Curious about PP Methergine use

[JaneyW]

I am currently working registry and get around to a lot of different hospitals. This keeps me on my toes. I am mainly an L&D nurse, but also do PP. I missed a med yesterday on a PP pt. I feel terrible as this is unlike me. I simply misread (or read too quickly) the checked off order sheet when I first came on. I always check orders because I don't know the hospitals or docs--this was my first day at this one facility.

They have an order for Methergine 0.2mg PO tid for PP patients. The MD can check this on a check off sheet and you all know how closely they pay attention to those kind of order sheets :uhoh21:. Anyway, I have only ever seen Methergine ordered PP as a PRN for excessive bleeding. I have never seen it as a routine and it seemed kind of cruel to subject normal, healthy patients to this--it certainly made pain meds necessary.

So, does anyone else do this? What are your thoughts/experiences? Where are you? I am in Southern CA and have been to about a half dozen or more hospitals here and have only seen the PRN order until yesterday. Thanks!

[Elvish, BSN, DNP, RN, NP]

I have never ever seen it as a standing. Unless they are doing a lot of unnecessary yanking of placentas etc. (whole other thread topic ) I would definitely question why they are doing this as a routine.

[jhhrn68]

We certainly do not use po Methergine as a routine. I have only seen it used for excessive bleeding and then it is given IM.

[NurseBlueEyesRN]

we have one physician (an older physician) that orders it tid for all of his pt's scheduled po PP. However, unless they're bleeding heavy, we just put that they refused, because, like you said, we're going through a TON more warm blankets for the tummy! I rarely use it on his scheduled pt's, we do have an IM prn methergine order that we can use also...one all PP pt's

[rph3664]

My experience is that PO Methergine is almost never used post partum, but is very commonly used after miscarriages. I rarely see it here in the hospital, but when I worked in retail pharmacy, we dispensed 10 tablets to be taken t.i.d. all the time.

[woknblues]

tid PO is weird. what if the pt has a fully contracted uterus, no bleeding and heck, HPN?

[babyktchr, BSN, RN]

We have used methergine PO, but not for quite some time. If there was a PP bleed, the IM version would be given first, with a 2 or 3 dose followup, depending on the bleed, most times it was for those lower segment boggy issues. The PO version is not as potent, but a BP check is still in order before giving it. Don't want to be giving all that to your hypertensives. If I remember correctly, it was 0.2 po q 6 x 2 or 3 doses.

[NurseNora, BSN, RN]

A long time ago it was standard to give Methergine po q6h. I haven't seen it ordered that way in a long time for normal, low risk patients. I used to just give it with pain medication. Then I learned that if I explained that this is the medication that gives you your severe cramps and you have the right to refuse it, I didn't have to give it as often

[jennf83]

Our one doctor, a fairly younger one, gives three doses post partum for all his deliveries, c-section or lady partsl, but our other doctor who is an older man, does not give it. I always questioned why he has this as a standing order if the patient is contracted, or not bleeding heavily.

[SmilingBluEyes]

Sounds like overkill to me.

[RNBelle]

We have a very old school doc who schedules it for all his vag deliveries, I can't remember if he writes for 3 doses or 6 total. I usually do not give it to my pts, I discuss it with them, assess their bleeding and let them tell me they don't want it so I can chart refused by pt.