Below is a general guide of the steps to be taken when initiating medication abortion (MA) services in your facility. Some of these may not apply, depending on your facility[12].

Review protocol:

• Review guidelines for MA.
• Prepare your protocol and invite the clinical team to review and give feedback on the protocol.
• Determine if purpose of offering MA is for occasional support for current primary care caseload or if it will be made available as a service in the community.
• Evaluate related protocols including contraception, STI testing and treatment and other sexual and reproductive healthcare services, and integrate them with the abortion protocols if appropriate.

Review regulations and compensation processes:

• Review provincial and territorial regulations and scope of practice for physicians and nurse practitioners, and assess the potential involvement of registered midwives in providing MA.
• For physicians, get familiar with provincial billing codes for provision of MA, including codes for any testing that you would be doing on-site.
• For nurse practitioners and registered midwives, review the compensation processes from the professional associations in your jurisdiction.

Address abortion concerns among your team:

• Explore the willingness to provide MA among all staff, address their concerns and determine how to best incorporate abortion services into your practice (see the next module).

Prepare plans to support underserved populations:

• Evaluate your services for its ability to serve underserved population such as non-insured patients, patients from Indigenous communities and patients identified as 2SLGBTQI+.
• Consider incorporating trauma-informed care and harm-reduction approaches in your services.
• Prepare plans to provide low-barrier MA services for underserved populations, and review these plans with your staff.

Review staffing and administrative capacity:

• Review current clinic capacity to provide MA.
• Determine key person or team to be primarily responsible for MA patients.
• Assess best times for scheduling MA patients.
• Review your clinic’s on-call schedule or your local hospital’s call service to connect with obstetricians.
• For clinical staff, arrange in-depth training on counselling, provision of Mifegymiso, and complication management.
• For support staff, prepare phone scripts and other resources for them to review and use.

Set up your facility:

• Assess the design of waiting rooms, reception areas and counselling rooms to ensure they promote patient privacy.
• Review arrangements with a lab or in-house capacity for a quantitative βhCG test and Rhesus testing and administration.
• Identify ultrasound facilities in your community, if not available on-site.
• Determine what additional supplies or equipment are needed.

Identify clinics for referral:

• Find procedural abortion clinics if you do not provide procedural abortion service.
• Identify abortion clinics in your area who can accept prompt referrals if your schedule cannot accommodate patients in a timely manner to ensure that your patients do not miss the window for MA.
• Find pharmacies that regularly stock Mifegymiso and develop relationships with local pharmacies who could stock Mifegymiso.

Prepare communication materials:

• Obtain or develop patient education materials, consent forms and other charting forms.
• Develop, print and distribute posters to let your clients know that you prescribe MA.