Impact of Adding Cabergoline to a Postpartum Order Set on Ordering and Administration Among Persons Living with HIV

In Canada, exclusive formula feeding is recommended for infant feeding among persons living with HIV. Cabergoline can be used to suppress physiologic lactation in people choosing not to breastfeed. Cabergoline was added to the postpartum order set in our institution's electronic medical record in December 2020. The primary objective of this study was to determine whether this intervention improved cabergoline ordering and administration.

A retrospective chart review was performed to assess sociodemographic and medical characteristics, and cabergoline ordering and administration, for births among people living with HIV pre-intervention (November 2018 to December 2020) and post-intervention (December 2020 to August 2022). Statistical analysis was performed using Fisher exact test, paired samples t test, Mann-Whitney test, and Quade analysis of covariance (ANCOVA).

Overall, 84 births were included, with n = 55 occurring in the pre-intervention period and n = 29 occurring post-intervention. Before amending the electronic order set, cabergoline was administered following 40 of 48 qualifying births (83%), compared with 19/21 (91%) post-intervention. The median time between birth and cabergoline administration was 257 minutes for the pre-intervention group compared with 157 minutes post-intervention (P = 0.032 Mann-Whitney, P = 0.064 Quade ANCOVA).

Cabergoline was administered in over three-quarters of births, both in pre- and post-intervention groups. For both groups, administration was timely. Once cabergoline was added to the order set, the time between birth and administration decreased by nearly 40% and ordering compliance may have improved. Our findings suggest that electronic order sets may be effective for streamlining clinical processes, especially among populations in which medical management may be overlooked.