Potential intravenous drug incompatibilities in a pediatric unit

Abstract

Objective To investigate potential intravenous drug incompatibilities and related risk factors in a pediatric unit.Methods A cross-sectional analytical study conducted in the pediatric unit of a university hospital in Brazil. Data on prescriptions given to children aged 0-15 years from June to October 2014 were collected. Prescriptions that did not include intravenous drugs and prescriptions with incomplete dosage regimen or written in poor handwriting were excluded. Associations between variables and the risk of potential incompatibility were investigated using the Student’s t test and ANOVA; the level of significance was set at 5% (p<0.05). Relative risks were calculated for each drug involved in potential incompatibility with 95% confidence interval.Results A total of 222 children participated in the study; 132 (59.5%) children were male and 118 (53.2%) were aged between 0 and 2 years. The mean length of stay was 7.7±2.3 days. Dipyrone, penicillin G and ceftriaxona were the most commonly prescribed drugs. At least one potential incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio). Most incompatibilities detected fell into the non-tested (93.4%), precipitation (5.5%), turbidity (0.7%) or chemical decomposition (0.4%) categories. The number of drugs and prescription of diazepam, phenytoin, phenobarbital or metronidazole were risk factors for potential incompatibility.Conclusion Most pediatric prescriptions involved potential incompatibilities, with higher prevalence of non-tested incompatibilities. The number of drugs and prescription of diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities.

Types and frequency of errors in the preparation and administration of drugs

“…Because of the clinical conditions of patients at the emergency department, treatment with intravenous medications is common, and can result in numerous risks, due to complexity of intravenous pharmacotherapy, especially administration of the medication. ( 28 )…”

“…It is necessary that the multiprofessional team be attentive to this problem, primarily due to the lack of knowledge and the lack of training of the professionals. ( 28 )…”

Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach

“…As far as we know, only five papers have studied potential DI in hospitalized children, as the majority of potential DI papers in pediatrics are population-based studies. A retrospective study evaluated more than 16 thousand children between 2006 and 2015 [ 11 ], and the other works were cross-sectional surveys conducted in less than 1 year [ 15 , 16 ]. All the authors identified potential DI through the analysis of the medication orders, only Gikic and collaborators [ 7 ] evaluate in loco the occurrence of incompatibilities at the moment of infusion.…”

Nanomedicine: a new paradigm to overcome drug incompatibilities

“…Furthermore, they stated that the total number of drugs and prescriptions that contain diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities. [11] Marsilio et al conducted a study to identify physical and chemical incompatibilities among the IV drugs administered in adult ICU. The authors found that the drugs most commonly involved in incompatibilities were midazolam, hydrocortisone and vancomycin.…”

“…ICUs. [10,11,27] Patients in ICUs are considered as a high-risk group for the occurrence of physicochemical incompatibilities due to the coadministration of multiple IV medications via the same venous port. [6,27] The concomitant administration of incompatible drug solutions through the same line can lead to harmful outcomes and even death in some extreme cases.…”