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Cavagna P, Bizet S, Fieux F, Houillez E, Chirk C, Zulian C, Perreux J, Fernandez C, Lescot T, Antignac M. Assessment of Good Practice Guidelines for Administration of Drugs via Feeding Tubes by a Clinical Pharmacist in the Intensive Care Unit. Crit Care Nurse 2022; 42:54-65. [DOI: 10.4037/ccn2022395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background
In intensive care units, patients are frequently unable to take oral drugs because of orotracheal intubation or sedation.
Local Problem
Adverse events occurred during the administration of drugs by feeding tube. This study assessed the impact of implementing good practice guidelines by a clinical pharmacist on the prescription and administration of drugs through feeding tubes.
Methods
Nonconformity of drug prescription and administration in patients with feeding tubes was assessed before and after implementation of good practice guidelines in the intensive care unit of a large teaching hospital. Data were collected from medical records and interviews with physicians and nurses using a standardized form. Assessment of prescription nonconformity included compatibility of a drug’s absorption site with the administration route. Assessment of administration nonconformity included the preparation method.
Results
The analysis included 288 prescriptions and 80 administrations before implementation and 385 prescriptions and 211 administrations after implementation. Prescriptions in which the drug’s absorption site was not compatible with the administration route decreased significantly after implementation (19.8% vs 7.5%, P < .01). Administration nonconformity decreased significantly in regard to crushing tablets and opening capsules (51.2% vs 4.3%, P < .01) and the solvent used (67.1% vs 3.5%, P < .01). Simultaneous mixing of drugs in the same syringe did not decrease significantly (71.2% vs 62.9%, P = .17).
Conclusion
Implementation of good practice guidelines by a multidisciplinary team in the intensive care unit significantly improved practices for administering crushed, opened, and dissolved oral forms of drugs by feeding tube.
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Affiliation(s)
- Pauline Cavagna
- Pauline Cavagna is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University, Paris, France
| | - Simon Bizet
- Simon Bizet is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Fabienne Fieux
- Fabienne Fieux is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Emilie Houillez
- Emilie Houillez is a nurse, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Caroline Chirk
- Caroline Chirk is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Chloé Zulian
- Chloé Zulian is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Jennifer Perreux
- Jennifer Perreux is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Christine Fernandez
- Christine Fernandez is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Thomas Lescot
- Thomas Lescot is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Marie Antignac
- Marie Antignac is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
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Programa de melhoria da qualidade na administração de medicamentos via sonda nasoenteral. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Karkossa F, Lehmann N, Klein S. A systematic approach for assessing the suitability of enteral feeding tubes for the administration of controlled-release pellet formulations. Int J Pharm 2022; 612:121286. [PMID: 34775043 DOI: 10.1016/j.ijpharm.2021.121286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
Enteral nutrition plays an important role for patients who are unable to properly swallow food. In such patients, enteral feeding tubes are often used, through which food, but often also oral medications, are administered. However, this can pose the risk of tube clogging. Compared to the administration of crushed tablets, multiparticulate dosage forms are often considered easier to administer and furthermore have the advantage of enabling the administration of even controlled-release preparations. The objective of this systematic study was to identify tube- and formulation-related factors that contribute to successful administration of coated pellet formulations via a variety of commercially available feeding tube devices. The suitability of enteral feeding tubes for the administration of controlled-release pellet formulations that differed in size and type of starter core and functional coating was investigated in a stepwise approach using a novel in vitro setup. Results of the study indicate that pellet diameter and inner diameter of the feeding tube are by no means reliable parameters for estimating the tube's suitability for pellet administration, but that many other tube and formulation-related factors and combinations thereof must be considered to ensure safe and effective drug administration via enteral feeding tubes.
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Affiliation(s)
- Frank Karkossa
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
| | - Nicole Lehmann
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
| | - Sandra Klein
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany.
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Blay N, Roche MA. A systematic review of activities undertaken by the unregulated Nursing Assistant. J Adv Nurs 2020; 76:1538-1551. [PMID: 32190928 DOI: 10.1111/jan.14354] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify activities performed by Nursing Assistants in acute and primary healthcare. DESIGN Systematic review. DATA SOURCES The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants. REVIEW METHODS From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories. RESULTS Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision. CONCLUSION Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training. IMPACT Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.
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Affiliation(s)
- Nicole Blay
- Western Sydney University School of Nursing and Midwifery, Penrith South DC, NSW, Australia.,Ingham Medical Institute, Liverpool, NSW, Australia.,South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Michael Anthony Roche
- University of Technology Sydney, Ultimo, NSW, Australia.,Mental Health Drug and Alcohol Directorate, Northern Sydney Local Health District, North Ryde, NSW, Australia
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Gimenes FRE, Pereira MCA, Prado PRD, Carvalho REFLD, Koepp J, Freitas LMD, Teixeira TCA, Miasso AI. Nasogastric/Nasoenteric tube-related incidents in hospitalised patients: a study protocol of a multicentre prospective cohort study. BMJ Open 2019; 9:e027967. [PMID: 31345968 PMCID: PMC6661907 DOI: 10.1136/bmjopen-2018-027967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hospitalised patients with nasogastric/nasoenteric tube (NGT/NET) are at constant risk of incidents; therefore, healthcare professionals need to routinely monitor risks and adopt strategies for patient safety and quality of care. AIM This study aimed to evaluate the NGT/NET-related incidents in hospitalised patients and associated factors. METHODS This is a multicentre study, with a prospective cohort design. Data will be collected at the general medical ward of seven Brazilian hospitals in the north, northeast, southeast and south. The sample will consist of 391 patients that require an NGT/NET during hospitalisation. Three different methods will be used to identify the incidents: (1) healthcare professionals and patients/caregivers will be required to report any NGT/NET-related incidents; (2) researchers will visit the wards to get information about the incidents with healthcare professionals and patients/caregivers; (3) the researchers will review the medical records looking for information on the occurrence of any NGT/NET-related incidents. Demographic, clinical and therapeutic details will be obtained from the medical records and will be registered in an electronic data collection tool developed for the purposes of this study. The complexity of patients will be assessed by the Patient Classification System, and the severity of comorbid diseases will be assessed through the Charlson Comorbidity Index. IMPLICATION FOR PRACTICE The results may encourage the use of evidence effectively to influence the scientific foundation for clinical practice and the development of evidence-based policies that will prevent, manage and eliminate complications caused by NGT/NET-related incidents, and improve the quality and safety of care provided to hospitalised patients. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee. Detailed information about the study can be provided by the principal investigator. The findings will be reported through academic journals, seminar and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.
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Affiliation(s)
- Fernanda Raphael Escobar Gimenes
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Marta Cristiane Alves Pereira
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Janine Koepp
- Nursing Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Ligia Menezes de Freitas
- Nursing Department, Faculty of Science and Technology of Campos Gerais, Campos Gerais, Minas Gerais, Brazil
| | | | - Adriana Inocenti Miasso
- Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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Sari D, Kadifeli D, Akbiyik A, Taşkiran N. Intensive care unit nurses' knowledge of medication administration via enteral tubes. Nurs Crit Care 2018; 23:141-146. [PMID: 29424127 DOI: 10.1111/nicc.12335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication administration via enteral tubes is a complex and key application for which nurses in intensive care units are responsible. AIM The aim of this study was to evaluate drug administrations via enteral tubes by nurses in intensive care units. METHODS This research was conducted using a descriptive and cross-sectional research design. The study was conducted with 289 nurses at intensive care units in hospitals in İzmir, Turkey. The data of the study were collected with the 'Sociodemographic Information Form' and the 'Enteral Medication Administrations Questionnaire', which was designed in accordance with the literature and consists of questions on interventions before, during and following medication administrations via enteral tubes. RESULTS It was found that more than half the nurses (62.3%) use nasogastric tubes for medication administrations and that all of them use the enteral way for the administration of medications in the form of tablets, while 58.8% use this method to administer the medications in the form of enteric-coated tablets. It was determined that approximately half the nurses (52.6%) apply more than one medication separately, and a majority (84.1%) use tap water to wash the enteral tube. CONCLUSIONS Enteral medication administration practices are inconsistent. Some nurses use unsafe practices and may therefore compromise patient care. RELEVANCE TO CLINICAL PRACTICE Conduction of education programmes on medication administration via enteral tubes for intensive care unit nurses is important in improving nurses' knowledge.
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Affiliation(s)
- Dilek Sari
- Ege University College of Nursing, Department of Fundamentals of Nursing, İzmir, Turkey
| | - Derya Kadifeli
- İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ayşe Akbiyik
- İzmir Katip Celebi University Faculty of Health Science, Department of Fundamentals of Nursing, İzmir, Turkey
| | - Nihal Taşkiran
- Adnan Menderes University College of Nursing, Department of Fundamentals of Nursing, Aydın, Turkey
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Joos E, Mehuys E, Van Bocxlaer J, Remon JP, Van Winckel M, Boussery K. Drug administration via enteral feeding tubes in residential care facilities for individuals with intellectual disability: an observational study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:215-225. [PMID: 24762229 DOI: 10.1111/jir.12129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The administration of oral medication to patients with an enteral feeding tube (EFT) is challenging. Compliance to guidelines concerning medication administration via EFT has been investigated extensively in the hospital setting. However, studies in residential care facilities (RCFs) for individuals with intellectual disability (ID) are very limited. Therefore, the present study aimed to collect direct observational data on drug administration practices to residents with EFT in multiple RCFs. METHOD This cross-sectional, observational study was conducted in six Belgian RCFs for individuals with ID. Observations of medication preparation and administration through EFT were carried out in two randomly selected units per participating RCF, on 2 days per unit during all daytime drug rounds, using a direct observation method. Afterwards, the recorded observations were compared with international guidelines on drug preparation and administration through EFT. RESULTS In total, 862 drug preparations and 268 administrations in 48 residents with EFT were witnessed. Mixing together multiple drugs, not diluting liquid formulations with at least an equal amount of water, not shaking suspensions/emulsions before use, and not selecting the most appropriate dosage form were the most common deviations from medication preparation guideline recommendations. For medication administration, not flushing the EFT with at least 15 mL water was the most common deviation. We also observed high variability in working methods regarding medication preparation and administration via EFT, even between staff members of the same unit. CONCLUSION This study found that current guidelines concerning medication preparation and administration through EFT are often not followed in Belgian RCFs for individuals with ID. Further research aimed at understanding why current guidelines are not followed seems warranted.
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Affiliation(s)
- E Joos
- Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
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The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses. Int J Clin Pharm 2012; 34:757-64. [DOI: 10.1007/s11096-012-9673-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
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Gimenes FRE, Marques TC, Teixeira TCA, Mota MLS, Silva AEBDC, Cassiani SHDB. Medication wrong-route administrations in relation to medical prescriptions. Rev Lat Am Enfermagem 2011; 19:11-7. [DOI: 10.1590/s0104-11692011000100003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 08/04/2010] [Indexed: 11/22/2022] Open
Abstract
This study analyzes the influence of medical prescriptions' writing on the occurrence of medication errors in the medical wards of five Brazilian hospitals. This descriptive study used data obtained from a multicenter study conducted in 2005. The population was composed of 1,425 medication errors and the sample included 92 routes through which medication was wrongly administered. The pharmacological classes most frequently involved in errors were cardiovascular agents (31.5%), medication that acts on the nervous system (23.9%), and on the digestive system and metabolism (13.0%). In relation to the prescription items that may have contributed to such errors, we verified that 91.3% of prescriptions contained acronyms and abbreviations; patient information was missing in 22.8%, and 4.3% did not include the date and were effaced. Medication wrong-route administrations are common in Brazilian hospitals and around the world. It is well established that these situations may result in severe adverse events for patients, including death.
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Palese A, Bello A, Magee J. Triturating drugs for administration in patients with difficulties in swallowing: evaluation of the drug lost. J Clin Nurs 2011; 20:587-90. [PMID: 21219531 DOI: 10.1111/j.1365-2702.2010.03577.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alvisa Palese
- School of Nursing, University of Udine, Udine, Italy.
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