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Wagner LAF, Neininger MP, Hensen J, Zube O, Bertsche T. Avoiding incompatible drug pairs in central-venous catheters of patients receiving critical care: an algorithm-based analysis and a staff survey. Eur J Clin Pharmacol 2023; 79:1081-1089. [PMID: 37284873 PMCID: PMC10361869 DOI: 10.1007/s00228-023-03509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE In a critical care setting, we aimed to identify and solve physico-chemical drug incompatibilities in central-venous catheters considering the staffs' knowledge and assumptions about incompatibilities. METHODS (i) After positive ethical vote, an algorithm to identify incompatibilities was developed and applied. The algorithm was based on KIK® database and Stabilis® database, the drug label, and Trissel textbook. (ii) A questionnaire was created and used that asked staff for knowledge and assumptions about incompatibilities. (iii) A 4-step avoidance recommendation was developed and applied. RESULTS (i) At least one incompatibility was identified in 64 (61.4%) of 104 enrolled patients. Eighty one (62.3%) of 130 incompatible combinations affected piperacillin/tazobactam and in 18 (13.8%) each furosemide and pantoprazole. (ii) 37.8% (n = 14) of the staff members participated in the questionnaire survey (median age: 31, IQR: 4.75 years). The combination of piperacillin/tazobactam and pantoprazole was incorrectly judged to be compatible by 85.7%. Only rarely felt the majority of respondents unsafe in administering drugs (median score: 1; 0, never to 5, always). (iii) In those 64 patients with at least one incompatibility, 68 avoidance recommendations were given, and all were fully accepted. In 44 (64.7%) of 68 recommendations "Step 1: Administer sequentially" was suggested as a avoidance strategy. In 9/68 (13.2%) "Step 2: Use another lumen", in 7/68 (10.3%) "Step 3: Take a break", and in 8/68 (11.8%) "Step 4: Use catheters with more lumens" were recommended. CONCLUSIONS Although incompatibilities were common, the staff rarely felt unsafe when administering drugs. Knowledge deficits correlated well with the incompatibilities identified. All recommendations were fully accepted.
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Affiliation(s)
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstraße 32, Leipzig, 04103, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, Leipzig, 04103, Germany
| | | | - Olaf Zube
- Bundeswehr Hospital, Hamburg, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstraße 32, Leipzig, 04103, Germany.
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, Leipzig, 04103, Germany.
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Cheon YJ, Ye KN, Park KH, Kim JB, Yoon JE, Lee MK, Kim JT, An SH. Implementation of pharmacists' monitoring for intravenous drug compatibility. Eur J Hosp Pharm 2023; 30:101-106. [PMID: 36810349 PMCID: PMC9986928 DOI: 10.1136/ejhpharm-2021-003187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Injectable medication errors primarily occur during preparation and administration. Currently, South Korea is experiencing chronic pharmacist shortages. Moreover, pharmacists have not routinely conducted prescription monitoring for intravenous compatibility. In the present study, we analysed the implementation of a pre-issue monitoring program using recently released cloud-based software to provide information on intravenous compatibility in the pharmacy at a general hospital in South Korea. OBJECTIVES The aims of this study were to determine whether adding an intravenous drug prescription review to pharmacists' actual work scope could promote patient safety, and to assess the impact of this new task on pharmacists' workload. METHODS Data on intravenous drugs prescribed in the intensive care unit and haematology-oncology ward were prospectively collected during January 2020. Four quantitative items were evaluated: the run-time, intervention ratio, acceptance ratio, and the information completeness ratio with regard to the compatibility of intravenous drugs. RESULTS The mean run-time of two pharmacists was 18.1 min in the intensive care unit and 8.7 min in the haematology-oncology ward (p<0.001). Significant differences were also found between the intensive care unit and the haematology-oncology wards in terms of the mean intervention ratio (25.3% vs 5.3%, respectively; p<0.001) and the information completeness ratio (38.3% vs 34.0%, respectively; p=0.007). However, the mean acceptance ratio was comparable (90.4% in the intensive care unit and 100% in the haematology-oncology ward; p=0.239). The intravenous pairs that most frequently triggered interventions were tazobactam/piperacillin and famotidine in the intensive care unit, and vincristine and sodium bicarbonate in the haematology-oncology ward. CONCLUSION This study suggests that despite a shortage of pharmacists, intravenous compatibility can be monitored before issuing injectable products in all wards. Because the prescribing pattern of injections varies across wards, pharmacists' tasks should be established accordingly. To improve the completeness of information, efforts to generate more evidence should continue.
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Affiliation(s)
- Young Ju Cheon
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Kyong Nam Ye
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | | | - Jung Bo Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Ji Eun Yoon
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Min Kyung Lee
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jung Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sook Hee An
- College of Pharmacy, Wonkwang University, Iksan, Jeollabuk-do, South Korea
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Fernández-Peña A, Katsumiti A, De Basagoiti A, Castaño M, Ros G, Sautua S, De Miguel M, Campino A. Drug compatibility in neonatal intensive care units: gaps in knowledge and discordances. Eur J Pediatr 2021; 180:2305-2313. [PMID: 33738517 DOI: 10.1007/s00431-021-04028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
In this work, we reviewed the compatibility data of drug combinations frequently administrated in nine Spanish neonatal intensive care units (NICUs) and analyzed the degree of agreement among three highly used databases (Micromedex, King Guide to Parenteral Admixtures, and Stabilis) through Cohen's kappa coefficient statistical analysis. Among 1945 drug combinations analyzed, 283 were compatible, 421 were potentially compatible, 216 were incompatible, 139 were controversial, and there was no data for 886 combinations. In general, the three databases showed a strong degree of agreement: Micromedex vs. King Guide (κ = 0.746; p < 0.001), King Guide vs. Stabilis (κ = 0.743; p < 0.001), and Micromedex vs. Stabilis (κ = 0.691; p < 0.001). However, in 6 of 648 (Micromedex vs. King Guide), 3 of 357 (King Guide vs. Stabilis), and 32 of 606 (Micromedex vs. Stabilis) comparisons, drug pairs were compatible according to the first database and incompatible according to the second, indicating discordances among databases.Conclusion: There is a gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs. Although the three databases showed strong concordance, for some drug combinations, important discrepancies were found. Thus, there is a need for further studies on drug compatibility to increase safety of intravenous administration. What is Known: • Y site-administration in NICUs is very common and some administration errors are related to the lack of information on the compatibility of intravenous drugs. • Physical compatibility data of drugs frequently used in NICUs is still very limited. What is New: • Physical compatibility data of drug combinations commonly used in Spanish NICUs was reviewed in three highly used admixture databases: Micromedex, King Guide to Parenteral Admixtures and Stabilis, and our results showed a strong degree of agreement between them, however for some drug combinations, important discrepancies were found. • Our results indicated that there is still a large gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs..
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Affiliation(s)
- Alba Fernández-Peña
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | | | - Amaya De Basagoiti
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Mikel Castaño
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Goizane Ros
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Saioa Sautua
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Monike De Miguel
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ainara Campino
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain. .,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
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Strategies to prevent drug incompatibility during simultaneous multi-drug infusion in intensive care units: a literature review. Eur J Clin Pharmacol 2021; 77:1309-1321. [PMID: 33768303 DOI: 10.1007/s00228-021-03112-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Drug protocols in intensive care units may require the concomitant administration of many drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible drugs. Incompatibilities can lead to the formation of particles and inactivation of drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. METHODS This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. RESULTS All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, incompatibility tables and databases, and the use of standard operating procedures. CONCLUSION Although many strategies have been developed in recent years to address drug incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Häni C, Vonbach P, Fonzo-Christe C, Russmann S, Cannizzaro V, Niedrig DF. Evaluation of Incompatible Coadministration of Continuous Intravenous Infusions in a Pediatric/Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2019; 24:479-488. [DOI: 10.5863/1551-6776-24.6.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to evaluate and quantify incompatible coadministrations of continuous intravenous medication in the daily clinical practice of a PICU/NICU.
METHODS We conducted a retrospective, observational study in the setting of an 18-bed PICU/NICU. All concurrently administered continuous infusions, including blood products and parenteral nutrition, were analyzed for 2 months. Raw electronic data were retrieved and subjected to quality controls. Infusion combinations were classified as compatible, incompatible, no data, or variable according to the internal hospital charts, Trissel's database, and the Swiss summary of product characteristics. For situations with incompatible coadministrations, we assessed alternative distributions of infusions among the currently available lumen.
RESULTS Data for 100 patients were analyzed. Patients were exposed to a mean of 6.9 ± 3.6 individual continuous infusions administered through 3.8 ± 1.8 lumina. Among the 1447 coadministered continuous infusions, we detected 146 incompatible combinations (10%), resulting in 105 individually relevant incompatible situations. Furthermore, 185 combinations (13%) were not covered by internal compatibility charts, and for 207 combinations (15%) no data on compatibility were available. We found that 58% of the incompatible situations could have been avoided by a redistribution of the infusions among the available lumina.
CONCLUSIONS Most infusion combinations in the studied PICU/NICU were compatible and covered by the internal compatibility charts. However, we also identified concurrent administrations of incompatible infusions or for which compatibility data are not available. A significant reduction of coadministrations of incompatible infusions could be achieved through optimal use of available lumina.
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Leopoldino RW, Costa HT, Costa TX, Martins RR, Oliveira AG. Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach. BMC Pharmacol Toxicol 2018; 19:83. [PMID: 30522525 PMCID: PMC6282361 DOI: 10.1186/s40360-018-0265-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023] Open
Abstract
Background There is little information on the frequency of drug incompatibilities in neonatal intensive care units (NICU) and the agents most commonly involved in them. The objective of the study was to characterize potential Drug Incompatibilities (DI) in the NICU by frequency, type and combination of drugs. Methods Between August 2015 and December 2016, all neonates admitted for more than 24 h and who received any drug treatment were included in this cohort study conducted in the NICU of a teaching maternity hospital in Brazil. Patient data were collected from patient records and prescription orders, and the compatibilities of all drug pairs were classified using the Trissel’s™ 2 IV Compatibility tool. Network analysis was performed in order to visualize the drug pairs commonly involved in potential DI. Results The study population consisted of 281 neonates with a median NICU length of stay of 11 days (range 2–184) and received 1343 intravenous medications. A total of 1114 potential DI were identified, 469 (42.1%) were restricted compatibilities, 348 (31.2%) unknown compatibilities and 297 (26.7%) documented incompatibilities. The incidence of documented incompatibilities in the NICU was 25.0% patient-days (95% confidence interval (CI) 19.4–30.7% patient-days). Incompatible potential DI affected 46.3% (95%CI 40.3–52.3%) of the neonates. Ampicillin (408 of 1114 pairs), gentamicin (216 of 1114 pairs) and aminophylline (197 of 1114 pairs) were the main medicines involved in potential DI. Conclusion Potential DI are extremely common in NICU, with half of the population susceptible to simultaneous administration of incompatible medications. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.
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Affiliation(s)
- Ramon Weyler Leopoldino
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil.
| | - Haline Tereza Costa
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - Tatiana Xavier Costa
- Maternity School Januário Cicco, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Rand Randall Martins
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - António Gouveia Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
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Benlabed M, Perez M, Gaudy R, Genay S, Lannoy D, Barthélémy C, Odou P, Lebuffe G, Décaudin B. Clinical implications of intravenous drug incompatibilities in critically ill patients. Anaesth Crit Care Pain Med 2018; 38:173-180. [PMID: 29680262 DOI: 10.1016/j.accpm.2018.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/06/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this review is to analyse the clinical consequences of intravenous drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. METHODS A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. DATA EXTRACTION Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. DATA SYNTHESIS Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different drug incompatibility situations. They report pulmonary toxicity. CONCLUSION Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.
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Affiliation(s)
- Malik Benlabed
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Maxime Perez
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Romain Gaudy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Stéphanie Genay
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Damien Lannoy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Christine Barthélémy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Pascal Odou
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Gilles Lebuffe
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pôle d'anesthésie-réanimation, CHU de Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France.
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Maiguy-Foinard A, Genay S, Lannoy D, Barthélémy C, Lebuffe G, Debaene B, Odou P, Décaudin B. Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units. Anaesth Crit Care Pain Med 2016; 36:53-63. [PMID: 27338523 DOI: 10.1016/j.accpm.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/25/2016] [Accepted: 02/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aims are to identify critical parameters influencing the drug mass flow rate of infusion delivery to patients during multidrug infusion and to discuss their clinical relevance. DATA SOURCES A review of literature was conducted in January 2016 using Medline, Google Scholar, ScienceDirect, Web of Science and Scopus online databases. DATA EXTRACTION References relating to the accuracy of fluid delivery via gravity-flow intravenous (IV) infusion systems and positive displacement pumps, components of IV administration sets, causes of flow rate variability, potential complications due to flow rate variability, IV therapies especially at low flow rates and drug compatibilities were considered relevant. DATA SYNTHESIS Several parameters impact the delivery of drugs and fluids by IV infusion. Among them are the components of infusion systems that particularly influence the flow rate of medications and fluids being delivered. By their conception, they may generate significant start-up delays and flow rate variability. Performing multidrug infusion requires taking into account two main points: the common dead volume of drugs delivered simultaneously with potential consequences on the accuracy and amount of drug delivery and the prevention of drug incompatibilities and their clinical effects. CONCLUSION To prevent the potentially serious effects of flow rate variability on patients, clinicians should receive instruction on the fluid dynamics of an IV administration set and so be able to take steps to minimise flow rate changes during IV therapy.
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Affiliation(s)
- Aurélie Maiguy-Foinard
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France; CHU Lille, Institut de Pharmacie, 59000 Lille, France
| | - Stéphanie Genay
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France
| | - Damien Lannoy
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France; CHU Lille, Institut de Pharmacie, 59000 Lille, France
| | - Christine Barthélémy
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France
| | - Gilles Lebuffe
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France; CHU Lille, Pôle d'Anesthésie Réanimation, 59000 Lille, France
| | - Bertrand Debaene
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Pascal Odou
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France; CHU Lille, Institut de Pharmacie, 59000 Lille, France
| | - Bertrand Décaudin
- University Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, 59000 Lille, France; CHU Lille, Institut de Pharmacie, 59000 Lille, France.
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Perez M, Maiguy-Foinard A, Barthélémy C, Décaudin B, Odou P. Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2016. [DOI: 10.1515/pthp-2016-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractOne of the fundamental principles guiding the pharmaceutical quality of parenteral products is to prevent injecting contaminants from microbiological, chemical or physical sources. It is just as difficult to ensure the absence of chemical and particulate contaminants in injectable products as it is to weigh up the microbiological risk. The problem of particulate matter is mainly related to the preparing and administrating of injectable drugs rather than through the contamination of marketed products. Particulate contamination also arises
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Perez M, Décaudin B, Foinard A, Barthélémy C, Debaene B, Lebuffe G, Odou P. Compatibility of medications during multi-infusion therapy: A controlled in vitro study on a multilumen infusion device. Anaesth Crit Care Pain Med 2015; 34:83-8. [PMID: 25858619 DOI: 10.1016/j.accpm.2014.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Drug incompatibilities can jeopardize the safety and effectiveness of intravenous drug therapies, especially in the field of anaesthesia and intensive care. Patients receive many drugs simultaneously through limited venous accesses. This study was designed to confirm the impact of a multilumen infusion device on the occurrence of known physical drug incompatibilities. STUDY DESIGN In vitro laboratory work. METHODS Two infusion devices were studied: a standard single-lumen set and a multilumen infusion access device (Edelvaiss Multiline-8, Doran International). Up to six drugs were infused simultaneously: three acidic solutions of midazolam, amiodarone and dobutamine, and three alkaline solutions of furosemide, pantoprazole and amoxicillin/clavulanate. Saline, Ringer' solution and 5% dextrose were used as hydration vehicles with an infusion rate initially set at 100 mL/h and with stepwise decreases of 10 mL/h until precipitation. Two methods were used to highlight physical drug compatibility according to the European Pharmacopoeia: visual inspection of the extension set and an obscured-light sub-visible particle count test of infusions. The lowest infusion rate value for vehicle infusion to satisfy the two tests in all trials is reported for each infusion device. RESULTS The standard set did not satisfy the test in 82% of the assessed drug combinations. The Edelvaiss Multiline-8 was able to prevent the occurrence of drug incompatibilities in 49% of the drug combinations tested. This device is therefore advantageous, especially when simultaneously infusing two or four incompatible drugs. CONCLUSIONS Infusion device characteristics have an impact on physical drug incompatibilities. Our results confirm that the Edelvaiss Multiline-8 device prevents physical drug incompatibilities under specified conditions.
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Affiliation(s)
- Maxime Perez
- Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France; Department of Pharmacy, CHRU Lille, 59037 Lille, France
| | - Bertrand Décaudin
- Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France; Department of Pharmacy, CHRU Lille, 59037 Lille, France.
| | - Aurélie Foinard
- Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France
| | - Christine Barthélémy
- Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France
| | - Bertrand Debaene
- Department of Anesthesia and Intensive Care, Poitiers University Hospital, Inserm U1070, 86021 Poitiers, France
| | - Gilles Lebuffe
- Department of Anesthesia and Intensive Care Medicine, Lille University Hospital, EA 1046, IFR 114, 59037 Lille, France
| | - Pascal Odou
- Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France; Department of Pharmacy, CHRU Lille, 59037 Lille, France
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Machotka O, Manak J, Kubena A, Vlcek J. Incidence of intravenous drug incompatibilities in intensive care units. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 159:652-6. [PMID: 25482735 DOI: 10.5507/bp.2014.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 10/16/2014] [Indexed: 11/23/2022] Open
Abstract
AIMS Drug incompatibilities are relatively common in inpatients and this may result in increased morbidity/mortality as well as add to costs. The aim of this 12 month study was to identify real incidences of drug incompatibilities in intravenous lines in critically ill patients in two intensive care units (ICUs). METHODS A prospective cross sectional study of 82 patients in 2 ICUs, one medical and one surgical in a 1500-bed university hospital. One monitor carried out observations during busy hours with frequent drug administration. Patients included in both ICUs were those receiving at least two different intravenous drugs. RESULTS 6.82% and 2.16% of drug pairs were found to be incompatible in the two ICUs respectively. Among the most frequent incompatible drugs found were insulin, ranitidine and furosemide. CONCLUSIONS The study showed that a significant number of drug incompatibilities occur in both medical and surgical ICUs. It follows that the incidence of incompatibilities could be diminished by adhering to a few simple rules for medication administration, following by recommendations for multiple lumen catheter use. Future prospective studies should demonstrate the effect of applying these policies in practice.
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Affiliation(s)
- Ondrej Machotka
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jan Manak
- Department of Gerontology and Metabolism, University Hospital Hradec Kralove
| | - Ales Kubena
- The Institute of Information Theory and Automation, Academy of Sciences of the Czech Republic, Prague
| | - Jiri Vlcek
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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Williams CN, Bratton SL, Hirshberg EL. Computerized decision support in adult and pediatric critical care. World J Crit Care Med 2013; 2:21-8. [PMID: 24701413 PMCID: PMC3953873 DOI: 10.5492/wjccm.v2.i4.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/02/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.
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13
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Seidling HM, Lampert A, Lohmann K, Schiele JT, Send AJF, Witticke D, Haefeli WE. Safeguarding the process of drug administration with an emphasis on electronic support tools. Br J Clin Pharmacol 2013; 76 Suppl 1:25-36. [PMID: 24007450 DOI: 10.1111/bcp.12191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/20/2013] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this work is to understand the process of drug administration and identify points in the workflow that resulted in interventions by clinical information systems in order to improve patient safety. METHODS To identify a generic way to structure the drug administration process we performed peer-group discussions and supplemented these discussions with a literature search for studies reporting errors in drug administration and strategies for their prevention. RESULTS We concluded that the drug administration process might consist of up to 11 sub-steps, which can be grouped into the four sub-processes of preparation, personalization, application and follow-up. Errors in drug handling and administration are diverse and frequent and in many cases not caused by the patient him/herself, but by family members or nurses. Accordingly, different prevention strategies have been set in place with relatively few approaches involving e-health technology. CONCLUSIONS A generic structuring of the administration process and particular error-prone sub-steps may facilitate the allocation of prevention strategies and help to identify research gaps.
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Affiliation(s)
- Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Foinard A, Décaudin B, Barthélémy C, Debaene B, Odou P. The Impact of Multilumen Infusion Devices on the Occurrence of Known Physical Drug Incompatibility. Anesth Analg 2013; 116:101-6. [DOI: 10.1213/ane.0b013e31826f5e02] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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