Public Health Dorset

This Patient Group Direction (PGD) must only be used by registered community pharmacists who have been named and authorised by their organisation to practice under it. The most recent and in date final signed version of the PGD should be used.

Patient Group Direction

for the supply of

Levonorgestrel 1500 microgram tablets

by registered community pharmacists for

Supply and Administration of Oral -Only Emergency Contraception (POEC) in

Public Health Dorset

Version number: 6.1

CHANGE HISTORY

1 First draft based on the previous Levonelle PGD and Dorset November 2017 HealthCare PGD (PH Internal copy) 2 Second draft - shared with Local Pharmaceutical Committee for December 2018 comment and review (including frontline use perspective) 3 Third draft (PH Internal) January 2018 4 Fourth draft - shared with Dorset CCG Medicines Management January 2018 T earn for updates 5 Fifth draft- updates by PHforfurth@r review byPGD.contributors 6 Final version May 2018 6.1 Revision to final version - change to wording in Records Kept August 2018 section (simplified for clarity) and updated consultation form in appendices to match PharmOutcomes - no clinically significant changes Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

1 PGD DEVELOPMENT

Health Programme Advisor, Public Health Jen Lages 15/08/18 Dorset, Dorset County Council Services and Claire Woollard Implementation Lead, 15/08/18 Dorset LPC Senior Pharmacist, Michelle Trevett 14/08/18 Dorset CCG

Pharmacy Technician, 1/1 A/\.,--,,.. r1rJLA {) Hayley Braid V 1/V ~ \)l..-/,V .··'4_ • 14/08/18 Dorset CCG Dorset HealthCare The organizations below (version 6 - May 2017) hold current PGDs which were used to develop this London C&SH PGD PGD Template (Updated October 2017)

PGD AUTHORISATION

Prescribing Lead, Dorset CCG

Senior pharmacist Head of Medicines 14/08/18 Katherine Gough Management, Dorset CCG

- -··------· ------Senior representative of professional group using the N/A PGD

Person signing on behalf of Dr Jane Horne ~ 15/08/18 authorising body Consultant in Public Health, · •• Dorset County Council

PGD ADOPTION BY THE PROVIDER ·

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

2 TRAINING AND COMPETENCY OF REGISTERED COMMUNITY PHARMACISTS WORKING UNDER THE PGD The community pharmacist must be authorized by name, under the current version of this PGD before working according to it.

Qualifications and Registered pharmacist professional registration Before offering the service, all Pharmacists providing treatment under this PGD must complete the CPPE e-learning course and Initial training online assessment for Safeguarding Children and Emergency Contraception ·. • CPPE e-learning course and online assessment for Safeguarding Children and Emergency Contraception and any additional local training to address changes to national guidance Competency assessment • Able to demonstrate competency in line with the NICE Good Practice Guidance: Patient group directions: competency framework for health professionals using patient group directions

Every 3 years • CPPE online assessment on Safeguarding Children and the CPPE Emergency Contraception e-learning course OR Ongoing training and • Attend the local CPPE Emergency competency (EHC) and Safeguarding course • The pharmacy must have a copy of the Current BNF available for reference and be familiar with the information in the BNF about the use of POEC • The pharmacy must have a copy of the CPPE learning pack with updates available for reference.

A registered pharmacist is accountable for his or her actions in accordance with the General Pharmaceutical Council. All registered pharmacists are personally accountable for their practice and in the exercise of professional accountability there is Lines of accountability a requirement to maintain and improve their professional knowledge and competence. The PGD.may be used only within the confines of the service specification by pharmacists and pharmacies commissioned by PH Dorset

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

3 CLINICAL CONDITION

Clinical condition or situation to which this Women of reproductive age requiring oral emergency contraception PGD applies

Any woman presentingJor emergency contraception, no more --- • than 72 hours (3 days) after Unprotected Sexual Intercourse (UPSI) or failed contraceptive method • Women requiring emergency contraception up to 72 hours where ulipristal is contraindicated. • Patient has no contraindications to acetate Inclusion criteria • Copper intrauterine device has been considered and declined or deemed inappropriate • Women who have vomited within 3 hours of taking levonorgestrel 1500 micrograms • Women under 16 years of age must be assessed competent using Fraser Guidelines

Personal Characteristics and Reproductive History • Pregnancy known, or suspected • Patient under 16 years of age and assessed as not competent using Fraser Guidelines • Patient is 16 years of age and over but assessed as not competent to consent • Any episode of UPSI more than 72 hours ago (refer to PGD for if appropriate) • Any other episode of UPSI since last menses • Previous use of emergency contraception (levonorgestrel or ulipris_tal ace!a~) ~il'l~elast_lllenses ------• Patients who are at risk of ectopic pregnancy (previous history of Exclusion criteria salpingitis or of ectopic pregnancy), in line with the Marketing Authorisation. A GP consultation is recommended to confirm any individual circumstance.

NOTE: supply against a third party request is not permitted under this direction and the client must be present in the pharmacy.

Other Conditions • Allergy or hypersensitivity to the active substance levonorgestrel or any of the excipients, or with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose- galactose malabsorption (tablets contain lactose) • Severe hepatic dysfunction . • Severe malabsorotion svndromes, such as Crohn's disease . Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

4 Advise the patient that in line with the Marketing Authorisation you are unable to supply levonorgestrel, however a GP consultation is recommended to ascertain if dose adjustment may be applicable. Interacting Medicines • Medicines containing cyclosporine (levonorgestrel contra- indicated) • Check with the patient what other medicines they take • If the patient is under 13 years of age follow local safeguarding policy (refer to information at the end of the Fraser Competence section below)

Breastfeeding • l.evonorqestrel is· secreted into· breast· milk. Potential exposure of an infant to levonorgestrel can be reduced if the breast-feeding woman takes the tablet immediately after feeding and avoids nursing for at least 8 hours following administration of the tablet. • United Kingdom Medical Eligibility Criteria UKMEC (2016) Cautions {including guidelines for emergency contraception POSTPARTUM any relevant action to (breastfeeding or not breastfeeding): be taken) 0 Emergency contraception is not required if unprotected sex or barrier method failure occurs <3 weeks postpartum.

0 Oral emergency contraception (as either levonorgestrel or ulipristal acetate) are indicated from 3 weeks postpartum.

0 Emergency Copper-IUD is indicated from 4 weeks postpartum.

0 Women who are fully breastfeeding, amenorrhoeic and <6 months postpartum can rely on the lactational amenorrhoea method (LAM) as an effective method of contraception. However if breastfeeding frequency decreases or menstruation recurs emergency contraception may be indicated. Arrangements for For advice contact Dorset Contraception and Sexual Health Service referral for medical on 0300 303 1948 advice • Do not supply levonorgestrel under PGD • Discuss reasons for exclusion and alternative contraception . • Advise that Copper IUD as emergency contraception is most effective method, and refer as appropriate Refer to appropriate/ preferred health provider as required: Action to be taken if • patient excluded Contraceptive and Sexual Health Service (C&SH) 0300 303 1948, or Make an appointment with GP, or Contact out-of-hours service on 0845 6001013 • Document all actions taken Note:

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

5 A&E departments do not fit intrauterine contraceptive devices (/UCO). An JUGO may be fitted up to 5 days after unprotected sexual intercourse or 5 days after expected date of ovulation in that cycle. Therefore refer to C&SH clinic or GP regarding this option. /UCO is the most reliable form of emergency contraception.

U/ipristal acetate (el/aOne®) is licensed for emergency contraception and may be provided up to 120 hours after unprotected sexual intercourse or contraceptive failure. • Discuss reasons for exclusion and alternative methods of emergency contraception e.g. IUCD Action to be taken if patient declines • Record the refusal in the relevant patient record treatment • Refer to appropriate / preferred health provider ( see above) • Document all actions taken • The metabolism of levonorgestrel is enhanced by concomitant use of liver enzyme inducers. Women taking enzyme inducing drugs, or within 4 weeks of stopping them, e.g. barbiturates (including phenobarbital and primidone ), ritonavir, carbamazepine, phenytoin, rifampicin, rifabutin, griseofulvin and St John's Wort - double the usual dose of levonorgestrel from 1500 micrograms to 3000 micrograms (i.e. 2 packs) as per European Medicines Agency advice. Drug interactions • Advise patient to have a pregnancy test to exclude pregnancy after use of levonorgestrel-containing emergency contraception • Advise them to seek prompt medical advice if they do become pregnant • Medicines containing levonorgestrel may increase the risk of cyclosporin toxicity due to possible inhibition of cyclosporin metabolism - use of levonorgestrel contra-indicated For more information refer to the Summary of Product Characteristics for Levonelle® ------·· ------_,

DETAILS OF THE MEDICINE

Name, form and strength of medicine Levonorgestrel 1500 microgram tablets

Legal category Prescription only medicine (POM) • For oral administration . Route/method of • One tablet should be taken as soon as possible, preferably within 12 hours, and no later than 72 hours after unprotected intercourse administration or failure of a contraceptive method. • For patients taking enzyme inducing (refer to drug interactions section above)

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

6 • The tablet(s) must be taken at the time of the consultation . • Dose to be taken as soon as possible and no later than 72 hours after unprotected sexual intercourse. • Dose is either one 1500 microgram Levonorgestrel tablet, or for Dosage/frequency patients taking enzyme inducing , two 1500mcg tablets • If vomiting occurs within three hours of taking the dose, another dose should be taken immediately, one further dose of either 1500mcQ or 3000mca can be suonlled under this PGD. Quantity to be • One 1500 microgram Levonorgestrel tablet or two 1500mcg administered and/or levonorgestrel tablets for patients taking enzyme inducing supplied medications (refer to drug interactions section above) Very common Itz 1/10) • Headache • Nausea • Lower abdominal pain • Bleeding not related to menses • Fatigue

Cornmon fjz 1/100 to <1/10), • Diarrhoea • Vomiting • Dizziness • Bleeding patterns may be temporarily disturbed, but most women will have their next menstrual period within 7 days of the Adverse effects expected time. • Irregular menses • Breast tenderness Refer to Summary of Product Characteristics (SPC) and current British National Formulary (BNF) for full list and further information. In the event of untoward or unexpected adverse reactions: • If necessary seek appropriate emergency advice and assistance • Document in the individual's medication record • Complete incident procedure if adverse reaction is severe (refer to local policy) Use the 'Yellow Card' system to report serious adverse drug reactions directly to the Medicines and Healthcare products Regulatory Agency (MHRA). Yellow cards are available in the back of the BNF or report online at htt~s://yellowcard.mhra.gov.uk/

The authorised community pharmacist must: 1. Enter required details on PharmOutcomes to ensure appropriate Records to be kept reimbursement and auditable outcomes. 2. OR, if unable to access PharmOutcomes, complete the Community Pharmacy EHC PGD consultation form ( enclosed) Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

7 recording: • Where appropriate the assessment of competence in line with Fraser guidelines • Appropriate local record of the supply • Details of any referrals e.g. to C&SH Information recorded on this form should be input into PharmOutcomes at the earliest opportunity.

Follow-up advice to • Client must be advised to attend an appropriate local healthcare be given to patient or provider (GP/ C&SH) following treatment if next period is delayed carer (more than 7 days), absent or abnormal e.g. exceptionally heavy or light, if they experience pelvic pain or are otherwise concerned. • Recommend a pregnancy test is taken at 3 weeks (see oral/ written information to be given to patient or carer). • Recommend referral I attendance at appropriate local healthcare provider (GP/ C&SH) for ongoing contraception and STI testing as required

PATIENT INFORMATION

• Provide the manufacturer's Patient Information leaflet • All clients should be signposted to the following websites:

o Family Planning Association (FPA) - www.fpa.org.uk o Sexual Health Dorset - https://sexualhealthdorset.org/

• Explain mode of action, side effects, benefits and how to take medication. Advise that menstrual periods may be early or delayed - most women will have their next menstrual period within 7 days of-the expected-time~ -

Oral/Written • Advise that if supplied under the PGD, the medication should be information to be taken immediately, before leaving the pharmacy given to patient • , Advise to adopt a regular method of contraception • Explain emergency post coital intrauterine device (IUD) is considered a more effective method of emergency contraception and community pharmacists should signpost to an appropriate healthcare provider after supply of levonorgestrel, where appropriate and acceptable to the patient • Advise about the risks of the medication including failure rates and side effects and actions to be taken • Advise breastfeeding is not recommended for 8 hours following ingestion of levonorgestrel, advise the individual to express and discard the breast milk during this time • Advise the atient to return to the

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

8 within three hours of taking the medicine (if vomiting occurs, one more dose can be provided under this PGD) • If a woman wishes to continue using hormonal contraception she can do so after using levonorgestrel (refer to relevant contraceptive PIL). The SPC for levonelle recommends using additional barrier contraception until the next menstrual period. • If no withdrawal bleed occurs in the next pill-free period following the use of levonorgestrel after regular hormonal contraception, pregnancy should be ruled out. • After Levonorgestrel intake, menstrual periods are usually normal and occur within 7 days of the expected date. If menstrual periods are delayed by more than 5 days or abnormal bleeding occurs at the expected date of menstrual periods or pregnancy is suspected for any other reason, pregnancy should be excluded. • If pregnancy does occur after treatment with levonorgestrel, the possibility of an ectopic pregnancy should be considered. The absolute risk of ectopic pregnancy is likely to be low, as levonorgestrel prevents ovulation and fertilisation. Ectopic pregnancy may continue, despite the occurrence of uterine bleeding. • Advise levonorgestrel is for occasional use only. It should in no instance replace a regular method of contraception. • Advise on safer sex practices and possible need for screening for sexually transmitted infections following UPSI • Ensure the individual has contact details of local contraceptive and sexual health services - Tel: 0300 303 1948 • Offer a pack of 3 condoms from pharmacy stock

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

9 Appendices

Appendix A Key references

1. Summary of product characteristics for each brand of the medicine(s) covered by the PGD

2. Current British National Formulary (BNF)

3. Questions and Answers on Levonelle® (European Medicines Agency), May 2016

4. GPhC Standards of conduct, ethics and performance code of conduct

5. NICE (MPG2) Patient Group Directions March 2017

6. NMC The Code, London 2015

7. NMC Standards for Medicines Management 2010

8. NICE Medicine Practice Guideline: Patient Group Directions (MPG2), August 2013

9. NICE Competency Framework for healthcare professionals using Patient Group Directions August 2013

10. FSRH. Clinical Guidance for Emergency Contraception March 2017

11. FSRH Clinical Guidance on Quick Starting Contraception April 2017. CEU 12. FSRH Clinical Guidance on Drug Interactions and Hormonal Contraception January 2017 CEU 13. FSRH UK Medical Eligibility Criteria for Contraceptive Use November 2016 CEU 14. FSRH Clinical Guidance Contraception after Pregnancy January 2017 CEU

Sources of further information

Faculty of Sexual and Reproductive Health (FSRH) (formerly Family Planning Association): https://www.fsrh.org/home/

NHS Clinical Knowledge Summaries http://www.cks.nhs.uk/contraception emergency

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

10 Appendix B Health professionals' agreement to practise

This Patient Group Direction is for use in

...... Pharmacy D

Or by a locum pharmacist in pharmacies approved to offer the service D

The direction must be read, agreed to and signed by each of the pharmacists who work within it. All professions must act within their appropriate Code of Professional Conduct. One copy should be given to each pharmacist with the master copy being kept by the manager of each pharmacy approved to offer the service. I confirm that I have read and understood the content of this Patient Group Direction and that I have received the appropriate training in order to implement it effectively. I agree to work within its parameters.

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national guidance Expiry date: July 2021

11 COMMUNITY PHARMACY LEVONORGESTREL EHC PGD CONSULTATION FORM (AUGUST 2018)

Pharmacists should enter the details of the consultation straight on to PharmOutcomes or, if access issues with PharmOutcomes, use this form to record. The information recorded here should be entered into the PharmOutcomes after the consultation to ensure payment.

Ph armacv, err en t an d GP d e t aI· 1 s Consultation date: Time: Pharmacist name: Client's name: (for pharmacy use only): Date of birth: If under 16, advise client of additional assessment requirements and limits of confidentiality to safeguard and protect the child Client's postcode (first portion of postcode e.g. DT3 or BH14): GP surgery: (if known, otherwise use pharmacy postcode)

err en t' s Eth ru· cr·t v White - British White - Irish White - any other white background Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Any other mixed background Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Any other Asian background Black or Black British - Caribbean Black or Black British - Any other Black Black or Black British - African background Other Ethnic Groups - Any other ethnic Other E:ttmic Group_s - Chinese ------group------,------Other Ethnic Groups - Note stated

Client Under 16 Years For clients who are under 16 years of age there should be a discussion with the young person to explore the following issues, including an assessment of the young person's maturity. Fraser assessment: • Understanding of advice given • Encouraged to involve parents • The effect of physical or mental health of your person if advice/treatment withheld • Action is in the best interest of the young person . Is the client Fraser competent? Yes No Referral for safeguarding? Yes No

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 12 R eason f or R equest The client requested emergency contraception due to: Unprotected sexual intercourse Condom failure Combined oral Contraceptive with rifampicin or Pill error itraconazole Decreased pill efficiency due to vomiting and Vomited previous EHC dose diarrhoea Other problems Was alcohol a factor in the UPSI Yes No Time since UPSI: If the client presented after 72 hours, were they offered Yes No ulipristal acetate (UPA)? If the client presented after 120 hours, were they referred elsewhere for further support? Yes No (For exclusions contra-indication or request for IUD)

Referred to GP Sexual Health A&E Outreach Nurse Contraception Service GUM Other (please state if known)

Referral Information Please enter any relevant referral information

M ens t rua IH"ISt Ory Cycle length _(in days) - length of normal cycle Date of last period (first day of bleeding) Day in cycle (pregnancy test if greater than cycle length)

Exclusion of Prior Pregnancy (if yes, please refer) Pregnancy or suspected pregnancy is a contraindication for supply under the PGD Was the last period unusual? Yes No (e.g. later, lighter or shorter than normal) Has unprotected sexual intercourse taken place since the last period Yes No (without appropriate EHC?)

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 13 Medical History Is the client breastfeeding? I Yes I I No I If yes refer to the PGD, SPC or NHS CKS for guidance on the use of ulipristal acetate in breastfeeding

Exclusion Criteria (if yes, or any apply please refer): Pregnancy known or suspected Yes No Patient under 16 years of age and assessed as not competent using Yes No Fraser Guidelines 16 years of age and over and assessed as not competent to consent Yes No Any episode of UPSI more than 72 hours prior to presentation (refer Yes No to PGD for UPA if appropriate) Other episode of UPSI since last menses Yes No Patients who are at risk of ectopic pregnancy (previous history of salpingitis or of ectopic pregnancy), in line with the Marketing Yes No Authorisation. A GP consultation is recommended to confirm any individual circumstance Allergy or hypersensitivity to the active substance Levonorgestrel or any of the excipients, of with rare hereditary problems of galactose Yes No intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (tablets contact lactose) Severe hepatic dysfunction Yes No Severe malabsorption syndromes, such as Crohn's disease

Advise the patient that, in line with the Marketing Authorisation, you Yes No are unable to supply Levonorgestrel, however a GP consultation is recommended to ascertain if dose adjustment may be applicable If yes to any of the above, refer to the PGD, SPC or NHS CKS to determine if EHC is appropriate for the client ------

Int eracf m g Med "ic.m es Medicines containing cyclosporine (Levonorgestrel Yes No contraindicated) List interacting medicines

Counselling Points - Levonorgestrel Please tick to indicate discussion has taken place

Mode of action Side effects Action if vomits Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 14 Effect on foetus STls Failure rate Next period When to seek medical advice Follow up Patient information leaflet Future contraception

Contraception Plan Made a contraception plan and referred to contraception service or GP to implement

~c·I· ·=o=~nt~ra=c=e~p~t~io~n~p=la=n=··· ~~~'=Y~e~s~~~~=J~N_o~·· -~~~=' EHC U se an d S uppty Client offered emergency hormonal copper IUD Yes No Client accepted emergency copper IUD Previous use of EHC Yes No In last month If yes, how long ago 6 months Year

Levonorgestrel supplied Yes I No If Levonorgestrel supplied: I Batch number j j Expiry date I

Chi amv d"1 a T es fm g an dC on d oms Client signposted to a Chlamydia test online Yes No Condoms supplied Yes No

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 15 FRASER COMPETENCE - form to use for EHC consultations

If a client is believed to be under 16 years of age, the pharmacist must assess the client's competence using Fraser Guidelines, and complete this separate section of the protocol. Discussion with the young person should explore the following issues at each consultation. This should be documented below:

Assessment of Fraser competence YES NO Does the client appear to understand the advice given? Have you discussed with her about informing her parents about the treatment? Has consideration been given to the effect on the physical or mental health of the young person if advice or treatment is withheld?

IF YOU HAVE ANSWERED NO TO ANY OF THE ABOVE QUESTIONS, THE CLIENT CANNOT BE DEEMED TO BE 'FRASER COMPETENT'. IN THIS CASE, YOU WILL NEED TO ENSURE THEY ATTEND A SEXUAL HEAL TH CLINIC OR SEE A GP AS SOON AS POSSIBLE. The Sexual Offences Act 2003 states that no child under 13 years is able to consent to any sexual activity. If the client is believed to be under 13 years of age, providing they have been assessed as 'Fraser competent', you should not withhold treatment, as the duty to safeguard the child from most harm, would include protecting them from an unintended pregnancy. You should record all the details of the consultation and discuss at the earliest opportunity with the Child Care Duty Team at the Local Authority (Social Services) or a member of the CCG Safeguarding Children Team (See contact details below) In an emergency, you can contact the police.

SAFEGUARDING CHILDREN GUIDANCE If a client appears to be under 18 years of age, the pharmacist must assess the welfare of the young person using the following protocol:

SAFEGUARDING CHILDREN ASSESSMENT YES NO Is the client under 13 years of age?

·-lsthere-ariycoricernab0utFraserc0m13etency'? ·· ------· - 1------...... , . . .. Is there any evidence of a coercive relationship (such as older partner, reluctance to allow young person to be seen alone) Is the client under 18 years of age and is the partner in a position of trust e.g. teacher/sports coach/youth worker? Is there any evidence that the young person may be engaged in prostitution? Is there any evidence of domestic violence? Is there any evidence of drug or alcohol misuse, relating to the sexual activity? Is there any evidence of threats, or attempts to gain secrecy? Is there any evidence of self-harm/psychiatric illness?

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 16 Are there any other issues, which lead you to be concerned about the young person's safety or welfare? If yes, please give details:

IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, OR YOU HAVE ANY OTHER CONCERNS REGARDING THE WELFARE OF THE YOUNG PERSON, PLEASE CONTACT THE CHILD CARE DUTY TEAM AT THE LOCAL AUTHORITY (SOCIAL SERVICES) OR ONE OF THE CCG SAFEGUARDING CHILDREN TEAM AS FOLLOWS~ CONTACT CONTACT DETAILS Safeguarding Children Team 01305 361469 helpline Open 9am to 5pm Monday to Friday

Your call will be transferred to the on-call safeguarding children advisor. Local Authority children's social work department, including out 01308 422234 of hours Bridport Christchurch 01202 474106 Ferndown 01202 877445 North Dorset 01258 472652 Weymouth/Portia nd 01305 760139 Purbeck 01929 553456 Dorchester/Sherborne 01305 224150 Poole 01202 735046 Bournemouth 01202 458102 Out of Hours 01202 657279

PLEASE REMEMBER THAT IF YOU SUSPECT THAT A CHILD IS BEING ABUSED: • Discuss with the Child Care Duty Team at the Local Authority (Social Services) • OR Discuss with a member of the Safeguarding Children Team • OR Inform the police, if you suspect a crime has been committed • Don't think someone else is doing something • Doing nothing is NOT an option

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 17 Appendix C: Information sheet for women whom have taken an enzyme inducer in the past 4weeks

••• .•....:.::..1,. •. Medicines & Healthcare products ••;.-.• ..•.• • MHRA Regulatory Agency • • • •

Levonorgestrel emergency contraception; Important Information for women taking other medlclnes

Some medicines, or nerbal remedies toot contain the Ingredient st John's wort, might reduce how well levonorgestrel emergency contraception works.

What you need to do Tell the doctor, pharmacist, or nurse if you are currently taking a medicine to treat any of the following, or you have used one in the past 4 weeks: • epilepsy (eg, medicines called barbiturates, primldone, phenytoin, or carbemazeplne) • tuberculosis (eg, rifamploln, rifabutin) • HIV (eg, rltonavlr, efavirenz) • a fungal Infection (eg, griseofulvin) • or if you have teken any herbal remedies that contain the ingredlent St John's wort (selentffic name Hyper/cum perfbratum)

If you are taking any medlclnes or herbal remedies and are not sure if they m[ght affect levenorpestrel emergency contraception check wlth your doctor, pharmacist, or nurse.

What happens now? Your doctor, pharmacist or nurse will talk to you about whether this applies to medicines you have recently taken. If It does, you shoukl either: • see a doctor or nurse to have another type of emergency contraception called a copper Intrauterine device or 'coil' inserted into the womb (this does not interfere with the aotlon of other medicines); or; • take a double dose of levonorgestrel emergency oontraceptlon. The pharmacist will give you 2 packs, whf,ch should be taken together at the same time

Further lnformatlon'about-1evonorge:strelemergencycontraceptlon- - Levonorgestrel ls a hormonal type of emer:gency contraception. It can be used Within 3 days (72 hours) after unprotected sex or falfure of a usual contraceptive method.

Levonorgestrel emergency contraception may not prevent pregnancy every tlme. It works bast the sooner it is taken-preferably within 12 hours.

Advice for women taking ievonorgestrel emergencycontraaeptlon: • see your doctor or nurse for advice on effective, ongoing contraception • do a pregnancy test to ensure that YoU are OQt pregnant 1f your period does not come at the right time or If you suspect you could be pregnant • if the test Is positive and you are pregnant (even after taking ievooorgestrel), see a doctor or nurse as soon as possjble to ensure that you receive the best care • read the leeflet that comes with levonorgestrel. whi<;h provides further information about this emergency contraception includmg any potential side effects • If you think that you may have had a slde effect after taking levonorgestrel, remember you can report it on a Yellow Card (https://yellowcard,mhra,gov.uk/)

Version number: 6.1 Valid from: August 2018 Review date: October 2020 or following new national Expiry date: July 2021 guidance 18