Background Parenteral drug compounding and its administration carries potential risks for patients. Safe handling procedures avoid healthcare workers’ exposure to hazardous drugs. Compounding preparations in a Centralised IntraVenous Additive Service (CIVAS) could minimise both risks.1
Purpose We conducted this study to assess patients and healthcare workers risk reduction by centralising parenteral preparations in a CIVAS compared to clinical areas (CA).
Material and methods Observational retrospective study in a 460-bed hospital. Inpatient parenteral preparations for CA (except Critical Care, Emergency Room and Neonatal Unit) and outpatient preparations were included from January 2017 to December 2017.
For each preparation was recorded: compounding area (CIVAS/CA); number and type of preparation (fluid (F), parenteral nutrition (PN) or parenteral drug (PD)); type of admixture (standardised/individualised); risk level for patients (high/medium/low);2 and hazardous level for healthcare workers (hazardous/non-hazardous).3
Results Overall, 3 22 693 preparations (F (19.8%), PN (1.6%) and PD (78.6%)) were compounded: 64.2% standardised, 26.9% medium-high risk preparations and 5.1% hazardous preparations. CIVAS coverage was 77.0% (248,254) (F (97.3%), PN (100.0%) and PD (71.3%)). CIVAS prepared 69.1% of total standardised preparations and 91.0% of individualised admixtures.
According to risk for patients, 89.6% (78,051) of medium-high risk preparations were centralised. Preparations that were not prepared in CIVAS corresponded to antibiotics, anti-epileptics, analgesics, proton-pump inhibitors and corticosteroids.
According to risk for operators, 75.7% (231,829) of non-hazardous drugs and 99.9% (16,425) of hazardous drugs were prepared in CIVAS, avoiding exposure risk for healthcare workers. Valproic acid was the only hazardous drug prepared in CA.
Conclusion Compounding in a CIVAS provides coverage of 77% parenteral preparations. Higher patient risk reduction and staff protection standards are provided by avoiding elaboration of 89.6% of medium-high risk preparations and 99.9% of parenteral hazardous drugs in clinical areas.
References and/or acknowledgements 1. Resolution CM/Res (2016) on good reconstitution practices in health care establishments for medicinal products for parenteral use. Available from: https://www.edqm.eu/sites/default/files/resolution_cm_res_2016_2_good_reconstitution_practices_in_health_care_establishments_for_medicinal_products_for_parenteral_use_.pdf [Date accessed:October 15th 2018]
2. Guía de buenas prácticas de preparación de medicamentos en servicios de farmacia hospitalaria. Ministerio de Sanidad, Servicios Sociales e Igualdad. June 2014.
3. Connor TH, et al. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication Number 2016–161.
No conflict of interest.
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