforced verbally at each point of the contact with health care providers during the encounter.

The Interview

The client will be seen by a nurse who will inquire as to the purpose for the client’s visit. The practitioner should peruse the entire client record and the following should be reviewed/discussed (over a number of sessions, priority depending on client’s need) with the client and the client should be counselled and referred as necessary:

• Contraceptive methods.
• Safer sex and prevention of STIs.
• Breast self examination (BSE) – ask the client if she is performing monthly BSE and if she has anything to report. If she is not doing so, encourage her to do so.
• Testicular self examination (TSE) – ask client if he is performing monthly TSE, and if he has anything to report. If he is not doing so, encourage him to begin.
• Health and Nutrition.
• Date of Last Menstrual Period.
• Abnormal vaginal bleeding or spotting.
• Dysparenia.
• Dysuria.
• Vaginal discharge.
• Laboratory results - if results are abnormal, refer client to Physician or Nurse practitioner.

Screening

• Blood pressure should be done at each visit.
• Urinalysis should be done at the first visit in each year for continuing clients. Diabetic clients urine should be tested at each visit for glucose.
• Weight at each visit.

Lab Investigation

• Haemoglobin.
• Venereal Disease Research Laboratory (VDRL).
• Human Immunodeficiency Virus (HIV). (written consent should be obtained following pre-test counseling).
• Hepatitis B.
• Rubella Titre.
• Pap Smear.
• Endocervical Smear (Gonorrhoea and Chlamydia).
• Prostate Specific Antigen (PSA) for men over 40 or at high risk for prostate cancer.

Examination

A Physician, Nurse Practitioner, or Nurse with additional training/certification in performing pelvic examination should conduct a thorough physical assessment of the client at this visit, inclusive of breast examination and pelvic exam. Screening for cervical cancer and Gonorrhoea and Chlamydia is done at this time. For male clients a digital rectal examination should be done.

Prescription of Contraceptive Method
(for clients to whom no method was prescribed at first visit)

The client’s choice of method should be discussed again at this time and any contraindications identified. The method is prescribed by a physician or nurse practitioner. On Family Islands, in absence of a physician or nurse practitioner, the registered Nurse/ nurse midwife, who is aware of contraindications and side effects of various methods, (previously trained in family planning/reproductive health locally or internationally) may prescribe a method.

Dispensing

Oral contraceptive methods – dispense 3 to 6 months supply. Record the amount given in the records and the control card.

• Injectable- Depo Provera – give every 12 weeks.
• Noristerat – give every 8 weeks.
• Mesigyna – give every 4 weeks (28 days).
• Condoms – give liberal supplies with instructions/demonstrations.

Discharge

The client is given an exit interview by the nurse, who reiterates the instructions on how to take the method, possible side effects, etc. and gives the client the opportunity to ask any unanswered questions.

The client is given a 3 week appointment to return for results of investigations. Stress to the client, the importance of keeping this appointment. Tell him/her that in the event he/she does not return and the results are abnormal, the clinic staff would contacting him/her.

Inform the client to return to the clinic if:

• Experiencing any side effects.
• Have any questions.
• Wish to switch to another method.
• Want to stop using the method.

The client is given another appointment to return for her method as follows:

• Oral Contraceptive Methods – give 3-6 month appointment according to the amount of cycles given.
• Injectable Depo Provera – give 11 week appointment.
  • Noristerat – give 7 week appointment.
  • Mesigyna – give 28 day appointment.
• IUDs
  • Give appointment for follow-up after the first menses or 3-6 weeks following insertion.
  • Advise the woman to return at any time to discuss side-effects or other problems, or if she wants to change the method.
  • For devices that have a high rate of expulsion, more frequent follow-up may be indicated.
  • Advise her to return when it is time to have the IUD removed.

Write the date of the appointment in the client’s passport, the appointment book and index/control card.

Documentation

• Family Planning Client Record.
• PHIS Encounter form.
• Client Take Home Record (passport).
• Appointment Book.
• Daily activity register.