Aim: The objectives of this study were to evaluate clinical interventions recorded by pharmacists in an Australian principal referral and specialist women's and newborns' hospital, as well as to identify common medications involved in each specialty area (neonatology, obstetrics and gynaecology), to assess the risks of medication-related problems (MRPs) likely to have been prevented, and to obtain institution-specific MRPs for future staff education. Methods: This retrospective, observational study involved an analysis of all interventions documented by pharmacists from January 2005 to December 2014. The interventions recorded were collated according to ward, medication involved, description of the intervention and the risk classification. Results: There were a total of 14 085 interventions documented over 10 years; 60.33% made in obstetric patients, 28.71% in gynaecology patients and 10.96% in neonates. The three main intervention types were: (i) dose/frequency/time incorrect (25.70%, n = 3260); (ii) prescribing clarification (21.77%, n = 3066); and (iii) medicine omission (15.21%, n = 2143). An average of 12.02% of the interventions were regarded as high-risk and 0.85% as extreme-risk. Of the MRPs documented within each specialty, the prevalence of extreme risk interventions was higher in the neonatal ward. Discussion: The most common intervention was identifying incorrect medication dose/frequency/time. Common medications involved in the MRPs included: opioids and antihypertensives in gynaecology; parenteral nutrition and gentamicin in neonatology; and opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in obstetrics. The medications involved in high and extreme risk MRPs included gentamicin, opioids and NSAIDs. Conclusion: This study demonstrates that hospital pharmacists contribute to the reduction of MRPs, including some potentially fatal adverse medicine events. These findings also enable targeted, site-specific education, which is valuable in improving patient safety. Analysis of pharmacists interventions ina women's and newborns' hospital 1 (1.8) Antiviral 1 (1.8) GORD = gastro-oesophageal reflux disease; NSAIDs = nonsteroidal anti-inflammatory drugs. Only the ten most common medications are reported for each specialty each year. Analysis of pharmacists interventions in a women's and newborns' hospital 141 (86.57) 894 (72.1) 1848 (70.53) NSAIDs = nonsteroidal anti-inflammatory drugs.

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This case describes the transfer of the antipsychotic drug amisulpride into milk and the estimation of infant exposure via breastfeeding. The dyad investigated was a 28-year-old lactating woman and her 13-month-old daughter. The woman had been taking 400 mg of amisulpride daily for 9 days and provided eight milk samples and one blood sample over a 24-hour dose interval. Amisulpride concentrations in these samples were measured by high-performance liquid chromatography, and infant dose was calculated by standard methods. The infant's health and progress were evaluated by a neonatal pediatrician. Transfer of amisulpride into milk was high, with a milk:plasma distribution ratio of 19.5 (5,188 μg/L in milk and 266 μg/L in plasma). The average amisulpride concentration in milk was 3,562 μg/L, which, when multiplied by an average milk intake of 0.15 L/kg/day, gave an absolute infant dose of 534 μg/kg/day. The relative infant dose was 10.7% of the maternal weight-adjusted dose (5,000 μg/kg/day), which is slightly above the usual 10% safety recommendation. The infant was in good health with an appropriate Denver development score for her age. She showed no acute drug-related adverse effects. Given that the infant had already benefited from 13 months of breastfeeding, that amisulpride has potential adverse effects, and that its relative infant dose was 10.7%, we recommended cessation of breastfeeding in the near-term.