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

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

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.

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.

 

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

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.

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.

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

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

Medications the require a heighten risk of causing significant patient harm when they are used in error.

When error occurs consequences more devastating

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

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

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

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

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

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

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

„ 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

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

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

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

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