Delivery meds

Specialties Ob/Gyn

Published

We recently got a pyxis for all of our meds. What do you all do about having meds at delivery ?? We have a doc who is trying to prove a point ( he hates the pyxis ) and is demanding pitocin, methergine, viscous lidocaine, 2% lidocaine and Hemabate at every delivery. He is calling a 200cc blood loss a hemorrhage just to prove a point. I am not comfortable returning Methergine and Hemabate to the refrigerator after they have reached room temperature. Conceivably, the same vials may not be used for several deliveries thus reaching room temperature countless times. The drug manufacturers say they need to be refrigerated for a reason. I presume that eventually they would not be effective if left at room temperature. There is a loss of quality control returning the same vials. I have told this physician that his patients will all be charged for these meds whether used or not and he became furious with me. I agree that in an emergency, it is vital they be instantly available and it is a pain to leave the room and have to program in names and codes etc. to have access to a refrigerator. I can't find any info online in regard to the stability of these drugs at room temperature or for what duration they are effective. I have yet to talk to our pharmacist, I suppose I could contact Pfizer........the maker of Hemabate. What does everyone else do in regard to having these drugs available at bedside ???

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Why is this doc over medicating his patients to prove a point?!?!?! We too have a pyxis, but we don't pull Hemabate or Methergine unless they are needed. Yes, that does mean we have run to the med room to get them or send someone STAT, but it has never been a problem. When we pull our IV at admission of the patient we pull baby meds, pitocin and lidocaine (common drugs in a delivery). Methergine and Hemabate aren't all that common and they do need to be refrigerated. I would discuss this problem with your director. Its not up to the doc where you keep your meds, just as long as they are readily available, and a pyxis system provides that. Also, don't forget to return the meds if they aren't used. It is considered fraud by the insurance companies to charge for medications not given.

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What a Royal pain in th a** - he is I take it it is a he we use a pyxis- with no problems what so ever- I would but the castrophic haemorrhage cart out side his room tell him if needed you have the code cart for him I bet he never uses it!-next time you work with him ask him if he as ever heard of a luddite. :lol2:

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Specializes in Community, OB, Nursery.

Our L/D unit uses a Pyxis & they also have a fridge that they keep the methergine & hemabate in. We have never had a problem getting meds where they were needed in case of a true hemorrhage.

And the doc is clearly outside guidelines for calling a 200ml blood loss a hemorrhage.

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Specializes in L&D.

We only pull out the erythromycin eye ointment, bag of oxytocin, and sometimes a vial of lidocaine (if mom goes without an epidural, or her epidural seems too light). We never pull out hemabate or methergine ahead of time - except for ONE doc who wants methergine given at the delivery of the anterior shoulder on all deliveries (except hypertensives or preeclamptics). In that case, I try to pull the methergine amp from the pyxis fridge as close to delivery time as I can. Yeah, sometimes it's room temp by then, but what can you do??

PS - all of our meds are in the Pyxis system

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My concern is the quality of the medications Methergine and Hemabate may be compromised after being out of the fridge and not used more than once........perhaps being brought to room temp and returned countless times.....which is conceivable. My feeling is that the drugs should be wasted rather than returned to the fridge. Where do you draw the line ?? Out of the fridge once for an hour, five days in a row for an hour ?? I feel the next patient who really needs those drugs may not be getting the benefit of a drug that has been properly cared for as directed by the manufacturer. I do plan to talk to the pharmacist and possibly speak with a Pfizer rep if possible. I see the doc's concern as I am the one who has to leave the room when time is of the essence........there is no one else to send STAT.....only one L & D nurse,( but we won't go there ).

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Specializes in L&D.

I found a site with a reference to hemabate being stable at room temperature for 9 days: http://www.squ.edu.om/med-Lib/MED_CD/E_CDs/Focus%20on%20Nursing%20Pharmacology%202000/mg/carboprost_tromethamine.htm

Methergine is good for 14 days unrefrigerated:

http://www.medscape.com/viewarticle/562416_Tables

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Suggest cytotec to the doc - it's stable at room temperature :nuke: That's what I keep in my rooms with someone who I think might hemorrhage.

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Specializes in L&D.

We only pull Methergine and Hemabate before delivery for someone at high risk for PPH, grand multip, really large baby, extra long labor with high doses of Pit. When we do pull it early, we set the amps in a cup of ice to keep it cool. Don't know if it actually helps, but it makes us feel better.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

That is what we did at the unit where we had pyxis. Had cytotec handy for PP hemorrhages. And we were able to get a nurse to pull needed methergine and/or hemabate quickly from pyxis in any other case. It just was not a problem for us.

Where I am now, we have no pyxis, so we are to have hemabate and methergine in our hands at EVERY delivery.

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Specializes in N/A.

Wifey agrees with Lizzy. You're 2 for 2 Lizzy keep it up!

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Thanks to all who replied to my question. We are trying to get approval for an emergency kit to be brought to every delivery and the patient would then be charged if we actually used and had to replace a drug in the kit. Turns out the doc who has been stamping his feet over his perceived delay in obtaining drugs with the pyxis has never talked to pharmacy about it at all. The pyxis is here to stay, he will have to deal with it. I do think the meds should be kept cool and the ice in a cup is a good idea. No one knows how long they will be out of the fridge and no one knows how many times they have been out. That was my original concern........in fact I thought they should be wasted rather than comprimise the quality of the drug for the next patient who might actually really need them.

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