Are patients with a nasally placed feeding tube at risk of potential drug-drug interactions? A multicentre cross-sectional study

Abstract

Aims The primary aims were to determine the rate of potential drug-drug interactions (pDDIs) in patients with nasally placed feeding tubes (NPFT) and the factors significantly associated with pDDIs. The secondary aim was to assess the change in pDDIs for patients between admission and discharge. Material and methods This multicentre study applied a cross-sectional design and was conducted in six Brazilian hospitals, from October 2016 to July 2018. Data from patients with NPFT were collected through electronic forms. All regular medications prescribed were recorded. Medications were classified according to the World Health Organization (WHO) Anatomical Therapeutic Chemical code. Drug-drug interaction screening software was used to screen patients’ medications for pDDIs. Negative binomial regression was used to account for the over dispersed nature of the pDDI count. Since the number of pDDIs was closely related to the number of prescribed medications, we modelled the rate of pDDIs with the count of pDDIs as the numerator and the number of prescribed medications as the denominator; six variables were considered for inclusion: time (admission or discharge), patient age, patient gender, age-adjusted Charlson Comorbidity Index (CCI) score, type of prescription (electronic or handwritten) and patient care complexity. To account for correlation within the two time points (admission and discharge) for each patient a generalised estimating equations approach was used to adjust the standard error estimates. To test the change in pDDI rate between admission and discharge a full model of six variables was fitted to generate an adjusted estimate. Results In this study, 327 patients were included. At least one pDDI was found in more than 91% of patients on admission and discharge and most of these pDDIs were classified as major severity. Three factors were significantly associated with the rate of pDDIs per medication: patient age, patient care complexity and prescription type (handwritten vs electronic). There was no evidence of a difference in pDDI rate between admission and discharge. Conclusion Patients with a NPFT are at high risk of pDDIs. Drug interaction screening tools and computerized clinical decision support systems could be effective risk mitigation strategies for this patient group.

Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior

“…Furthermore, it is worth noting that even with the strategies pointed out in this study, the necessity of combining drugs that may potentially interact is not uncommon, considering its risk-benefit for treating patients with complex conditions (Gimenes et al 2019).…”

“…Furthermore, it is worth noting that even with the strategies pointed out in this study, the necessity of combining drugs that may potentially interact is not uncommon, considering its risk-benefit for treating patients with complex conditions ( Gimenes et al., 2019 ). Therefore, individualized and rigorous evaluation of the risk-benefit of drug therapy is needed, especially for patients with previous suicide attempts with a greater potential of drug use as a suicide method attempt.…”

Impacto de um programa de melhoria da qualidade nos erros de preparo e administração de medicamentos orais via sonda nasoenteral: estudo de intervenção

“…O preparo e a administração corretas de medicamentos via sonda nasoenteral para pacientes adultos (tubo de alimentação inserido via nasal com a ponta distal posicionada no estômago ou intestino delgado)(LORD, 2018) apresenta um grande desafio, como: interação entre nutriente e medicamentos o que pode resultar em eventos adversos ao paciente (BOULLATA; BRANTLEY; CORKINS; GUENTER et al, 2009;BAYSARI;.…”