title: Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units.
abstract: OBJECTIVE
  Intravenous drug administration in neonatal (NICU) and paediatric intensive care units (PICU) is critical because of poor venous access, polymedication, fluid restriction and low infusion rate. Risk is further increased by inadequate information on the physicochemical compatibility of drugs. Eight decision-supporting tools were hence evaluated to improve the detection of drug incompatibilities in paediatric wards.
  
  
  METHODS
  NICU and PICU, University hospital.
  
  
  METHODS
  Eight tools (Thériaque 2007, Stabilis 3, Perfysi 2 databases; KIK 3.0 software; Neofax 2007 handbook; King 2008 Guide, CHUV 9.0, pH 2007 cross-tables) were assessed by two pharmacists using 40 drug pairs (20 incompatible; 20 compatible) frequently prescribed in PICUs and NICUs. Trissel's 14th Ed. handbook served as the gold standard. Four criteria were evaluated (each with a maximum of 250 points): accuracy (sensitivity, specificity, positive and negative predictive values), completeness (number of drug pairs documented), comprehensiveness (presence of 16 different items), and applicability (by combining the time needed by 7 pharmacists to classify 5 drug pairs, plus an evaluation of their design, usefulness, reliability and ergonomics, using visual analogy scales). The percentage of non-compliant answers (NCA) was calculated for both the performing pharmacists and the tools.
  
  
  METHODS
  Global score of drug incompatibilities (accuracy + completeness + comprehensiveness + applicability).
  
  
  RESULTS
  Thériaque obtained the best global score (840/1000 points), followed by pH (807), CHUV (803), Perfysi (776), Neofax (678), King Guide (642), Stabilis (584) and KIK (523), respectively. The highest scores were reached by Thériaque for accuracy (234/250); Thériaque and pH for completeness (200/250); Thériaque and Perfysi for comprehensiveness (218/250); and pH for applicability (298/250). The range of pharmacists' NCAs was between 9% (4/45 NCAs) and 33% (15/45), whereas that for drug pairs was between 10% (6/63) and 30% (19/63). The range of NCAs for tools was between 6% (2/35, pH) and 49% (18/35, Perfysi).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hospital Pharmacy, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Isabella
authors.initials: I
authors.lastname: De Giorgi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guignard
authors.forename: Caroline
authors.initials: C
authors.lastname: Fonzo-Christe
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards*; D004344:Drug Incompatibility; D004346:Drug Information Services / Q000458:organization & administration*; D004359:Drug Therapy, Combination; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007363:Intensive Care Units, Neonatal; D015278:Intensive Care Units, Pediatric; D008508:Medication Errors / Q000517:prevention & control; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D013557:Switzerland