Inappropriate crushing information on ward lists: cytotoxic drugs, capsules, and modified release formulations are gravely neglected

Lohmann, K; Ferber, Julia; Send, Alexander Francesco Josef; Haefeli, Walter E.; Seidling, Hanna M.

doi:10.1007/s00228-013-1638-x

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…As the first intervention, we integrated a previously developed electronic database with information on crushing and suspending solid peroral drugs, the selection of proper solvents and – if necessary – safety standards (i.e. gloves, face masks) in the electronic drug information system of our hospital.…”

Section: Methodsmentioning

confidence: 99%

More than just crushing: a prospective pre-post intervention study to reduce drug preparation errors in patients with feeding tubes

et al. 2015

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Section: Methodsmentioning

confidence: 99%

More than just crushing: a prospective pre-post intervention study to reduce drug preparation errors in patients with feeding tubes

et al. 2015

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“…In order to avoid preventable manipulations, it is also important to provide the physicians and nurses with an overview of the available dosage forms and strengths appropriate for children. It has been shown that informational material regarding drug administration procedures on the wards is often outdated or not even available [ 17 ]. Therefore, integrating the information on drug dispensation and administration in paediatric wards as well as regular training should be part of each hospital quality management system.…”

Section: Discussionmentioning

confidence: 99%

“…They can affect dosing accuracy, bioavailability and integrity of the dosage form to an unknown extent. As a result, sub-therapeutic or toxic doses may be administered to vulnerable patient populations [ 12 , 15 , 16 , 17 ]. A randomised study in patients aged from 10–16 years showed that administration of crushed lopinavir/ritonavir tablets significantly reduced drug exposure compared to patients receiving whole tablets [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Manipulation of Medicinal Products for Oral Administration to Paediatric Patients at a German University Hospital: An Observational Study

Zahn¹,

Hoerning²,

Trollmann³

et al. 2020

Pharmaceutics

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Pharmacotherapy in children requires medicinal products in age-appropriate dosage forms and flexible dose strengths. Healthcare professionals often encounter a lack of licensed and commercially available formulations, which results in the need for manipulation. This study aimed to investigate the nature, frequency and preventability of the manipulation of medicinal products before oral drug administration to paediatric inpatients in Germany. A prospective, direct observational approach was used. Two thousand and three medication preparation processes (MPP) in 193 patients were included in the analysis. Medicines were manipulated in 37% of oral administrations, affecting 57% of the patients. The percentage of manipulations was highest in infants/toddlers (42%) and lowest in adolescents (31%). Antiepileptics were most frequently manipulated (27%), followed by vitamins (20%) and drugs for acid-related disorders (13%). Fifty-six per cent of all manipulations were off-label. In 71% of these, no alternative appropriate medicinal product was commercially available. These results demonstrate that the manipulation of medicinal products before oral administration is common in paediatric wards in Germany. About half of the manipulations were off-label, indicating that no suitable formulation was available. Evidence-based guidelines for manipulations are required, with the overall aim of improving the safety of paediatric drug therapy.

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“…This type of administration error has also been reported in hospitals . Lists about the appropriateness of crushing or suspending oral dosage forms can be found on hospital wards, but the correctness of these lists has been found to vary 67.7%‐92.0% …”

Section: Discussionmentioning

confidence: 94%

Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark

Druedahl

Hansen

Freese

et al. 2018

Basic Clin Pharma Tox

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Medication use is a complex process involving different types of health care personnel. This study investigated and compared mandatory medication content in the curricula of six types of health care personnel with patient contact. Using content analysis, three independent raters analysed the mandatory medication content for physicians, pharmacists, pharmaconomists, nurses, health care assistants and support workers in the Capital Region of Denmark. Three dimensions were analysed as follows: communication with patients about medication, medication use or pharmacology and medication formulation and production. ECTS credits were totalled for courses analysed to have high or medium content, and inter-rater reliability was tested with Fleiss' kappa. The total mandatory medication content for pharmacists was 197.0 ECTS, physicians 136.0 ECTS, pharmaconomists 123.3 ECTS, nurses 52.0 ECTS, health care assistants 17.8 ECTS and support workers 0.0 ECTS. Communication with patients about medication was included to the greatest extent in the educations of pharmaconomists (112.0 ECTS), pharmacists (37.5 ECTS) and physicians (25.0 ECTS). Knowledge about medication use and pharmacology was taught primarily to pharmacists (146.5 ECTS), physicians (123.6 ECTS) and pharmaconomists (89.8 ECTS) and to a lesser extent nurses (52.0 ECTS), health care assistants (17.8 ECTS) and support workers (0.0 ECTS). Medication formulation and production were taught only to pharmacists (93.0 ECTS) and pharmaconomists (25.1 ECTS). Mapping the basic competencies about medication taught to each of the six health care personnel types can lead to a better understanding of how they can complement each other in patient care. The study points to weaknesses in medication curriculum content for health care personnel with the most patient contact. K E Y W O R D S curriculum, Denmark, education, health care, medication

show abstract

Inappropriate crushing information on ward lists: cytotoxic drugs, capsules, and modified release formulations are gravely neglected

Cited by 11 publications

References 33 publications

More than just crushing: a prospective pre-post intervention study to reduce drug preparation errors in patients with feeding tubes

More than just crushing: a prospective pre-post intervention study to reduce drug preparation errors in patients with feeding tubes

Manipulation of Medicinal Products for Oral Administration to Paediatric Patients at a German University Hospital: An Observational Study

Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark

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