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Background: Medication errors are common in neonatal care and can lead to significant harm. We sought to explore utilization of various medication error prevention strategies across Australian and New Zealand neonatal units (NNUs) through a clinical practice survey. Methods: An electronic survey was distributed in October 2016 to relevant staff at each of the 29 level III NNUs identified as members of the Australian and New Zealand Neonatal Network (ANZNN). The survey contained questions relating to a range of medication error prevention strategies identified from a previous systematic review on the topic. The evaluated interventions targeted different aspects of the medication-use process including prescribing, evaluation/checking of orders by clinical pharmacists, transmission, preparation and dispensing of orders, storage of medications, and medication administration. Results: From the 20 respondents, the evidence-based strategies most commonly utilized were use of smart pumps ( n = 18; 90%), and ward-based clinical pharmacists ( n = 17; 85%). Interventions least commonly utilized included barcode scanning with medication administration ( n = 0; 0%), electronic prescribing and clinical decision support ( n = 1; 5%), and dedicated medication administration nurse ( n = 2; 10%). The total number of evidence-based medication error prevention strategies utilized in each NNU ranged from 2 to 10 (median = 7), 10 of 16 strategies were utilized by less than 50% of NNUs. Conclusion: While evidence supports utilization of a number of medication error prevention strategies, these appear inconsistently utilized across current practice settings.

Background: Despite the large burden medication-related morbidity and mortality places on the Australian health care system, there is little known about the extent of this problem in a women’s health (obstetric and gynecology) setting. Objective: Determine the frequency and nature of medication-related problems (MRPs) occurring in a women’s health unit (WHU) of an Australian teaching hospital. Methods: A prospective audit of consecutive cases of patients treated in the WHU at a tertiary-level teaching hospital was undertaken by a clinical pharmacist over a 5-week period. Data collected included the following: patient characteristics, type of MRP (using a modified version of the Hepler-Strand classification system), medication involved (according to the World Health Organisation Anatomical Therapeutic Chemical classification system), and clinical significance (using a 2-level severity index). Results: A total of 454 potential MRPs were identified over the 5-week period among 241 patients. A total of 39 MRPs (8.6%) identified were deemed to be of moderate/high clinical significance. The highest number of MRPs (221; 49%) was identified among women admitted following a cesarean delivery, with 83 of 85 women in this group experiencing at least 1 MRP. Additional factors associated with an increased likelihood of patients experiencing a MRP included increased age, length of hospital stay, and number of regular medications taken prior to and during admission ( P < 0.05). Conclusion: The widespread nature of identified MRPs in this setting suggests that various approaches to minimizing these problems and mitigating the associated burden on the health care system are warranted.

To date, the investigation of teratogenic effects of medications has largely focused on physical alterations present at birth (i.e. malformations) as opposed to functional alterations (i.e. neurodevelopment, metabolic function) that may not be apparent at birth but could influence an individual’s health and risk of disease in later life. The use of routinely collected health data represents one approach to better identifying, quantifying, and understanding the long-term risks or benefits of medication use during pregnancy. As such, the objective of this review was to identify and explore opportunities and challenges associated with using routinely collected health data to examine long-term effects of medication use during pregnancy. Drawing on published research several key methodological issues associated with their use in investigating long-term outcomes are reviewed. While significant opportunities exist to make greater use of routinely collected health data, there are a number of key challenges. Identified challenges relate to aspects of study design and analysis, and include obtaining access to data, the ability to match records across datasets and over long periods of time, how medication exposures are ascertained and classified, issues around loss to follow-up how outcomes are ascertained and classified, and the careful interpretation of results in light of study and data limitations. Understanding key challenges associated with using routinely collected health data to investigate long-term effects of medication use during pregnancy is essential in supporting their appropriate use and interpretation, which will contribute to improving the quality of research undertaken and ensure the reliability of results obtained. Refereed/Peer-reviewed

Background: Domperidone is often used to promote lactation among women who have difficulty breastfeeding. Objective: To examine prescribing and dispensing practices of domperidone at the Women’s and Children’s Hospital (WCH), Adelaide. Methods: A retrospective audit of domperidone dispensing among women with singleton pregnancies who delivered at the WCH between January 2000 and July 2010 was undertaken. Women dispensed domperidone were identified using WCH pharmacy dispensing records. Maternal and infant clinical data were obtained from the WCH Perinatal Statistics Collection. An audit of paper-based medical records was undertaken for a random sample of 261 mother-child pairs to collect prescribing and additional clinical data. Results: From 2000 to 2010, 1605 women were dispensed domperidone. There was a steady increase in the percentage of women dispensed domperidone, from < 0.5% in 2000 to > 5% of total WCH pregnancies in 2010. Among women dispensed domperidone, the percentage of women who received > 1 dispensing remained consistent (20%) over time, as did the median number of days (12) from delivery to first dispensing. Multiparous women were more likely to receive domperidone within 3 days following delivery compared to primiparous women (8% vs 4%; P < .01). Most women (80%) received directions to take domperidone according to a standard tapering dosing regimen over 12 days. Notably, 60% of women had no documentation of being assessed by a lactation consultant. Conclusion: From 2000 to 2010, there was a considerable increase in domperidone dispensing. With a lack of clinical evidence to guide use, current practice appears to be based on anecdotal evidence.