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

Article Article scientifique Article Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units eng 2010-06-17 2010-08 author De Giorgi Isabella Hospital Pharmacy, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. 503168 author Guignard Bertrand 0009-0002-4328-0375 604263 author Fonzo-Christe Caroline Cécile 501778 author Bonnabry Pascal 21883 Section des sciences pharmaceutiques (FARMA) 520-529 10.1007/s11096-010-9403-z 20556656 0928-1231 https://link.springer.com/article/10.1007/s11096-010-9403-z 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 2008 Guide, 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). Results: Thériaque 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). Conclusions: Thériaque 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. Decision Support Systems, Clinical / standards Drug Incompatibility Drug Information Services / organization & administration Drug Therapy, Combination Hospitals, University Humans Infusions, Intravenous Intensive Care Units, Neonatal Intensive Care Units, Pediatric Medication Errors / prevention & control Pharmacy Service, Hospital / organization & administration Switzerland Dewey 615 31 Section des sciences pharmaceutiques 17 false 887 Pharmacie hospitalière et clinique Pharmacy world & science 32 4 99ca7514-5b1a-40e2-b177-da41442198f0 Article (Published version) Restricted s11096-010-9403-z.pdf 192859 application/pdf 4d48a04b6cbb6378a3cf8690a74be7fc96347f21e841be8a0a58ed38393e57bf restrictedAccess Faculté des sciences / Section des sciences pharmaceutiques

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Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units	Pharmacy world & science			2010	62	0

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