Nexplanon implant pre-insertion counselling checklist

The interactive checklist below could be used during a consultation with women considering the use of the Nexplanon implant. Fill in the boxes as you go, then print out and keep a copy of the completed checklist in the patient file.

1. Medically eligible (check medical and family history)

2. No contraindications to Nexplanon or local anaesthetics used

3. Advantages and limitations of contraceptive implant explained

4. Mode of action and efficacy discussed

5. Insertion and removal procedure (including possible complications) explained

6. Possible changes in bleeding patterns outlined explained

7. Correct timing for insertion determined

8. Discuss location of Nexplanon, effects of local anaesthetic

9. Show product sample of Nexplanon

10. Provided appropriate written information
(e.g. complications of insertion/removal; supportive information on Nexplanon; maximum period of use; option to discontinue at any time; return to pre-existing fertility; possibility of second implant)

Additional comments

Print checklist

Request a visit from a Schering-Plough representative to learn more about Nexplanon, including how to train to insert and remove the contraceptive implant.

Information for the general public about the contraceptive implant, Nexplanon.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk.
Adverse events should also be reported to MSD Drug Safety Department on 01707 363773

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Date of Preparation 6/2011
Code 6/12 - NEX.10.GB.9260.AVc

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