AIBU to make a complaint about this nurse ??

[catsmother]

First, am sorry this is so long. Second, if, by any chance, my 2 RL MN friends happen across this, please keep it to yourselves and don't tell anyone else we know because thsu far, I haven't told anyone).

Bit of background:

..... found out I was pregnant a week ago on 30 Aug (I am almost 44 OMG !). My LMP started (I think) on the 26 July, so am guessing that conception would have been around 12, 13, 14 Aug.

Anyway, I developed terrible cystitis at the end of that week, with blood in my urine and then it moved into my kidneys. I eventually went to the doctors on Tues 21 Aug and saw the nurse practitioner, who prescribed me something (this then has to be signed by an actual GP).

Well, you can probably guess what I am going to say can't you. Once I found I was pregnant, I looked up the drug I'd taken and it was Trimethroprim, which isn't recommended during the 1st trimester as it can block the effects of folic acid, which, in turn, leads to a theoretical, greater risk of spina bifida, cleft palate and various other things I can't remember right now.

The thing is, when I saw the nurse, I didn't know I was pregnant, though had I been asked, I would have replied that it was possible as we had been trying (only for a couple of months, so am a bit shocked to have fallen so quickly).

In my past experience - and surely this must be recommended practice ? - when I have been to the doctor, as a woman of child bearing age - with various complaints, I have always been asked previously if there's a possibility of me being pregnant before being given any drug which has contra-indications for pregnancy. Always. It therefore didn't occur to me to announce that I was trying, because I imagined the responsibility of safely prescribing any drug to a patient falls upon the person prescribing it - by way of asking pertinent questions, as necessary. Is that ridiculously naiive ???

I am now in a complete state. I did actually phone the practice once I realised what had happened and my GP spoke to me at length ( I am actually seeing him tomorrow). He confirmed that what I found out was correct but after a lot of umming and aahing and phoning some consultant pharmacologist (or somesuch) he advised that the risk to the fetus is a theoretical one and that the occurence of SB etc in babies whose mums have taken Trimethoprim is no greater than mums who haven't taken it. Yet if that is so, why do they "prefer" (apparently) not to use it in the 1st trimester ?

There's a lot of stuff about it on the net but I have stopped looking now as I was getting no real answers from it and I know that the ONLY answer to my worries is a thorough diagnostic scan at around 20 weeks. However, having been exposed to this risk (theoretical or not) I have now got to worry for the next almost 4 months, in addition to the concerns of a nuchal scan which I was going to have to have anyway (I know I don't have to have it, but I want it).

I feel very strongly that the nurse has been negligent in her duties. Maybe she assumed that because of my age I was unlikely to be pregnant, but if so, that is one hell of an assumption to make when prescribing a potentially dangerous drug. I don't look 60 or anything - hopefully I look younger than I am. I'm thinking it was more likely that she simply didn't remember to check the various contra-indications and ask the right questions. If that is the case, then I am concerned she might not be asking the right questions and/or reading drug info thoroughly when prescribing to other women of child bearing age (or, of course, anyone at all who might be diabetic, smoke, or 1001 other reasons why they shouldn't have a particular drug).

OTOH, I am also aware that I've had a bit of a shock, am worried and upset, and I am questionning - stupidly ?? - if I am right to be complaining at all ? But then I come back to the prospect of a very traumatic late abortion if the worst comes to the worst, which could have been prevented with one simple question. (I know that it is entirely possible to be facing similar dilemmas without ever having taken this particular drug, but if it turns out my baby is damaged in any way, I'll be unable to forget I've taken it and would always wonder how things would have been if I hadn't).

Like I said I see the doctor tomorrow. I am also worrying now about the process of making a complaint - whether I'd have to see and/or speak to this nurse again as part of the complaint, and whether or not my name would consequently be mud at the surgery where I'll be receiving my antenatal care.

Can someone please advise ? I am tying myself up in knots about this - but if I'm going to make an official complaint it really has to be done sooner than later, if only to prevent the same thing happening to someone else.

oh sweetheart ((((((((((((((())))))))))))))))
i would say that you mention to the doc tomorrow that you had said it was possible other than that i don't know what to say sorry hthxxxx

Congratulations Catsmother!!

In a similar vein to LL, im afraid you have to share the responsibility, that is why the info leaflets are given with prescribed medication.

i think the vast majority of drugs are contra indicated in early pregnancy, mostly becasue you cannot do ethical tests on pregnant women! so in all likelihood , you will be just fine.

yes, nurse should have asked

yes, you shoudl have read the leaflet etc

certainly talk it through with your doc and get some more info and it sounds like a very , very, very small risk, blocking the effecrt of folic acid is not the same as acutally causing a birth defect ifyswim

hope you are feeling less panicked soon and congratulations

Congratulations on your pregnancy

I do think you would be being unreasonable to report the nurse.

Congratulations!

I know it is a stressful time but you were only taking this drug for a FEW DAYS at a very early stage of pregnancy. Not throughout your first trimester or anything.

ALL drugs are untested on pregnant women, but that doesn't mean they are unsafe. You just aren't allowed to experiment with pregnant women!

Lots of people don't know they are pregnant until quite late on and take all sorts of things.

As far prescribing is concerned, the chance of a 44 year old getting pregnant is very slim as you know, so I'm not surprised it wasn't asked - and agree, you must have read the patient leaflet and should have asked questions then really.

Good luck with the pregnancy.

I understand that this must be very worrying for you but I don't think it is fair or necessary to complain about the nurse.

The only time I have ever been asked about possibility of pregnancy is when they want to rule it out as a cause of symptoms. I mean, let's face it, most prescription medicines are not recommended for pregnant women theoretically.

I think the responsibility was on you to say "I am TTC, is this ok if I am pregnant?". Good luck with the baby and congratulations! Lot's of us do "bad" things in early pregnancy, drinking, smoking, all the bad foods etc. Am sure your risk is very low.

I found this, which might reassured you:

"While there are no large well-controlled studies on the use of trimethoprim in pregnant women, Brumfitt and Pursell, (4) in a retrospective study, reported the outcome of 186 pregnancies during which the mother received either placebo or trimethoprim in combination with sulfamethoxazole. The incidence of congenital abnormalities was 4.5% (3 of 66) in those who received placebo and 3.3% (4 of 120) in those receiving trimethoprim plus sulfamethoxazole. There were no abnormalities in the 10 children whose mothers received the drug during the first trimester. In a separate survey, Brumfitt and Pursell also found no congenital abnormalities in 35 children whose mothers had received trimethoprim plus sulfamethoxazole at the time of conception or shortly thereafter."

I appreciate what you're saying and I admit I didn't read the leaflet. Obviously, I am now kicking myself hugely.

It's simply that in the past, I have been asked so often about possible pregnancy, for all sorts of different drugs, that I suppose I was under the illusion that the patient would always be asked about anything potentially dangerous. Similarly, I've also been asked about smoking, about family history, about not driving, about not drinking while on the course, all sorts.

I'd only just started trying. I now feel very ignorant, and an awful person for exposing my baby to this risk, for imagining that at 43 it would take a year or more to fall.

I suppose what I'm asking is who bears the greater responsibility when a drug is prescribed ? ...... is it the nurse/doctor, or the patient ? Like most people, you tend to place your trust in the medical profession and surely, drugs can't be prescribed willy-nilly, without any questions that need to be asked being asked, in the "hope" that every patient is going to read, and actually understand the leaflet enlcosed in the drug box ? (I would have personally understood it had I read it .... and I am kicking msyelf so much now .... but I bet a lot of people would struggle with reading such stuff - which is why these questions need to be asked IMO).

If I do complain, do you think I am going to get short shrift then ?

I would make a complaint to stop this happening to other mums to be. I would put it in writing to the practice manager.

Good luck and congratulations x

I think ultimately it is the GP who is responsible, although if you are trying to get pregnant you should let your GP know when anything is prescribed

but I don't know where the final legal responsibility would lie

Thanks v much for that MP ! (though it was only the one drug I had, not the sulfamethoxazole as well).

I think I will raise this with the doctor along the lines of asking if it's standard practice to ask such questions or not and take it from there.

Congrats on your pg

Im sorry but i dont think she was negligent. I think its unlikely you are asked 'before you take any drug' if you are pregnant, because that would include absolutely everything.

The only time I am aware of being asked if theres a chance is for xrays/scans etc.

If you thought there was a chance then it was your responsibility to mention it, to check with the pharmacist, to read the instructions yourself.

Im sorry but you have to take some responsibility the leaflets are there because doctors/nurses dont have the time to go through every possible side effect or risk of medication or they would only see about 3 patients a day

I think she should have asked you and I know when I got the same drug a couple of moths ago the Dr made a big thing about asking me if I was pg. But agree that if you're trying for a baby then I do think you should mention this to any health professional when they're prescribing you something.

If I were you I would make an unofficial complaint. Tell your GP that you would like this nurse reminding (they have probably spoken to her already to be honest). If I'd made this mistaKE I'd be so mortified that I'd never do it again. Would thing she's learned from it, as you probably have as well. Try not to worry too much.

Congratulations on your pregnancy! I am sorry to say that I agree with everyone else. The nurse had no way of knowing that you were trying to conceive without you telling her. She therefore didn't have this information when she suggested the antibiotic.

Only you knew the possibility of being pregnant, and should have asked if it was safe. Although you didn't know, and in that situation couldn't be expected to predict pregnancy, you chould have and should have read the information leaflet supplied by the pharmacy, which would have alerted you to the risks for your baby if you were indeed pregnant.

To reassure you, bear in mind that many women have very little folate prior to discovering their pregnancy.

Thanks all. As I said before, I think I will be "raising" it as a "point of concern" with my GP but won't be making it official.

I am really surprised though that so few of you haven't been asked about the possibility of being pregnant before. I have been asked many times and I suppose I therefore got complacent that if something was risky I would have been alerted to the fact. I confess I rarely read the leaflets you're given unless I get a rash or a headache or something. Stupid

Catsmother your approach sounds sensible. Don't worry too much, if you were obsessing about TTC and looking for contraindications in everything you would probably be a nervous wreck and never get around to having sex in the first place. Good luck with everything.

I was recently prescribed something by my GP who knew very well I was TTC and when I opened the packet and checked the leaflet it had in bold writing not to take if you were even trying to conceive. I was livid, partly because I had just spend £7 ish on drugs I ended up putting in the bin. I didn't make a complaint though, I think mistakes like this are made all the time and I think it was my responsibility to check the leaflet that came with it which is what I did.

I have made complaint about a nurse at our medical centre before though, and had good grounds to. I just rang the medical centre, said I wanted to make a formal complaint and asked who I needed to address it to. They politely gave me the name of the practice manager and I got a response saying they had reviewed the case and changes had been made to ensure the same mistake wouldn't happen again. There was certainly no problem as a result of me making that complaint.

I have also made a formal complaint to a hospital and they were absolutely brilliant in the way they dealt with it, but again, I had very good grounds for making the complaint.

catsmum, you could raise it with your GP, in writing, as a 'no blame' clinical incident. That way, staff within the practice are reminded of the importance of double checking with women of child-bearing age before issueing a prescription.

I think if you go down the road of an official complaint, where you clearly want someone's head to roll, you'll just generate bad feelings and nothing positive will come of it.

If you make a formal complaint that doesn't necessarily mean you want 'someone's head to roll' though. At least it didn't when I have made a formal complaint. Its just bringing a mistake to the attention of people to make sure it doesn't happen again.
To a certain extent I think we do have to expect that people will make mistakes from time to time, and I just think myself lucky that I'm not in a job where someones health might suffer when I make a mistake. However, the best way of reducing the chances of a mistake being repeated is to make people aware of it.

I've been prescribed trimethoprim many times and never been asked if I was pregnant. When I went to the GP when we were trying I told him and he prescribed something safe. That's the way it works - unless they are prescribing something that is specifically dangerous to the foetus.
On the plus side - there's very little chance that it has done any harm. Your baby was barely attached to a placenta and so it would have absorbed a negligent amount, if at all. If you make sure you take folic acid from now on you will be fine.

I would imagine it would be whoever signed for the medication ie the Doctor is whom the blame should lie with.

Yes the nurse should probably have asked, but if i was pregnant or thought I may be then it would surely be up to me to mention it.

Whilst breastfeeding i attended the GP and the dentist on various occasions and before being prescribed something i would inform them i was breastfeeding, they would not know otherwise.

Congratulations!

Sorry, but I'm going to have to agree with some of the other posters... I think that if there was a small chance you could be pregnant, it's up to you to mention that to them when they are prescribing you drugs iyswim? And read the leaflet. Unless, obviously, the drug has very bad side effects in pregnancy. But just blocking the folic acid I shouldn't think will cause any problems at all... I'll be willing to bet thousands annd thousands of women (myself included) only begin to take folic acid whhen they learn they're preg anyway. Please try not to worry! But it might ba an idea to mention it to your gp, 'oh I took this medicine before I found out, whatt do you think....?' to guafe his reaction and go from there. Truthfully, I think he'll reassure you lots. Congrats again!

The warnings on drugs are mainly to cover the manufacturer's backside because they can't do proper controlled trials.

A doc has to compare the possible risk of taking the drug against the risk of not taking it - and the risk of having a UTI spread to your kidneys and then needing loads of really nasty drugs is probably way higher than taking trimethoprim (I'm not a doc, but I'd bet on it). I'd suggest mentioning to the GP that you were surprised not to be asked about pregnancy given the warning on the packet - my GP has the computer flash up questions as soon as he adds a drug to a prescription, so it would say "Warning! Possible interaction with XYZ" and we can then discuss whether to continue or not.

If you conceived only a week or so before taking the drug, the neural tube wouldn't yet be closing and doing the bits that it needs folic acid for, as that starts a while later in humans, so I wouldn't worry. (this bit is my field!)

Hi Catsmother, first of all congratulations!!

I work within the Health Service and we are asked to assume everyone of childbearing age is pregnant unless they confirm they are not and we do ask them.
I do agree with the other posters though and to a certain extent you do have some responsibility towards your health but I think you are doing the right thing by informally raising the issue, as it should have a positive outcome, the nurse shouldnt get disciplined but highlighting this will help to ensure that this shouldnt happen again.

OTOH with my fist pregnancy I didnt realise I was pregnant until 6 weeks (was not planned) and had been on nights out etc not taking folic acid and my DC is absoloutely fine.
Hope all works out for you.