Misoprostol, used to treat post-delivery hemorrhages, will become a Schedule IV controlled dangerous substance in Louisiana effective Oct. 1 under a new law. The designation means the medicine will have to be securely stored, raising concerns among doctors who say they rely on immediate access to the medication in life-threatening situations. (Anna Moneymaker/Getty Images)
NEW ORLEANS — Louisiana hospitals have scrambled to update their guidelines for misoprostol, a common pregnancy care medication that a new state law will reclassify as a controlled dangerous substance starting Oct. 1. Misoprostol is used for a variety of medical reasons, including postpartum hemorrhages.
LCMC Health and Ochsner Health System, which own and operate hospitals throughout Louisiana, will keep the drug in a centralized, passcode-protected lockbox on their maternity units. The Illuminator has reviewed guidance each system provided to physicians this week.
Dr. Stacey Holman, lead physician for LCMC Health’s maternal quality committee, said the system has had several meetings with physician and pharmacy leadership to discuss how their protocols will change. They’ve also performed timed drills to understand what delays to expect .
“Access in a cart in the labor room remains the faster option versus a nurse leaving the bedside to obtain medication from the automatic dispensing system,” Holman said.
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Through simulated emergencies with a post-delivery patient bleeding out, LCMC Health noted a two-minute delay between having the misoprostol in a cart in the room versus down the hall in passcode-protected dispensing system.
Earlier this month, the Louisiana Department of Health released guidelines for the controversial new law, suggesting hospitals modify their equipment to add a locked container for misoprostol on their obstetric hemorrhage carts. According to physicians interviewed that suggestion has not proven realistic so far.
“In our conversations with our pharmacy, we looked at the possibility of a locked section on the hemorrhage cart and determined that it was not a feasible option,” Holman said.
Doctors have sought additional guidance from the state health department about how to create secure storage on hemorrhage carts, but they have yet to receive any response.
Physicians and pharmacists are prioritizing the safe care of patients with the knowledge the protocols they have put into place to reduce mothers dying during or after childbirth have to be changed to accommodate the new law, Act 246.
Holman said LCMC is aware “every second counts” when it comes to postpartum hemorrhaging, so it will implement two initiatives to minimize delays in administering misoprostol.
One will be to have the misoprostol on “override” in the event of an emergency, which Holman said consists of a verbal order given to a nurse to pull the medication immediately from the dispensing system outside of the patient’s room.
The second initiative will be to encourage obstetricians to order the misoprostol for all patients ahead of delivery. In the event that a patient is high-risk, the physician can choose to bring misoprostol into the room prior to delivery.”
The Illuminator obtained a copy of “Frequently Asked Questions” about Act 246 that Ochsner Health System made available to its physicians.
Like LCMC, Ocshner hospitals will store misoprostol in a large, passcode-protected dispensing system centrally located within labor and delivery units. This means misoprostol will no longer be stored in the patient rooms in carts, kits or plastic “bleed boxes.”
At a recent New Orleans city health department webinar, a nurse asked whether she would still be able to carry misoprostol around in her pocket.a Experts advised her against it.
“Ochsner Health continues to provide care for patients in accordance with the law, using misoprostol when it is clinically indicated, following the protocols in place for all controlled substances,”Ochsner Health president Dr. Robert Hart said in a statement provided Friday.
Ochsner has updated its processes to be compliant with the new law and are “ensuring that misoprostol will be readily and immediately available in Labor & Delivery units across the system, including in emergency situations,” Hart added.
Rural hospitals, which do not have the same access to resources as Ochsner and LCMC Health, could feel the most impacts from the new legislation.
One obstetrician in rural northwestern Louisiana told the Illuminator her hospital has yet to release guidance on the new law, which goes into effect in four days. Additionally, she said that this week a nurse practitioner refused to write a misoprostol prescription for a patient with a confirmed miscarriage. The OB ended up writing the prescription herself, even though she hadn’t seen the patient, she said.
The consequences of politicizing medicine because of its association with abortion is precisely why so many doctors have spoken up against this law, which experts say could create a chilling effect or fear around medication that is safe.
Dr. Jennifer Avegno leads the New Orleans health department and is an emergency room physician. She’s leading a New Orleans City Council investigation into the impact of the new law that reclassifies misoprostol and mifepristone as controlled substances.
“Unfortunately, this will result in delays in administration of the drug in an emergency situation,” Avegno said.). “But hospitals must comply with the law and are encouraged to run drills and/or develop processes that mitigate these delays as much as possible.”
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