Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units
- 670 Downloads
Objective Intravenous drug administration in neonatal (NICU) and paediatric intensive care units (PICU) is critical because of poor venous access, polymedication, fluid restriction and low infusion rate. Risk is further increased by inadequate information on the physicochemical compatibility of drugs. Eight decision-supporting tools were hence evaluated to improve the detection of drug incompatibilities in paediatric wards. Setting NICU and PICU, University hospital. Method Eight tools (Thériaque 2007, Stabilis 3, Perfysi 2 databases; KIK 3.0 software; Neofax 2007 handbook; King 2008Guide, CHUV 9.0, pH 2007 cross-tables) were assessed by two pharmacists using 40 drug pairs (20 incompatible; 20 compatible) frequently prescribed in PICUs and NICUs. Trissel’s 14th Ed. handbook served as the gold standard. Four criteria were evaluated (each with a maximum of 250 points): accuracy (sensitivity, specificity, positive and negative predictive values), completeness (number of drug pairs documented), comprehensiveness (presence of 16 different items), and applicability (by combining the time needed by 7 pharmacists to classify 5 drug pairs, plus an evaluation of their design, usefulness, reliability and ergonomics, using visual analogy scales). The percentage of non-compliant answers (NCA) was calculated for both the performing pharmacists and the tools. Main Outcome Measure Global score of drug incompatibilities (accuracy + completeness + comprehensiveness + applicability). ResultsThériaque obtained the best global score (840/1000 points), followed by pH (807), CHUV (803), Perfysi (776), Neofax (678), King Guide (642), Stabilis (584) and KIK (523), respectively. The highest scores were reached by Thériaque for accuracy (234/250); Thériaque and pH for completeness (200/250); Thériaque and Perfysi for comprehensiveness (218/250); and pH for applicability (298/250). The range of pharmacists’ NCAs was between 9% (4/45 NCAs) and 33% (15/45), whereas that for drug pairs was between 10% (6/63) and 30% (19/63). The range of NCAs for tools was between 6% (2/35, pH) and 49% (18/35, Perfysi). ConclusionsThériaque proved outstanding as a drug-incompatibility tool. However, all resources showed some shortcomings. The large ranges of pharmacists’ NCAs shows that such an assessment is subject to different interpretations. Standard operating procedures for drug-incompatibility assessment should be implemented in drug-information centres. Tools with low NCA percentage, such as the pH or CHUV tables, may be useful for nurses in ICUs.
KeywordsDrug-incompabilities Intensive care Neonatology Peadiatrics Switzerland Tools
The authors wish to acknowledge all the pharmacists who took part in this study and the pharmacy of the CHUV, of the Central Institute of Valaisan Hospitals and of Schaffhausen’s Hospital for providing the tools they have developed. The authors thank Bernard Testa, Emeritus Professor, for his help in revising the article.
No financial support was received.
Conflicts of interest
None to declare.
- 9.De Giorgi I, Fonzo-Christe C, Bonnabry P. University of Geneva. January 2005. Sécurité de préparation et d’administration des médicaments en pédiatrie. [Security of preparation and administration of drugs in Paediatrics]. http://pharmacie.hug-ge.ch/ens/mas/diplome_idg.pdf (8 January 2009).
- 17.Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda: American Society of Health System Pharmacy; 2007.Google Scholar
- 18.Di Paolo E, et al. Pharmacy of Lausanne’s University Hospital. Soins intensifs et continus de pédiatrie—Compatibilités des médicaments injectables administrés en Y. [Paediatric intensive and continuous care—Injectable drug compatibilities Y-admix] May 2006. http://files.chuv.ch/internet-docs/pha/medicaments/pha_compatibsipi_v9.pdf (8 January 2009).
- 19.Vogel Kahmann I, Bürki R, Denzler U, Höfler A, Schmid B, Splisgardt H. Inkompatibilitätsreaktionen auf der intensivstation [Incompatibility reactions in the intensive care unit. Five years after the implementation of a simple colour code system]. Anaesthesist. 2003;52:409–12.CrossRefPubMedGoogle Scholar
- 20.Bensimon E. Perfysi v.2, ICHV, 12. 2007.Google Scholar
- 21.B∣Braun Medical AG. Kompatibilität Im Katheter 3.0 software Switzerland, 09.2002.Google Scholar
- 22.Infostab. http://www.stabilis.org/ Vigneron J, et al. Stabilis 3. CHU-Nancy, 11.2005.
- 23.Theriaque, http://www.theriaque.org/compatibilites/incompatibilites/home.cfm (Accessed February 1, 2010).
- 24.Young TE, Mangum B. Neofax. 20th ed. ISBN: 978-1-56363-672-1. Montvale: Thomson Healthcare, 2007.Google Scholar
- 25.Catania PN (Eds). KING Guide to parenteral admixtures. Wall chart. 2008.Google Scholar
- 30.International Journal of Pharmaceutical Compounding. The KING® Guide to Parenteral Admixtures®. CD-ROM 2008.Google Scholar
- 32.Camut A, Noirez V, Gustin B, Khalife A. Amélioration des pratiques d’administration des antibiotiques injectables: proposition et évaluation d’un guide de compatibilité physico-chimique. [Improvement of antibiotics infusion practices: proposition and evaluation of a good practices’ guide]. J Pharm Clin. 2007;26(3):143–50.Google Scholar
- 34.Trissel LA. Trissel’s 2 clinical pharmaceutics database [electronic database]. Cashiers, NC: Tripharma Communications. Updated regularly.Google Scholar
- 37.UK Medicines Information. NHS; 11 January 2009. Medicines Information. Enquiry answering guidelines. UKMi. www.ukmi.nhs.uk/filestore/ukmiacg/Enquiryanseringguidelines2009.doc#_Toc224986466 (21 March 2009).