Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme

TL;DR

A pharmacy-led program allows lactation consultants to safely prescribe domperidone for breastfeeding mothers, improving access and confidence.

Contribution

A novel pharmacy-developed system enables lactation consultants to initiate domperidone therapy with a checklist and database support.

Findings

34% of patients were referred to a physician, but no referrals were documented in the checklist.

Staff satisfaction with the SASA system was rated 4.6 out of 5.

88.9% of staff felt confident using the checklist to assess therapy appropriateness.

Abstract

Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist.

To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey.

Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA.

Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician.

The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

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