• nexplanon
• medico-legal
• implants

Following the Medicines and Healthcare products Regulatory Agency (MHRA) alert about migration of Nexplanon^® on 15 June 2016,1 we audited the quality of insertion of the implant in patients at our surgery.

We wrote to a total of 127 patients asking them whether they could feel the shaft and/or the ends of the implant in their arm. They were asked to post their responses back to one of us (KS) in addressed stamped envelopes.

We were, however, disappointed to receive only 60 (47%) responses. Of these, only one patient could not feel her implant. We had set aside appointments and telephone consultations, if needed, to deal with worried patients. Somewhat surprisingly, these were not required.

The patient who could not feel her implant was given an appointment within 2 days and the presence of the implant was confirmed by palpation, reassuring the patient. Each patient had a copy of her letter and questionnaire incorporated into her medical record. This was important for medico-legal purposes to confirm that the surgery had responded to the concerns raised in the MHRA alert.

Discussion of the results raised the issue of how to deal with those patients who had not responded to the letter. A medical defence organisation suggested the following options:

1. Follow up patients with a second letter

2. Display a notice in the surgery waiting room

3. Provide information on the practice website

4. Send text messages to patients.

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While we believe that the MHRA alert is a timely reminder about the need for safety in the insertion and removal of Nexplanon, our limited experience does not confirm a widespread problem with palpation of the implant.