Abstract: The aim of this study is to carry out performance qualifications of 2 processor-controlled dosing pumps for the production of mixed infusion solutions in a closed system.: Two dosing pumps have been qualified regarding their use: a processor-controlled dosing pump MediMix: The mean relative biases found with different products used for the qualifications of the two controllers were below the manufacturer’s specifications. When pumping operations were performed outside the manufacturer’s recommended ranges of volumes, relative bias remained below 10 %. Low relative bias (<3 %) and relative standard deviation (<1 %) were also found with routine controls (weight, osmolality, sodium concentration, potassium concentration) performed on test batches produced with the 12-pumps automated compounding device (ACD).: The single pump controller MediMix
AbstractParenteral nutrition (PN) in the neonatal intensive care unit (NICU) involves a succession of risky processes. The objective was to identify and prioritize the risks associated with PN in order to improve the quality of the pathway. A failure modes, effects, and criticality analysis (FMECA) was used to identify potential PN pathway failure modes. A multidisciplinary working group conducted a functional analysis of the processes, then listed the failure modes (FM). The FM criticality was assessed on a scale from 1 to 5 for occurrence (O), severity (S), and detection (D). The risk priority number (RPN), ranging from 1 to 125, was calculated. The FMECA identified 99 FM (prescription (n=28), preparation (n=48), and administration (n=23)). The median RPN was 12, with scores ranging from 3 to 48. 25 % of the scores had an RPN>21.75.Among them, 12 were associated with prescription FM, 5 were associated with FM related to preparation and 8 were associated with a FM linked to administration. It allowed us to prioritize areas of potential quality improvement for parenteral nutrition of the preterm infant. The results demonstrated the need for the presence of a clinical pharmacist in the NICU to ensure the quality of PN process.
Summary
What is known and objective
Behavioural disorders are difficult to manage in elderly demented patients because of the lack of appropriate drugs or difficulties surrounding the route of administration. The tolerability of Midazolam is well described in the emergency management of agitation for young patients, when administered intramuscularly or intravenously. However, very little data are available on the use of oral Midazolam for this indication and in the elderly population.
Methods
A literature review was conducted, and studies were included if involving adults, receiving Midazolam, alone or in combination, whatever the route, dosage or indication and if they reported adverse events related to the use of Midazolam.
Results and Discussion
Forty‐one articles were included. Eleven different adverse events were identified from the studies. Hypotension and desaturation were the two most frequent adverse events reported. Adverse reactions appear to be more common in older patients but also when Midazolam was used in combination with other drugs. The frequency of these adverse effects was lower than those reported for neuroleptic drugs.
What is new and conclusion
The oral route appears to be appropriate to provide a rapid and well‐tolerated response. Further studies will be needed to confirm the good tolerance of oral Midazolam in the management of acute agitation in elderly demented patients.
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