Review, update and develop a dissemination strategy for the National Clinical Guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn for NSW

The National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn (the Guidelines) were commissioned by the Ministerial Council on Drug Strategy and were published in March 2006. The aim of the Guidelines was to develop a comprehensive, coherent and consistent approach to the clinical care of women with problematic drug or alcohol use during pregnancy and to the care of mother and child in the early developmental stages of the child’s life. The Guidelines are intended for use by all health care practitioners working with pregnant women experiencing a drug or alcohol problem.

These nationally agreed guidelines cover a range of topics including but not limited to: the obstetric and neonatal complications associated with the use of a range of substances (including alcohol, tobacco, cannabis, amphetamines, cocaine, inhalants and benzodiazepines), breastfeeding, pain management, vertical transmission of blood-borne viruses and the management of neonatal abstinence syndrome. In addition, where relevant, specific guideline statements identify the needs and appropriate care of Aboriginal and Torres Strait Islander women with drug and alcohol issues.

NSW Health disseminated the Guidelines to all AHSs across the State in 2006. The dissemination strategy was designed to make the Guidelines available to clinicians (particularly those working in rural and remote areas) and to clinicians who may not have work-based access to the Internet. Copies of the Guidelines were sent to all AHSs (for distribution to all relevant departments, particularly emergency departments, maternity and drug health services), public and private pharmacotherapy clinics, non-government organisations, early childhood services, university medical schools, and ambulance services.  The background papers for the Guidelines (which contain more detailed discussion of the issues and the evidence for best clinical practice) were less widely distributed, but they were made available on the NSW Health website along with the Guidelines.

As part of the response to Recommendation 9 of the NSW Ombudsman’s Report of Reviewable Deaths in 2005: Child Deaths, NSW Health was required to investigate the issue of promoting and ensuring compliance with the Guidelines. The findings from a study undertaken to identify the current levels of awareness, knowledge and compliance with the Guidelines across NSW indicated that further work was required.  Most notably the guidelines required updating to bring them in line with changes to the National Health and Medical Research Council Guidelines regarding alcohol use in pregnancy; recent research findings with respect to the safety of buprenorphine use in pregnancy and to ensure that the guidelines were suitable for the NSW context.