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General and Risk Management, Patient Safety (including: medication errors, quality control)
Drugs administration in patients who receive enteral nutrition: analysis of pharmaceutical interventions
  1. F. Apolo Carvajal,
  2. M. Fernández Arévalo,
  3. M. Valera Rubio,
  4. C. Bustos Morell,
  5. J. Mateos Rubio,
  6. P. Moya Gómez
  1. 1Hospital Virgen de la Salud, Pharmacy, Toledo, Spain

Abstract

Background The concomitant use of enteral nutrition (EN) and medicines through enteral feeding tube (EFT) can cause drug administration errors and adverse drugs events.

Purpose The aim of this study is to describe pharmaceutical interventions (PI) performed in patients who receive EN to prevent and solve drug-related problems.

Materials and methods One month prospective study, conducted in patients admitted to clinical wards with single-dose distribution system, who started receiving EN. The authors daily reviewed all prescription orders and recorded prescribing service, access device (checked in patient medical record), time of treatment with EN, and prescribed drugs. PIs were classified into drug-EN incompatibilities and proper drug administration through EFT. PIs were notified in writing to physicians and nursing staff. The authors noted if PIs were accepted by the prescribers.

Results 30 patients were included. EN was administered through nasogastric tube to 12 patients and through gastrostomy to one patient. Average EN treatment length was 6 days and average concomitant medication was 10. The authors carried out 81 PIs and 61 of them (75%) were conducted in patients who had an EFT. These PIs involved 80% of patients.

The authors accomplished:

  • 32 PIs (39,5%) to correct the EN route of administration and medication, because it was unmentioned or incorrect on prescription order.

  • 11 PIs (13,6%) to avoid incompatible drugs with administration through EFT.

  • 38 PIs (46,9%) conducted to avoid EN-drug incompatibilities.

The authors observed that clinicians accepted 74 PIs (91, 3%).

Conclusions Drug-related problems can be identified in a high percentage of patients receiving EN. The development of a pharmaceutical care plan can solve these problems and optimises quality of patient care. Most of PIs were conducted in patients who had an EFT. Drawing up a drug administration guideline and indepth healthcare team education are needed. Real and potential administration errors of medication through EFT can be identified and reduced by means of pharmacist's review of medication charts.

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