The use of audit to improve clinical effectiveness in an infrequent obstetric therapy: magnesium sulphate in severe pre-eclampsia.
Magnesium sulphate has been established as the drug of choice in the management of eclampsia and even when used in cases of severe pre-eclampsia it is given infrequently. It is recognised to have potentially severe toxic effects but there is a need to achieve therapeutic levels quickly enough to prevent seizures. This paper reports an audit following the introduction of a protocol for the use of magnesium sulphate in eclampsia and severe pre-eclampsia at Ninewells hospital, Dundee. Problems were identified with both the time taken to reach therapeutic levels and clinical monitoring of magnesium levels despite the use of loading doses commonly recommended. Reaudit after changes to the protocol and the introduction of an administration/monitoring chart showed a significant improvement in both monitoring and the adequacy of prophylaxis. This demonstrates how audit of clinical practice has been used to improve clinical effectiveness in an area in which a potentially toxic drug is used infrequently but with potentially life saving benefits.
Taylor
G M
GM
Department of Obstetrics and Gynaecology, Ninewells Hospital, Dundee. GZTAYLOR@obgyn.dundee.ac.uk
McKenzie
C A
CA
Mires
G J
GJ
D000927:Anticonvulsants / Q000627:therapeutic use*; D002985:Clinical Protocols; D016903:Drug Monitoring / Q000379:methods; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008485:Medical Audit / Q000379:methods*; D008499:Medical Records; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000458:organization & administration*
D000927:Anticonvulsants; D008278:Magnesium Sulfate