Editorial: Electronic files could cut abuse of medication

A shocking event at Moncton Hospital in New Brunswick has implications for hospitals on Vancouver Island. Between 2013 and 2017, a nurse administered the drug oxytocin to at least two expectant mothers in the delivery room. She had no authority to do so.

The drug is used to induce contractions, but in the quantities she is believed to have administered, it can be dangerous, to both mother and child. Both women underwent emergency caesarean sections when their conditions deteriorated rapidly.

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That is perhaps only the tip of a larger iceberg. The nurse was dismissed early this year, but police investigations are underway, and it is possible more than two women were victims.

Indeed, it seems almost inevitable. Between 2013 and 2017, the number of routine C-sections at Moncton Hospital increased by 11 per cent, but emergency C-sections rose 33 per cent.

There is no medically obvious explanation for the dramatic spike in emergency procedures. And more than 40 mothers have filed a class-action lawsuit against the hospital, alleging they, too, were improperly given the labour-inducing drug.

How this could have happened? There are two parts to that question.

The first is: How could a nurse gain unauthorized access to a dangerous medication? Most hospitals maintain an on-site pharmacy, where a licensed pharmacist will dispense drugs ordered by physicians.

But in addition, many hospitals also stock commonly used drugs in cabinets on each ward. Since no pharmacist is present to oversee these medications, it’s possible the nurse in question simply drew the oxytocin without being authorized.

Since the hospital has not returned our calls, we can’t be certain that is what happened. Yet it appears the most likely explanation.

The second part of the question is why it took four years for hospital management to realize they had a crisis on their hands. Surely someone should have noticed that emergency C-section rates were going through the roof.

Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, had this to say: “Typically, a lot of water will have gone under the bridge before you’re presented with [the relevant] data, so you could hardly make a timely assessment that there’s a problem.” And she went on to suggest that the earliest warnings hospitals receive are often based on anecdotes from staff.

This is outrageous. The Canadian Institute for Health Information maintains a registry of C-section rates, by province and by hospital. While emergency procedures are not reported publicly, they can be accessed simply by calling CIHI and asking for the data.

If a Globe and Mail reporter could dig out this information (which is how the details became known), Moncton hospital certainly could have. Moreover, the Society of Obstetricians and Gynecologists claims to: “Measure, assess and catalyze best practice, from research to health-system outcomes.” Shouldn’t that include monitoring the national C-section database?

How does this have implications for Vancouver Island? The local health authority, Island Health, plans to introduce an electronic health record for each patient in the region.

The project is being piloted at Nanaimo Regional General Hospital. It’s fair to say there have been problems with the rollout. Technologies of this kind are often a challenge for both staff and management.

But one of the features of the new system is that drugs from ward cabinets are computer-controlled.

To withdraw a medication, the nurse must enter her password, the patient’s ID number, and the name of the physician who placed the order.

Since the system is audited regularly on site, and can be scrutinized from Victoria, as well, it would be professional suicide for a nurse to make an unauthorized withdrawal.

So far, the new technology is limited to Nanaimo. But there are plans to expand it across the Island, meaning that expectant mothers can be reassured that in the future, what happened in Moncton is extremely unlikely to happen here.

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