Information on medication safety with a focus on nurses, and obstetrics

2.  Over 95% of pregnant women
will receive a prescription or
medication at sometime during
their pregnancy.
 45% of pregnant women use
herbal remedies
 Approximately 2-3% of births are
associated with birth defects
due to the drugs used during
pregnancy
 Increase medication use with
advance age
 Increase medications with
patients with co-morbidities

3.  49% of OB medication errors
occurred in the L&D area
 41% occurred in the maternal
unit (AP or P)
 10% occurred in OB recovery

4.  Category A: Adequate and well-controlled studies
have failed to demonstrate a risk to the fetus in the
first trimester of pregnancy.
 Category B: Animal reproduction studies have failed
to demonstrate a risk to the fetus and there are no
adequate and well-controlled studies in pregnant
women.
 Category C Animal reproduction studies have shown
an adverse effect on the fetus and there are no
adequate and well-controlled studies in humans, but
potential benefits may warrant use of the drug in
pregnant women despite potential risks.

5.  Category D: Evidence of human fetal risk based
on adverse reaction data from investigational or
marketing experience or studies in humans, but
potential benefits may warrant use of the drug in
pregnant women despite potential risks.
 Category X: Studies in animals or humans have
demonstrated fetal abnormalities and/or there is
positive evidence of human fetal risk based on
adverse reaction data from investigational or
marketing experience, and the risks involved in
use of the drug in pregnant women clearly
outweigh potential benefits.

6.  Teras-”MONSTER”
 Genic-”PRODUCING”
 Birth defect/distortion of gross anatomy.
 Ex: cleft lip, cleft palate, clubfoot, neural
tube defects, missing or malformed
limbs/fingers.
 Behavioral or biochemical abnormalities

7.  Category X
 Anti-coagulant normally prescribed in
case of diseases like DVT or pulmonary
thromboembolism etc.
 When given during pregnancy, it can
result in CNS defects, spontaneous
abortion.
 Still births, post-partum
hemorrhage and ocular
abnormalities.

8.  Category X
 Indicated for various skin disorders.
 Use during pregnancy can lead to facial,
ocular, otologic and skull abnormalities.
 It has also been shown to cause CNS
and cardiac defects along with
hormonal abnormalities.
 Cases of low IQ after isotretinoin use
have also been reported.

9.  Use during pregnancy can result in fetal
hydantoin syndrome which is characterized
by cranial, facial and limb defects.
 Cleft lip or palate and abnormal size of
head are common in children suffering from
it.
 Distal phalangeal hypoplasia, reduced size
or absence of nails, abnormal palmar
crease are the limb defects noted in such
children.
 Low IQ level has also been attributed to
phenytoin use during pregnancy

10.  Use during pregnancy has
been related to bipolar
disorder in the new born.
 Lead to congenital cardiac
defects particularly Ebstein's
anomaly, cyanosis in
newborns, Hypotonia, atrial
flutter and bradycardia.
 Effects seen in infants
breastfed

11.  Medications the require a heighten risk
of causing significant patient harm when
they are used in error.
 When error occurs consequences more
devastating

12.  Epinephrine, subcutaneous
 insulin U-500
 magnesium sulfate injection
 methotrexate, oral, nononcologic use
 oxytocin, IV

13.  Considered a high risk medication
 Slow attainment of steady-state
 Unpredictable theraputic index
 Can have negative effect on fetus
 Monitoring effects can be difficult

14.  23 y/o G1P0 41 g.a.
 Favorable cervix and
Bishop score
 MD order “Pitocin per
protocol”
 Nurse mixes Pitocin in 1L
of NS
 Begins infusion at
0.5mU/min

15.  Patient requests to ambulate
 Nurse documents fetal heart tones and
increases Pitocin
 Patient is disconnect to external
monitoring to ambulate
 30 minutes later patient returns
tachystole and fetal Bradycardia is
found

16.  Prescribing safety
› Standard order
› Evidence-based rates
 Dispensing safety
› Standardized preparation by pharmacy
 Administration and monitoring safety
› Parameters to identify tachystole
› Assessment of fetal heart rate and uterine
activity every 15 minutes in 1st
stage and every 5
min in 2nd
stage

17.  Considered high risk
medication
 Used in high doses on
labor and delivery and
places patients at risk of
magnesium toxicity
 Dosing errors occur
often due to confusing
abbreviations

18.  Omission
 „ Improper dose/quantity
 „ Wrong time
 „ Unauthorized drug
 „ Prescribing error
 Transcribing error
 „ Extra dose
 Dispensing error

19.  „ Performance deficit
 „ Procedure/protocol not followed
 „ Communication
 „ Knowledge deficit
 „ Documentation
 „ Transcription inaccurate/omitted
 „ Dispensing device involved
 „ System safeguards
 „ Improper use of pump
 „ Drug distribution system

20.  Misprogramming infusion pumps
 Misconnected or disconnected IV tubing
 Administering peripheral IV solutions
through epidural catheter
 Omission of antibiotic prophylaxis per
protocol
 Lack of drug allergy information at time of
drug administration
 Incomplete communication and
documentation

21.  Rights of medication
adminstration
› Right patient
› Right medication
› Right dose
› Right route
› Right time
› Right documentation
› Right situation
› Right place
› Right to refuse

22. http://www.jointcommission.org/assets/1/18/do_not_use_list.pdf

23.  Administer bolus doses from pharmacy
mixed bags and not the maintenance
solution
 Verify magnesium and pitocin pump
settings by two nurses
 Use luer lock connectors in all IV tubing
 Clearly label iv solutions, tubings, &
connections with a unique labeling
system that identifies the solution used