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  7. Client suitability, administration, timing of first injection, documentation
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Client suitability, administration, timing of first injection, documentation

Assessment of client suitability

History

Clinical history taking and examination allow an assessment of medical eligibility for DMPA use. See UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)

In this context the history should include:

  • medical and drug history
  • family history
  • details of reproductive health and previous contraceptive use.
  • relevant social and sexual history (to assess risk of sexually transmitted infections – STIs)

Risk factors for osteoporosis should be assessed and alternative contraceptive choices discussed as appropriate.

Patient self administration of Sayana Press

See procedure for self-administration


Examination

BMI should be noted where possible prior to commencement of the injection. Patient self-reported is adequate.

Pelvic examination and cervical cytology if indicated 

Administration

Shake syringe vigorously

Subcutaneous DMPA

Activate the injector according to manufacturer's instructions

  • Inject into upper anterior thigh or abdomen.
  • Point needle downwards (towards the floor) and inject over 5 to 7 seconds.
  • Licensed for self-administration and can be offered routinely by staff trained to instruct patients.
  • See procedure for self administration.

 

Inreamuscular DMPA

  • IM injection into gluteus maximus or other muscle, e.g. deltoid.
  • IM administration into ventrogluteal site. This is the preferred site as it reduces the risk of superficial injection and sciatic nerve injury.
  • If not yet trained in ventrogluteal injection, or if client requests, the dorsogluteal site (upper outer quadrant of buttock) or deltoid should be used.

Management & timing of first injection

Management & timing of first injection

General initiation

Ideally, first injection should occur between days 1 to 5 (inclusive) of a normal menstrual cycle. No additional contraception is required.

Injections may also be initiated at any other time in the menstrual cycle if the clinician is reasonably certain that the woman is not pregnant and that there is no risk of conception. Additional contraception (barrier method or abstinence) should be advised for 7 days after initiation.

If the woman is amenorrhoeic, the clinician must be reasonably certain that the woman is not pregnant and there is no risk of conception. Additional contraception should be used for 7 days.
Post-partum

Up to day 21 postpartum – no additional contraception required

Day 21 post partum and beyond – additional 7 days contraception required
Following miscarriage
or termination

Initiate on day of surgical or second part of medical abortion or immediately following miscarriage: no additional contraception is required.

If started more than 5 days after
abortion or miscarriage, additional contraception is required for 7 days.
Switching from CHC

Up to day 3 of hormone-free interval – no additional contraception required

Day 4 of hormone-free interval to end of 1st week of pill-taking – 7 days of additional contraception required.

During weeks 2 or 3 of pill-taking – no additional contraception required provided method has been used correctly in preceding 7 days
Switching from
PO implant

3 years or less since implant insertion – no further contraception required.

More than 3 years since implant insertion – 7 days additional contraception
required.
Switching from POP
or levonorgestrel IUD		 Additional contraception for 7 days required.
Switching from
PO injectable		 If the woman’s previous method was another injectable, she should have the injection before or at the time the next injection was due. No
additional contraception is needed.
Switching from Cu-IUD
or barrier method

Days 1 to 5 of cycle – no additional contraception required.

After day 5 of cycle – further 7 days of contraception required.
Quick starting after
oral emergency
contraception

After levonorgestrel: give DMPA immediately and advise condoms for 7 days.

After ulipristal: wait for 5 days following ulipristal before administering DMPA. Advise condoms for a further 7 days (12 days in total following emergency contraception).

Patient requires a pregnancy test 3 weeks after last UPSI.

 

Documentation

  • The full visit history should be completed or updated as required on NaSH.
  • Written method information including contact number is given to client.
  • Prescription is recorded and dated.
  • Site of injection, batch number and expiry date of medication recorded.
  • Record date when injection is next due
  • Nurse supplying where appropriate under patient group direction
  • Consider notifying GP of prescription, if permission is given for correspondence.

Editorial Information

Last reviewed: 31/05/2024

Next review date: 31/05/2026

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group .

Version: 10.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health

Reviewer name(s): janice.allan@nhs.scot .