A number of years ago I worked for a busy OB/GYN practice. We had several unplanned pregancies, all due to patients’ misunderstanding of the proper use of their chosen method of contraception. One patient became pregnant while using a diaphragm that had developed a small hole, so she had “repaired” the hole with a Band-Aid. Another patient was taking oral contraceptives in a vertical fashion, rather than horizontally, which resulted in her taking a placebo pill every 4 days. Another patient became pregnant using contraceptive OTC foam. (I take responsibility for that one.) I had a vaginal/uterine plastic model in front of the patient as I demonstrated to her how to fill the vaginal applicator and insert it into the vagina, and then I pushed the plunger (into my palm) to show her how the applicator worked. Later, she explained, “And I put the foam into my palm, just as the nurse showed me. I rubbed it in well, too.” And lastly, a patient became pregnant while “on the pill.” Our office had not prescribed the oral contraceptive to her, so when questioned further she revealed that she was not on an oral contraceptive at all. She thought a woman would not get pregnant if she was taking any pill, so she was taking a daily aspirin! Funny stories, but not really. These are all examples of not taking the time to educate patients and making sure they understand before they leave the office.—Rhonda McKanna, RN, Canadian, Texas (218-3)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.