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Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units

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Abstract

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.

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Notes

  1. See Appendix for calculation details.

  2. ibid.

  3. ibid.

  4. ibid.

  5. ibid.

  6. ibid.

  7. In order to scale the score of accuracy, completeness, comprehensiveness and applicability to 250 for the gold standard, correcting factors have been used.

  8. ibid.

  9. ibid.

  10. ibid.

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Acknowledgements

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.

Funding

No financial support was received.

Conflicts of interest

None to declare.

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Authors and Affiliations

  1. Hospital Pharmacy, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland

    Isabella De Giorgi, Bertrand Guignard, Caroline Fonzo-Christe & Pascal Bonnabry

  2. School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland

    Isabella De Giorgi & Pascal Bonnabry

Authors
  1. Isabella De Giorgi
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  2. Bertrand Guignard
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  3. Caroline Fonzo-Christe
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  4. Pascal Bonnabry
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Correspondence to Pascal Bonnabry.

Appendix

Appendix

Sensitivity: The ability to correctly detect incompatibilities for drug pairs from I1 and I2 = Number of true positives/(number of true positives + number of false negatives) = Sen = TP/(TP + FN)

Specificity: The ability to ignore incompatibilities for drug pairs from C1 and C2 = Number of true negatives/(number of true negatives + number of false positives) = Spe = TN/(TN + FP)

Positive Predictive Value (PPV): The probability that, when the tool identified an incompatibility, it was an incompatibility defined as I1 or I2. = Number of true positives/(number of true positives + number of false positives) = PPV = TP/(TP + FP)

Negative Predictive Value (NPV): The probability that, when the tool ignored an incompatibility, it was a compatibility defined as C1 or C2. = Number of true negatives/(number of true negatives + number of false negatives) = NPV = TN/(TN + FN)

Accuracy score = (Sen + Spe + PPV + NPV) × 62.5Footnote 7

Completeness score = Number of drug pairs × 6.25Footnote 8

Comprehensiveness score = [Number of items/2.08] × [40/number of drug pairs]Footnote 9

Applicability score (adapted from Barrons [26]) = [1/(mean time needed to classify 5 drug pairs) × 1000/3.33] + [EVA(design) × 7.04] + [EVA(usefulness) × 5.44] + [EVA(reliability) × 5.32] + [EVA(ergonomics) × 6.49]Footnote 10

Global score = Accuracy score + Completeness score + Comprehensiveness score + Applicability score

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De Giorgi, I., Guignard, B., Fonzo-Christe, C. et al. Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units. Pharm World Sci 32, 520–529 (2010). https://doi.org/10.1007/s11096-010-9403-z

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