Drug use evaluation on cabergoline for post-partum lactation suppression at Canberra Health Services

Kalya Cho

MPharm | Rotational Pharmacist, Canberra Health Services

[Pharmacy GRIT Article No: 20241395]

As part of the Canberra Health Services Clinical Guideline: Termination of Pregnancy (TOP), Miscarriage or Fetal Death Management,1 1 mg oral cabergoline post-partum is offered after birth for breast milk suppression to reduce breast pain from engorgement. The rationale for cabergoline is for post-partum lactation suppression in the puerperium, thus reducing the emotional toll for patients, as well as providing symptom relief.  The Canberra Health Services (CHS) Clinical Guideline1 recommends drug administration ideally within 12 hours of birth for maximal efficacy, while other guidelines2,3,4 recommend drug administration within 24 hours of birth.

At Canberra Hospital, cabergoline was only available through the Main Pharmacy and it was assumed the lengthy medication supply process was extending timeframes for medicine administration. My project aimed to investigate if CHS met the recommend timeframe of <12 hours of birth as per CHS Termination of Pregnancy Policy or <24 hours as per other guidelines by performing a Drug Use Evaluation (DUE) using the ‘Reports’ function within our digital medication record to search for applicable patients, and analyse the data for the time in between drug charting, birth, and drug administration and later, to conduct post-implementation analysis after introducing cabergoline to TCH birthing suites. 

While undertaking my research, I encountered several challenges. The most significant was although cabergoline was physically added to the Birthing Suite imprest during the study period, the location was not updated in the digital medication chart so nursing staff and pharmacists were not aware of the change, hence medication supply still resulted through the Main Pharmacy. This error has since been amended but meant I was unable to fully complete my project during the study period for my residency as it limited data collection, leading to a small sample size and reduced significance, as well as the post-implementation analysis not being able to be conducted.

For future projects, I will have more experience in submitting research protocols for ethics approval and fully appreciate the benefits of starting a project as early as possible to enable as much time for data collection to improve the research power. This project also expanded my data collection abilities using the reports functionalities of our digital medication record which was a new activity for me.

References

  1. Canberra Hospital and Health Services. Canberra Health Services Clinical Guideline: Termination of Pregnancy (TOP), Miscarriage or Fetal Death Management. Version 1.2. Canberra: Canberra Health Services Policy Register; 2017.
  2. Australian Medicines Handbook (AMH) [online]. Cabergoline. Adelaide: AMH; 2023.
  3. Berens P. Overview of the postpartum period: Normal physiology and routine maternal care. In: Prabhu M, ed. UpToDate. Waltman, DC: Wolters Kluwer; 2023. Available from: https://sso.uptodate.com/contents/overview-of-the-postpartum-period-normal-physiology-and-routine-maternal-care/print.
  4. Merative. Cabergoline. In: Merative Micromedex. Michigan: Merative; 2023.