Medication Management in Lactation-A Pharmacist Education Pilot Project: Part one survey.

BACKGROUND: Pharmacists as the most accessible health professionals can serve as an important resource on medication safety for breastfeeding women. Previous research suggests that a barrier to pharmacists providing optimal pharmaceutical care for this population is a lack of knowledge. OBJECTIVE: To evaluate pharmacist perceptions and barriers related to medication management of patients who are breastfeeding. METHODS: A 25-question electronic survey was distributed via e-mail list servers to members of state pharmacy organizations. Pharmacists were queried on the importance of breastfeeding, barriers to pharmaceutical care, comfort level in making pharmacotherapy recommendations, adequacy of pharmacy school's curriculum, breastfeeding resources used, and need for continuing pharmacy education regarding medication use during breastfeeding. RESULTS: Pharmacists from all geographic regions of the United States and diverse practice settings agreed to participate in the survey (N = 197). Most pharmacists reported feeling somewhat or extremely comfortable making recommendations and counseling breastfeeding patients on over-the-counter (102 of 187, 55%) and prescription medications (110 of 187, 59%). In contrast, 66% (123 of 187) reported feeling somewhat or extremely uncomfortable making recommendations and counseling on the use of herbal supplements in breastfeeding. Notably, 95% of pharmacists (171 of 180) responded that there is an unmet need for continuing pharmacy education on medication use in lactation. CONCLUSION: Pharmacists are generally uncomfortable when making recommendations and counseling breastfeeding patients on herbal and other supplements. Most pharmacists agree that there is a lack of available continuing pharmacy education on breastfeeding.

Breastfeeding and the Pharmacist's Role in Maternal Medication Management: Identifying Barriers and the Need for Continuing Education.

Breastfeeding offers a multitude of benefits for infants, mothers, and society. Exclusive breastfeeding of infants is recommended for at least the first 6 months of life. Although transfer of drug into breastmilk can occur, most medications are safe to use during breastfeeding. Pharmacists, regarded as the most accessible health care professionals, recognize their role as medication specialists for breastfeeding women. Unfortunately, a lack of formal and continuing education on medication use during lactation often results in pharmacists providing the unnecessary recommendation to disrupt breastfeeding during medication use. In addition to lack of education, other barriers pharmacists experience in providing optimal patient care during lactation include difficulty identifying breastfeeding status and inconsistency in recommendations between scientific resources. Pharmacists must voice their need for additional continuing education and take action to close the knowledge gap and address barriers to providing care.

Neonatal Abstinence Syndrome Practices in the United States.

OBJECTIVE: To survey current practices for the treatment of neonatal abstinence syndrome (NAS) among institutions in the United States to identify changes in national practice over time. METHODS: Previous NAS management reports were referenced in the development of our 26-question electronic survey, which was distributed in the fall of 2019 to pediatric practitioners of 2 national clinical pharmacy organizations via email list servers. Not all questions required a response and responses from incomplete surveys were included. Institution demographics and NAS management strategies, including location of care, observation period, and inpatient and outpatient pharmacotherapy, were queried. RESULTS: Seventy respondents representing institutions from all US geographic regions participated in the survey The most commonly reported inpatient observation durations were 3 (18 of 61, 29%) and 5 (22 of 61, 36%) days. Respondents indicated that neonates were typically transferred to the NICU if pharmacologic management was required (38 of 56, 68%). According to participants, first-line agents used for NAS management were morphine (45 of 56, 80%), methadone (5 of 56, 9%), clonidine (2 of 56, 4%), and buprenorphine (2 of 56, 4%). Among respondents, only 20% (11 of 56) reported that infants may be discharged home on pharmacotherapy, including morphine (n = 6), phenobarbital (n = 3), clonidine (n = 1), and methadone (n = 1). CONCLUSIONS: Opioids are the most commonly used first-line agents for NAS management in the United States. The primary site of NAS management is the inpatient setting, as only 20% of institutions report discharging patients on pharmacotherapy.