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THILO BERTSCHE, PH.D., is head pharmacist, Cooperation Unit Clinical Pharmacy, Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany. YVONNE MAYER is pharmacy student; REBEKKA STAHL, R.N., is head nurse, Intensive Care Unit, Department of Internal Medicine IV, Gastroenterology; TORSTEN HOPPE-TICHY, PH.D., is pharmaceutical director, Pharmacy Department; JENS ENCKE, M.D., is senior physician, Intensive Care Unit, Department of Internal Medicine IV, Gastroenterology; and WALTER EMIL HAEFELI, M.D., is medical director, Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg.

Address correspondence to Dr. Haefeli at the Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 40, 69120 Heidelberg, Germany (walter.emil.haefeli{at}med.uni-heidelberg.de).

Purpose. 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%. Conclusion. Administration of incompatible i.v. drugs in critically ill patients was frequent but significantly reduced by procedural interventions with SOPs. Index terms: Antiinfective agents; Drug administration; Errors, medication; Hospitals; Incompatibilities; Injections; Protocols; Stability

 

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				T. Bertsche, L. Munk, Y. Mayer, R. Stahl, T. Hoppe-Tichy, J. Encke, and W. E. Haefeli One-year follow-up on procedure to prevent i.v. drug incompatibilities in an intensive care unit Am. J. Health Syst. Pharm., July 15, 2009; 66(14): 1250 - 1253. [Full Text] [PDF]