Drug incompatibilities in the adult intensive care unit of a university hospital

Abstract

ObjectivesThis study sought to identify the physical and chemical incompatibilities among the drugs administered intravenously to patients admitted to an adult intensive care unit. We also aimed to establish pharmaceutical guidelines for administering incompatible drugs.MethodsThis cross-sectional, prospective, and quantitative study was conducted from July to September 2015. Drug incompatibilities were identified based on an analysis of the patient prescriptions available in the hospital online management system. A pharmaceutical intervention was performed using the guidelines on the preparation and administration of incompatible drugs. Adherence to those guidelines was subsequently assessed among the nursing staff.ResultsA total of 100 prescriptions were analyzed; 68 were incompatible with the intravenous drugs prescribed. A total of 271 drug incompatibilities were found, averaging 4.0 ± 3.3 incompatibilities per prescription. The most commonly found drug incompatibilities were between midazolam and hydrocortisone (8.9%), between cefepime and midazolam (5.2%), and between hydrocortisone and vancomycin (5.2%). The drugs most commonly involved in incompatibilities were midazolam, hydrocortisone, and vancomycin. The most common incompatibilities occurred when a drug was administered via continuous infusion and another was administered intermittently (50%). Of the 68 prescriptions that led to pharmaceutical guidelines, 45 (66.2%) were fully adhered to by the nursing staff.ConclusionPatients under intensive care were subjected to a high rate of incompatibilities. Drug incompatibilities can be identified and eliminated by the pharmacist on the multidisciplinary team, thereby reducing undesirable effects among patients.

European Databases on Stability and Compatibility of Injectable Medicinal Products in Europe

“…Risk minimization in coadministration of injectable drugs remains important because polymedication is common practice in various patient groups like cancer patients, transplant patients and intensive care patients (neonatal, paediatric, adult). In recent reports, rates of compatibility varied from 9 to 42 % and of incompatibilities from 15 to 68 % [20][21][22][23][24]. Hospital pharmacists should not only answer questions regarding drug-drug compatibilities, but develop together with physicians and nurses incompatibility-reducing infusion schemes to be used in vulnerable patient groups.…”

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

“…These data are similar to the characteristics of patients admitted in other ICUs of the country, where a predominance of male patients and mean age of 53.69 years, 55.8 years, and 60.0 years was observed. [21][22][23] Population aging in the country, resulting in an increased number of individuals with noncommunicable chronic diseases, leads to a higher level of vulnerability of older age groups and increases morbidity and the frequency of hospitalizations of elderly individuals.…”

Nanomedicine: a new paradigm to overcome drug incompatibilities

“…Intravenous (IV) therapy is commonly used in hospital setting, and it is essential for patients who require urgent medical care or when barriers to oral drug administration exist. [6] The number of IV pharmacotherapies has expanded vastly over the last century and has been associated with a constant need for the concurrent administration of several medications. However, coadministration of IV therapies is sophisticated and usually associated with the risk of incompatibilities between the administered drugs.…”

“…However, coadministration of IV therapies is sophisticated and usually associated with the risk of incompatibilities between the administered drugs. [1,6] Drug incompatibilities are undesirable interactions that occur during drug preparation or administration process, when two or more drug solutions are mixed in the same syringe, tubing or container. [7] Tissot et al [8] reported that drug incompatibilities account for 14.3% of all intensive care units (ICUs) medication errors.…”

“…Moreover, the authors observed that the most frequent incompatibility was between midazolam and hydrocortisone (8.9%), followed by hydrocortisone and vancomycin (5.2%). [6] Vijayakumar et al conducted a prospective observational study for a period of 4 months to determine the incidence of drug-related problems among IV drugs administrated by hospitalized patients. The authors reported that simultaneous IV administration of two incompatible drugs was the main predicament of the reported drug-related problems with a percentage of 40.9%.…”