CHANGING PRESCRIBING CULTURE - A FOCUS ON CODEINE POSTPARTUM

Area of Science:

• Pharmacology
• Neonatal Safety
• Maternal Health

Background:

• Codeine and its combination products pose safety risks to breastfed infants due to potential for high morphine concentrations in neonates.
• A fatal case of a neonate exposed to maternal postpartum codeine, linked to CYP2D6 ultrafast metabolism, highlighted the urgent need for intervention.
• International regulatory bodies and drug compendia have issued warnings and recommendations against codeine use in breastfeeding mothers.

Purpose of the Study:

• To eliminate the prescribing of codeine and its combination products in the postpartum period.
• To enhance the safety of breastfed infants by revising maternal analgesic regimens.
• To implement evidence-based changes in postpartum pain management protocols.

Main Methods:

• A comprehensive review of evidence on codeine safety in postpartum breastfeeding infants was conducted.
• Evidence was presented to key stakeholders, including obstetricians, midwives, and pharmacy staff, to facilitate discussion and consensus.
• An agreed-upon protocol for postpartum analgesia was developed, supported by targeted training and education sessions for medical and nursing staff.

Main Results:

• Prior to the intervention, over 90% of postpartum women received codeine-containing analgesics.
• Following the intervention, codeine combination product prescriptions for postpartum women decreased to less than 5%.
• Ongoing education for medical and pharmacy staff ensures continued adherence to the new protocol.

Conclusions:

• Collaborative efforts among healthcare professionals can effectively change prescribing habits and improve patient safety.
• Evidence evaluation, stakeholder engagement, and continuous education are crucial for successful implementation of safety protocols.
• The successful elimination of postpartum codeine prescribing demonstrates a significant enhancement in patient and infant safety.