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General and Risk Management, Patient Safety (including: medication errors, quality control)
Implementation of a centralised intravenous additive service with limited personnel resources
  1. K. Nemec,
  2. I. Breitschopf,
  3. R. Lemmens-Gruber
  1. 1Donauspital, Hospital pharmacy, Vienna, Austria
  2. 2University of Vienna, Department of Pharmacology and Toxicology, Vienna, Austria

Abstract

Background In many countries the centralised preparation of intravenous medicines is a service provided by hospital pharmacists. Besides cytostatics and parenteral nutrition, the pharmacy in the Donauspital currently prepares about 20 intravenous formulations per day, mostly weight-calculated antibiotics for neonates.

Purpose As the service shall be extended, the need for it and the number of potential preparations have to be assessed.

Materials and methods Over three months all intravenous medicines that were prepared in 50 ml syringes by nurses on three intensive care units (anaesthesiology, medical, paediatric ICU) were recorded. The assessment on the neonatal ICU was stopped since medicines there are not standardised. All intravenous medicines were checked for the right solvent and a literature search was performed on the stability of the drugs in plastic syringes. Nurses were asked if they would appreciate such a service.

Results Nearly 15,000 intravenous preparations were recorded. The most commonly used drugs were midazolam, morphine, clonidine, norepinephrine, heparin and insulin. The prospect of these preparations being provided by the pharmacy was welcomed by the ICU staff, but these numbers would result in 250 syringes being prepared per day (working Monday to Friday), which is not realistic because the staff of the INTRAVENOUS service will probably consist of only one pharmacist working a maximum of 4 h daily. To cut down the number of preparations a risk analysis was made. According to the literature most intravenous medication errors on wards occur with drugs being diluted. If these solutions only were provided by the pharmacy (55% of the recorded preparations), there would be 140 preparations per day. Literature research showed that solutions of these drugs are stable for a least a couple of days, so syringes could be prefilled and stored.

Conclusions Due to the lack of staff it might be possible to implement CIVAS by preparing high-risk intravenous ICU drugs only. Pharmaco-economic considerations will follow.

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