Evaluation of the importance of mixing during preparation of antibiotic infusions

Abstract

Background The mixing step after medication addition to the infusion bag is frequently omitted during the preparation of drug infusions. However, the importance of mixing when preparing antibiotic infusions is still unknown. Methods The primary aim of this study was to assess the importance of the mixing step by comparing the concentrations of unmixed antibiotic infusions (cefuroxime, flucloxacillin, meropenem, and vancomycin) with the declared concentration at regular intervals during infusion. The secondary aim was to compare concentrations between preparation sites (hospital pharmacy versus clinical ward). Infusion bags were run through electronic infusion pumps. For cefuroxime, flucloxacillin, and meropenem, samples were collected 1, 15, and 20 min after starting the administration (infusion duration: 30 min). For vancomycin, samples were collected after 1, 60, and 110 min (infusion duration: 120 min). Vancomycin concentrations were measured using the Architect c4000 analyser and other concentrations using a validated UPC2-MS–MS multimethod. Results The median concentrations of the four antibiotics were comparable to the declared concentration at all three time points. No significant differences were found between preparation sites. Conclusions Spontaneous mixing occurred in the examined antibiotic solutions during normal handling.

Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study

“…This error type was excluded because it was considered irrelevant because spontaneous mixing occurs during normal handling, especially with antibiotic admixtures (82% of the included admixtures). 23 , 24 …”

“…The error type incomplete mixing (i.e., container inverted less than 3 times or not shaken) occurred in the vast majority of admixture preparations (n = 1334; 82.0%). This error type was excluded because it was considered irrelevant because spontaneous mixing occurs during normal handling, especially with antibiotic admixtures (82% of the included admixtures) 23,24 …”

“…This error type was excluded because it was considered irrelevant because spontaneous mixing occurs during normal handling, especially with antibiotic admixtures (82% of the included admixtures). 23,24 The potential severity of IAPEs was classified according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index, 25 which ranges from category A (circumstances or events that have the capacity to cause error) to I (an error occurred that may have contributed to or resulted in the patient's death).…”

Correction to: Evaluation of the importance of mixing during preparation of antibiotic infusions

“…Following publication of the original article [ 1 ], the authors identified an error in the authors’ list.…”