Prevention of intravenous drug incompatibilities in an intensive care unit.
OBJECTIVE
The frequency of drug administration errors and incompatibilities between intravenous drugs before and after an intervention in an intensive care unit (ICU) is discussed.


METHODS
Critically ill adult patients with intoxications, multiorgan failure, and serious infections were included in a retrospective analysis and in a prospective two-period, one-sequence study. In the retrospective analysis, the most frequent brands of i.v. medications used in the ICU of a gastroenterologic department in a teaching hospital were identified. All possible combinations and resulting incompatibilities were defined. Based on the results, a standard operating procedure (SOP) was established to prevent frequent and well-documented incompatibilities among i.v. medications. In the prospective study, trained pharmacy students assessed incompatible coinfusions before and after SOP implementation.


RESULTS
In the retrospective analysis of 100 patients, 3617 brands of drug pairs were potentially given concurrently through one i.v. line and 7.2% of the drug pairs were incompatible. Antibiotics, such as piperacillin-tazobactam and imipenem-cilastatin, were the most frequent incompatible drug pairs. The newly developed SOP mandated that administration of these drugs be separated from all other drugs and suggested the use of an idle i.v. line for infusion whenever possible. In the prospective study of 50 patients, the frequency of incompatible drug pairs was reduced by the time of intervention from 5.8% to 2.4%. Incompatible drug pairs that were governed by the new SOP were reduced from 1.9% to 0.5%.


CONCLUSIONS
Administration of incompatible i.v. drugs in critically ill patients was frequent but significantly reduced by procedural interventions with SOPs.
Bertsche
Thilo
T
Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
Mayer
Yvonne
Y
Stahl
Rebekka
R
Hoppe-Tichy
Torsten
T
Encke
Jens
J
Haefeli
Walter Emil
WE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002985:Clinical Protocols; D016638:Critical Illness; D004344:Drug Incompatibility; D005858:Germany; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008508:Medication Errors / Q000517:prevention & control; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents