Third Stage: Implementation and Sustainability
The third stage of immediate postpartum LARC implementation is implementation and sustainability. A successful immediate postpartum LARC program requires piloting and adaption to be fully implemented and sustained. Each hospital will need to adjust its program to local circumstances.
Some hospitals may consider establishing immediate postpartum LARC programs offering only one type of device, with plans for expansion to other devices, to pilot the process. Others may consider a low-volume trial period for troubleshooting the process. Frequent communication among implementation team members is essential to responding to challenges and improving immediate postpartum LARC programs.
Key Steps by Department:
Key steps by task:
1. Clinician equipment and supplies
Like the office setting, clinicians may approach device placement by having a list of equipment and supplies to gather or by creating ready-to-open kits. Communication among clinical personnel including technicians who may gather supplies, information technology personnel who create electronic order sets, and pharmacists can be helpful in deciding which approach to try first and whether to test other approaches.
2. Clinician education, including educational refreshers and new hire training
Once hospitals begin offering immediate postpartum LARC, clinicians may need updates about process changes, procedural reminders, or additional practice. Additionally, new staff requires education about the immediate postpartum LARC program and their role in it. The new hire training process may prompt educational updates, and clinician refreshers may inform training for new staff members. This step applies to the pharmacy and finance departments as well.
3. Device storage, placement, and timing
After a few IUD postplacental placements, the flow of devices through the hospital should be evaluated. Slow transport from IUD storage location to the delivery room may trigger a change in IUD storage location. Contraceptive implant placement is less time-sensitive and may occur in any location.
Patient delays related to implant placement may require re-evaluation of placement timing, which could impact placement and storage locations. The physical layout of obstetrical care units, staffing capabilities, and clinician and pharmacist input can all inform the best placement and storage plan for each hospital.
4. Claim submission and payer communication
Financial processes may also require adjustment, and tracking early LARC orders, coding, charges, and payment claims with troubleshooting as needed is key to program sustainability.
After submitting the first LARC charges, finance or billing personnel should follow up to ensure correct payment and may need to communicate with insurers to identify whether they must change or resubmit claims. As with any new program, this submission and communication process may require refinement.
Citation: Hofler LG, Cordes S, Cwiak CA, Goedken P, Jamieson DJ, Kottke M. Implementing immediate postpartum long-acting reversible contraception programs. Obstet Gynecol 2017;129:3-9. Reprinted with permission from Wolters Kluwer Health, Inc.