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

Abstract

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.

Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients

“…Double-entry tables, or lists of drugs commonly used, can be drawn up [62]. Although a number of publications and databases deal with the subject [63][64][65], discrepancies exist among available references, data is often non-existent or incomplete, and usually describe only one mixture. In-line filters can also be an effective solution for blocking particles generated by a drug-drug incompatibility and potentially administered to the patients, especially in neonatal and paediatric care.…”

Computerized decision support in adult and pediatric critical care

“…Ventilator fraction of inspired oxygen [41] Pressure support ventilation [42] Antibiotic recommendation [43,44] Blood glucose control [46][47][48] Sepsis [21] Heparin dosing after myocardial infarction [45] Research Mortality prediction [29] Prediction of fluid requirement [53] Predictive alerts for hemodynamic instability [49][50][51] Ventilator settings [76] Prediction of dialysis need [52] Insulin e-protocol [54,85] Pediatric and neonatal critical care Diagnostic ISABEL (www.isabelhealthcare.com) [59,86] SimulConsult (www.simulconsult.com) [87] MEDITEL pediatric diagnostic system [58] Outcome prediction and severity of illness [55][56][57] Alert and Reminder Drug interaction [62] Prescription errors and adverse drug events [18,61] Parenteral nutrition orders [61] NICU pulse oximeter [60] Protocol/Procedure Blood transfusions [63] Medications [61] Parenteral nutrition [64] Management Oxygen in ventilated newborns [68] Antibiotic recommendation [44,65] Blood glucose control [69] Medication information databases [88] Medication dosing calculators [61] Ventilator management in neonates [66,67] Research Virtual PICU (www.pi...…”

“…PRISM models and score for acute neonatal physiology (SNAP) models are validated tools for mortality risk prediction in pediatric and neonatal patients [55,56] . CDS alerts improve patient safety and are used to warn of drug interactions and adverse events and to improve the specificity of monitor alarms [18,[60][61][62] . Kadmon et al [18] found alert CDS tools integrated with CPOE significantly decreased dosing order errors and potential adverse events in a pediatric ICU.…”

Drug incompatibility

“…Neke od široko prepoznatih referenci su: Triselov Priručnik za injekcione lekove, "Thériaque" "King Guide to Parenteral Admixtures", "Trissel's™ 2 Clinical Pharmaceutics Database", "Micromedex IV INDEX System", "Clinical Pharmacology, Elsevier / Gold Standard", "CompoundingToday.com", "Facts and Comparisons", "Stabilis", "Neofax", "Australian Injectable Drugs Handbook" i drugi. 15,35,36 Disiminacija informacija iz ovih i drugih sličih izvora se vrši kako u klasičnoj, monografskoj formi, tako i na raznovrsnim informatičkim i telekomunikacionim platformama čineći ih relativno lako dostupnim najširem krugu zainteresovanih.…”

“…Takodje, postoje i značajne razlike u pogledu tačnosti prezentovanih podataka kao i njihove primenljivosti u svakodnevnoj praksi. 36 Bez obzira na ove nedostatke, lekar i drugi zdravstveni radnik koji propisuje i upotrebljava parenteralne lekove svakako je obavezan da konsultuje ove ili njima slične relevantne izvore. Integrisanje svih znanja je neophodno u procesu unapredjenju kvaliteta lečenja, a unutar njega, individualizacije terapije vulnerabilnih populacija bolesnika.…”