12.44 Administration of Lupron (Leuprolide) in Clinics
Category: UWHC Departmental Policy
Policy Number: 12.44
Effective Date: March 25, 2015
Section: Clinic Specific (Ambulatory)
To establish a process for the Registered Nurse (RN) or Medical Assistant (MA) to administer Lupron (Leuprolide). Lupron is a
medication administered intramuscularly that inhibits growth of endometrial cells and prevents menstruation. Common indications
for use are anemia, precocious puberty, endometriosis, treatment for prostate and breast cancer and others. It is generally
administered in Pediatrics, Internal Medicine, OB/GYN, General GYN, Pediatrics Specialties, Radiation Therapy, and Urology Clinics.
A. Verify patient has a current prescription for the medication. If prescription is not current, the provider will be contacted to
B. If patient has been on medication for six months, verify that a re-assessment by the provider has been done. If re-
assessment has not been done by the sixth injection then the ordering provider will be contacted prior to administration.
C. Send request to and obtain medication from a UWHC Pharmacy. (Do not administer medication brought in by the patient.)
D. If pregnancy is a possibility, obtain a provider’s order for a urine pregnancy test and inform provider of results, prior to
E. The RN/MA will evaluate the patient for any adverse effects and discuss any concerns with provider. Documentation will be
made in the patient’s electronic medical record (EMR).
F. Lupron should be handled as a hazardous drug with appropriate precautions. (See Hospital Administrative Policy 8.89 -
Preventing Non-Therapeutic Exposure to Hazardous Drugs.)
G. Record the site, route, time, dose, expiration date, manufacturer, and lot number of the Lupron in the patient’s EMR.
H. Registered Nursing staff will review with the patient, if appropriate, the need to use a non-hormonal form of contraception
to prevent pregnancy while receiving Lupron. Document learning assessment, teaching, and patient response in the
I. Registered Nursing staff will instruct the patient how and when to schedule their next appointment. Review potential side
effects and when and how to call the clinic.
Hospital Administrative Policy 8.17 - Administration of Medications
Hospital Administrative Policy 8.89 - Preventing Non-Therapeutic Exposure to Hazardous Drugs
Nursing Patient Care Policy 10.19 - Medication Administration Using Scanning Technology
IV. WRITTEN BY
Clinic Nurse Clinician
V. REVIEWED AND APPROVED BY
Clinical Nurse Specialist, Children's Hospital Administration, Pediatrics Clinic
Clinic Coordinator, UW OB/GYN-West Clinic
Clinic Manager, Urology Clinic
Ambulatory Policy and Procedure Committee
Teri Kuntzsch, MSN, RN, Director Outpatient Health Link Ops, Director Ambulatory Ophthalmology, Clinics Administration