Optimizing inpatient access to oral contraceptives: A quality improvement approach in behavioral health

TL;DR

A hospital improved access to birth control for mental health patients by creating a new workflow, significantly increasing the chances of patients receiving their medication during hospital stays.

Contribution

A structured workflow for oral contraceptive procurement was implemented and evaluated in a behavioral health unit.

Findings

Oral contraceptive administration improved from 33% to 78% after implementing the workflow.

Patients were seven times more likely to receive oral contraceptives post-intervention.

The workflow demonstrated scalability and potential for advancing reproductive health equity.

Abstract

Continuity of oral contraceptive use during hospitalization is critical for reproductive health, yet behavioral health settings often deprioritize this need. At a Midwestern community hospital, pre-admission oral contraceptives were frequently withheld due to absent workflows, inventory limitations, and provider uncertainty.

The purpose of this quality improvement initiative was to design, implement, and evaluate a structured oral contraceptive procurement workflow to improve continuity of care and support reproductive autonomy for hospitalized behavioral health patients.

A quality improvement initiative introduced a structured oral contraceptive procurement workflow in an adult inpatient behavioral health unit. Using Plan-Do-Study-Act cycles, the multidisciplinary team addressed medication reconciliation, pharmacy coordination, and provider education. Data were collected retrospectively (2022−2023) and prospectively (January–April 2025) for females aged 18–49 prescribed oral contraceptives prior to admission.

Oral contraceptive administration improved from 33 % (17/51) pre-intervention to 78 % (7/9) post-intervention (p = .023). Patients were seven times more likely to receive oral contraceptives after implementation, with a 95 % confidence interval ranging from 1.31 to 37.40. Missed doses persisted due to provider unawareness of workflow and outpatient pharmacy stock constraints.

Implementing a standardized workflow significantly enhanced oral contraceptive continuity for behavioral health inpatients. This systems-based approach demonstrates the value of interdisciplinary collaboration and pharmacy integration in closing reproductive care gaps. Future priorities include sustainability, electronic medical record integration, and broader adoption to advance reproductive health equity.

•OC access rose from 33 % to 78 % after workflow implementation.•Patients were 7× more likely to get OCs post-intervention (p = .023).•A pharmacy workflow improved OC continuity in behavioral health inpatients.•Multidisciplinary teamwork streamlined pharmacy coordination.•The model is scalable and supports reproductive health equity.

OC access rose from 33 % to 78 % after workflow implementation.

Patients were 7× more likely to get OCs post-intervention (p = .023).

A pharmacy workflow improved OC continuity in behavioral health inpatients.

Multidisciplinary teamwork streamlined pharmacy coordination.

The model is scalable and supports reproductive health equity.

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