Appropriately trained nurses are competent at inserting intrauterine devices: an audit of clinical practice

Very few nurses in the UK insert intrauterine devices (IUDs). Within King's Healthcare, nurses with the advanced family planning qualification (ENB AO8), who have also undertaken further training in IUD insertion, have done so for many years. This is a controversial issue and our aim was to evaluate whether women who had IUDs inserted by specialist nurses had significantly more problems compared with those inserted by doctors.

This was a prospective, ongoing, cohort study of all IUD insertions in hospital-based family planning clinics over a 3-month period. A medical, gynecological, obstetric and contraceptive history was taken, paying particular regard to the reason for requesting an IUD. Clinical assessment, bimanual examination findings and any difficulties with insertion were noted at the time. Any postinsertion problems were noted at the follow-up visit.

Fifty IUDs were inserted, 28 by doctors and 22 by nurses. Sixteen were for postcoital contraception and five were routine reinsertions alter removal of an existing IUD. Eleven nulliparous women had insertions (six by doctors and five by nurses). The specialist nurses did not have to consult the doctor with any problems or difficulties with insertion. Twenty-nine clients attended for their follow-up appointment at 6 weeks. Three IUDs required early removal due to unacceptable bleeding and pain--all three had been inserted by doctors. Two postcoital IUDs were removed following menstruation. Of the remaining patients, eight were noted to have minor problems (divided equally between doctor and nurse insertions).

This study provides favorable evidence that adequately trained nurses are proficient and safe at IUD insertions, regardless of the woman's parity. IUDs inserted by nurses are also likely to have additional benefits of cost-effectiveness and increased client and nurse satisfaction. Follow-up is ongoing.