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DD-005 COBUS clinical audit: a vehicle to improve prescribing of albumin
  1. F Caruso,
  2. V Cascone,
  3. S Meli,
  4. G Rizza
  1. ASP of Ragusa, Hospital Pharmacy, Ragusa, Italy

Abstract

Background The analysis of consumption data monitoring in 2012, in Civil-MPA hospital ASP 7 Ragusa, showed a high consumption of albumin, a physiological plasma expander with a limited availability and high cost. A clinical audit by COBUS (Good Use of Blood in Hospital Commission) was arranged to disclose any corrective actions needed for proper albumin use.

Purpose To define the effectiveness of corrective actions taken following the COBUS clinical audit, one year after the review, by analysing consumption and appropriate prescribing.

Materials and methods Individual application forms were reviewed to check prescribing practice and encourage the appropriate use of albumin. The review extended to the integration of missing fields (laboratory reports, amount of albumin requested, number of vials/day, days of treatment, doctor and pharmacist notes for off-label prescriptions), and prescriptions were checked carefully before dispensing. Consumption and appropriateness of prescribed albumin were compared to evaluate the efficiency of corrective actions taken during a three-month period of 2012 and 2013.

Results In 2012, in three months, 79 requests for albumin were received in the pharmacy, 45 (57%) on-label and 34 (43%) off-label by COBUS criteria, for a total of 823 vials dispensed. Orthopaedics (100%), obstetrics-gynaecology (100%) and intensive care (92.3%) were responsible for the greatest off-label prescribing. As result of corrective actions taken, in 2013 a smaller number of requests was received (47 requests, 34 (72%) on-label and 13 (27%) off-label) and fewer vials (162 vials) were dispensed, a decrease of 80.3%. Orthopaedics (100%) and obstetrics-gynaecology (100%) were still using the greatest proportion of off-label albumin (use in unauthorised conditions or with albumin level beyond the limits).

Conclusions The data obtained show the effectiveness of the corrective actions taken, confirming lower consumption and a more appropriate use of albumin. The monitoring effected before dispensing allowed vials needed for daily treatment to be dispensed correctly, limiting waste and possibility of therapeutic errors. In addition, an improvement was found in the appropriateness of the albumin prescribed in the intensive care unit. Given the peculiarities of treatment it is essential to monitor use rigorously to control the off-label prescribing that still results in high use in some wards.

No conflict of interest.

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