{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T08:46:00Z","timestamp":1648975560027},"reference-count":3,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2016,9]]},"abstract":"Aim<\/jats:title>To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.<\/jats:p>Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1\n<\/jats:p><\/jats:sec>Methods<\/jats:title>The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff.<\/jats:p><\/jats:sec>Results<\/jats:title>The evidence that was presented to key stakeholders included:<\/jats:p>\u25b8\u2002Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding<\/jats:p>\u25b8\u2002Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).<\/jats:p>\u25b8\u2002Recommendations from the Australian Medicines Handbook to avoid in breast feeding2\n<\/jats:p>\u25b8\u2002Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data\u2013probably compatible) to L4 (limited data\u2013possibly hazardous).3\n<\/jats:p>Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their \u2018as required\u2019 analgesic regimen.<\/jats:p>Since the intervention, codeine combination products have now been almost completely eliminated on medication charts for postpartum women (less than 5%). Those that are prescribed are ceased once highlighted to medical staff. The obstetric pharmacist now presents a session on postpartum analgesia at every new resident medical officer orientation outlining suitable medications to prescribe. In addition all new pharmacists to the women's and new born's team receive training about postpartum analgesia.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>This study highlights the impact that can be achieved when health care professionals work together to change the culture and prescribing habits in a hospital setting, to enhance patient safety. Evaluating the evidence and presenting to stakeholders as well as providing ongoing training and education to medical, nursing and pharmacy staff are all essential to a successful outcome.\n<\/jats:p><\/jats:sec>","DOI":"10.1136\/archdischild-2016-311535.2","type":"journal-article","created":{"date-parts":[[2016,8,18]],"date-time":"2016-08-18T07:07:30Z","timestamp":1471504050000},"page":"e2.12-e2","update-policy":"http:\/\/dx.doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["CHANGING PRESCRIBING CULTURE \u2013 A FOCUS ON CODEINE POSTPARTUM"],"prefix":"10.1136","volume":"101","author":[{"given":"Noor","family":"Al-Adhami","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Whitfield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"North","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,8,17]]},"reference":[{"key":"2021051107151299000_101.9.e2-k.1","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/S0140-6736(06)69255-6","article-title":"Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother","volume":"19","author":"Koren","year":"2006","journal-title":"Lancet"},{"key":"2021051107151299000_101.9.e2-k.2","unstructured":"Australian Medicines Handbook. Codeine \u2013 Analgesics. In: Australian Medicines Handbook. Adelaide: AMH Pty Ltd; 2015. p. 50\u20131."},{"key":"2021051107151299000_101.9.e2-k.3","unstructured":"Hale T, Rowe H, Medications in Mothers Milk 1992\u20132014 16th Ed Hale Publishing."}],"container-title":["Archives of Disease in Childhood"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2016-311535.2","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T14:30:04Z","timestamp":1620743404000},"score":1,"resource":{"primary":{"URL":"https:\/\/adc.bmj.com\/lookup\/doi\/10.1136\/archdischild-2016-311535.2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,17]]},"references-count":3,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2016,8,17]]},"published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1136\/archdischild-2016-311535.2"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2016-311535.2","relation":{},"ISSN":["0003-9888","1468-2044"],"issn-type":[{"value":"0003-9888","type":"print"},{"value":"1468-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8,17]]}}}