12.61 Administration of Depo‐Provera in Clinics
Category: UWHC Departmental Policy
Policy Number: 12.61
Effective Date: January 16, 2013
Section: Clinic Specific (Ambulatory)
To establish a process for the nursing staff to administer Depo-Provera (medroxyprogesterone acetate injectable
With appropriate training, nursing staff may administer Depo-Provera (medroxyprogesterone acetate injectable
suspension) per order. Medical Assistants (MAs), Licensed Practical Nurses (LPNs) or Registered Nurses (RNs) may
administer injection as directed by provider.
A. RN or LPN will check patient record to determine that there is a current order for Depo and the date of last
injection. RN or LPN will screen for side effects from Depo (See section E below). If patient has had side
effects, RN or LPN will consult provider for direction.
B. If last injection was not given in current clinic, confirmation of the date of last Depo should be obtained
from the clinic where it was given.
C. If this is first Depo shot, the patient should come into clinic during the first 5 days of her menstrual cycle.
1. No pregnancy test is necessary during the first 5 days. If unsure, if patient is teenager or an
unreliable historian, obtain an order for a pregnancy test and ensure test result is negative before
administering Depo shot.
2. If the patient has a history of irregular periods, determine the last unprotected sexual encounter
where applicable and consult provider about next steps.
D. Patient teaching with first injection should include common side effects such as irregular menstrual
bleeding, amenorrhea, weight gain, headache, nervousness, stomach pain or cramps, dizziness,
weakness, fatigue, decreased sexual drive, breast tenderness and acne.
E. If this is a repeat Depo shot, and the last Depo was given between 11-13 weeks ago, and the patient has
no side effects that warrant holding the injection, the injection may be given. Side effects that warrant
holding the injection can be remembered with the acronym, ACHES: Abdominal pain (severe); Chest
pain(cough, shortness of breath); Headache (severe) with any numbness, weakness or dizziness, speech
problems; Eye problems such as vision loss or blurring; Severe leg pain (calf or thigh)
F. If patient presents in the clinic after the 1
day of the 13
week, an order for urine pregnancy test should
be obtained. If negative, the Depo may be given. Follow steps E-G and patient should be instructed to
return to clinic in 2 weeks for a repeat pregnancy test. If the patient is concerned she may be pregnant
she has the option to abstain from intercourse for 2 weeks, repeat a pregnancy test and, if negative, then
receive the Depo injection.
G. Prior to giving the injection, assess medication for proper dose (150mg intramuscular (IM)), expiration
date and lot number. Depo should be administered deep in deltoid muscle. Document all information in
patient’s electronic medical record (EMR) along with site of injection. Complete pharmacy billing.
H. Ascertain due date of next Depo injection by consulting the Depo-Provera perpetual contraceptive
calendar. Next injection should be given between due dates listed on the calendar.
I. Record due date for next injection in patient’s EMR and in the patient instructions in Health Link. Patient
will receive the information on the AVS and/or wallet sized reminder card, and should be encouraged to
make this appointment before leaving.
Hospital Administrative Policy 8.17 - Administration of Medications
Hospital Administrative Policy 8.89 - Preventing Occupational Exposure to Hazardous Drugs
Nursing Patient Care Policy 10.19 - Medication Administration Using Scanning Technology
IV. WRITTEN BY
Pat Kokotailo, MD
Clinical Nurse Specialist, Infectious Disease & Immunology Clinic
Clinical Nurse Specialist, Children's Hospital Administration
Clinic Coordinator, UW OB/GYN-West Clinic
V. REVIEWED AND APPROVED BY
Ambulatory Policy and Procedure Committee
Deborah D. Tinker, RN, MS, Director, Ambulatory Nursing