Domperidone: Pharmacists Stimulating Clinical Change for Lactation Consultants ^†

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 to screen and initiate domperidone using a checklist. The study aimed to validate a domperidone screening tool via an analysis of its use and compliance. Records were extracted from the RedCAP^® database for the first 50 women with a documented domperidone supply and reviewed against medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. Records of supply from the RedCAP^® database revealed 34% (17/50) of patients were referred to a physician, revealing a discrepancy between RedCAP^® reporting and checklists as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6/5. In total, 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place, and 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. Only 55.6% (5/9) indicated the checklist was used with each screening. The SASA education package is being updated to clarify the requirements for checklist completion and standardise frameworks to document follow-up.