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

Abstract

BackgroundThere is little information on the frequency of drug incompatibilities in neonatal intensive care units (NICU) and the agents most commonly involved in them. The objective of the study was to characterize potential Drug Incompatibilities (DI) in the NICU by frequency, type and combination of drugs.MethodsBetween August 2015 and December 2016, all neonates admitted for more than 24 h and who received any drug treatment were included in this cohort study conducted in the NICU of a teaching maternity hospital in Brazil. Patient data were collected from patient records and prescription orders, and the compatibilities of all drug pairs were classified using the Trissel’s™ 2 IV Compatibility tool. Network analysis was performed in order to visualize the drug pairs commonly involved in potential DI.ResultsThe study population consisted of 281 neonates with a median NICU length of stay of 11 days (range 2–184) and received 1343 intravenous medications. A total of 1114 potential DI were identified, 469 (42.1%) were restricted compatibilities, 348 (31.2%) unknown compatibilities and 297 (26.7%) documented incompatibilities. The incidence of documented incompatibilities in the NICU was 25.0% patient-days (95% confidence interval (CI) 19.4–30.7% patient-days). Incompatible potential DI affected 46.3% (95%CI 40.3–52.3%) of the neonates. Ampicillin (408 of 1114 pairs), gentamicin (216 of 1114 pairs) and aminophylline (197 of 1114 pairs) were the main medicines involved in potential DI.ConclusionPotential DI are extremely common in NICU, with half of the population susceptible to simultaneous administration of incompatible medications. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.

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“…The particulate contaminants can be detectable particles that are visible on visual inspection with sizes ≥50 µm or sub-visible particles that are not detectable on visual inspection with sizes varying between 2 and 50 µm 36 . Both visible and sub-visible particulate contaminations in parenteral fluids or solutions are dangerous [36][37][38][39][40] as these fluids are meant to pass through the blood vessels. The present study showed that the drug products are free from both visible and sub-visible particulate contaminations and their use cannot lead to the deleterious effects of particulate contamination.…”

European Databases on Stability and Compatibility of Injectable Medicinal Products in Europe

“…Risk minimization in coadministration of injectable drugs remains important because polymedication is common practice in various patient groups like cancer patients, transplant patients and intensive care patients (neonatal, paediatric, adult). In recent reports, rates of compatibility varied from 9 to 42 % and of incompatibilities from 15 to 68 % [20][21][22][23][24]. Hospital pharmacists should not only answer questions regarding drug-drug compatibilities, but develop together with physicians and nurses incompatibility-reducing infusion schemes to be used in vulnerable patient groups.…”

Nanomedicine: a new paradigm to overcome drug incompatibilities

“…Moreover, the authors reported that ampicillin, gentamicin and aminophylline were the main drugs involved in the drug incompatibilities. [10] Leal et al conducted a cross-sectional analytical study to investigate potential IV drug incompatibilities and related risk factors in a paediatric unit. The authors found that at least one potential drug incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio).…”

“…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.…”