Analysis of drug compatibility in Y in intravenous therapy: preparation of a preventive tool for a university hospital in Petrolina – PE

Objectives: To elaborate instruments for the analysis of the compatibility of intrave-nous medications, in order to assist in the conduct and routines of the assistance teams of the Federal University of the São Francisco’s Valley (HU-Univasf) Methods: Injectable drugs were initially selected, which belong to the HU-Univasf stand-ardization list. Information on the pH of medicines, compatibilities and incompatibili-ties, were extracted from the databases: Lexi-comp® Inc, Micromedex IV Compatibil-ity, Internet website Stabilis and King Guide to Parenteral Admixtures®. This work was carried out in two stages: (1) Creation of a tool to analyze the compatibility of injectable medications used in the hospital in a guide format; (2) Elaboration of the cross-table for quick consultation of the compatibility of the most prevalent medica-tions in the Intensive and Semi-Intensive Care Unit (UCISIN), in the parenteral dos-age form for intravenous administration (IV). Results: The Guide for analysis of Y compatibility in intravenous drug administration for a University Hospital in Petroli-na-Pe, was published with ISBN (International Standard Book Number): 978-85-92656-19-5 and it is available on the HU-Univas institutional website for free ac-cess. This material suited as the basis for the construction of the drug compatibility chart that contains the 50 most distributed items from the pharmacy to UCISIN. From this table, 1,225 pairs of drugs were obtained, of which 36% (N = 444) corresponded to compatible pairs and 20% (N = 241) to incompatible pairs. It should be noted that a higher value of pairs was observed with the indefinite compatibility 44% (N = 540), that is, without data in the consulted literature. Conclusions: It was possible to prepare the Guide for Analysis of Y Compatibility in Intravenous Medication Administra-tion and the HU-Univasf Y-Drug Incompatibility Cross-Table Graph, already availa-ble for the entire team. Therefore, it is expected that these instruments facilitate the access of the multiprofessional team to quality information, expanding the role of the pharmacist in the care of critical patients, improving patient safety in the use of intra-venous medications in the hospital.

Gravidade das incompatibilidades medicamentosas em pacientes críticos: Uma revisão integrativa

Objetivo: analisar as evidências científicas acerca dos eventos adversos provocados pelas incompatibilidades medicamentosas, com foco para a identificação de estratégias de prevenção. Método: trata-se de uma revisão integrativa de literatura, realizada nos diretórios da Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PubMed) e The Scientific Electronic Library Online (ScIELO) com os descritores “drug incompatibility”, “patient safety”, “critical care”, “infusions”, “intravenous” e “nursing care”. A busca resultou em em 09 estudos, publicados entre o período de 2014 a 2019. Resultados: dos artigos selecionados possibilitaram elaborar duas categorias: gravidade dos eventos adversos ocasionados pelas reações de incompatibilidade e estratégias de prevenção para evitar as incompatibilidades. Conclusão: os eventos adversos provocados pela incompatibilidade medicamentosas mais relatados foram a terapia ineficaz e a ocorrência de oclusão do cateter. As estratégias de prevenção mais citadas foram o uso de cateteres multilúmen a consulta ao farmacêutico clínico e o treinamento da equipe de enfermagem.

Medication Errors and Their Relationship with Care Complexity and Work Dynamics

BACKGROUND: Medication errors are currently known as the most common medical errors. Research shows that work environment and organisation management, in addition to the role of nurses, contribute to the occurrence of an error. AIM: Therefore, the present study was conducted to determine the rate of nurses’ medication errors and its relation to the care complexity and work dynamics in the Taleghani Pediatric Hospital of Gorgan in 2017. MATERIAL AND METHODS: This was a descriptive-correlational and cross-sectional study. Sampling was done through census method (N = 100). The data collection tools consisted of four questionnaires of demographic information, Salyer work dynamics, Medication Administration Errors, and Velasquez Nursing Care Complexity. Data were analysed in SPSS V.16 software using descriptive and inferential statistical methods including independent t-test and Pearson’s correlation. RESULTS: Medication calculation errors, wrong dose and wrong medication were the most common non-injectable medication errors, respectively. Drug incompatibility, wrong infusion rate and medication calculation errors were the most common injectable medication errors, respectively. There was a positive correlation between medication calculation errors (P = 0.02, r = 0.23), wrong solvent (P = 0.04, r = 0.21), and drug incompatibility (P = 0.01, r = 0.25) with amount of work dynamics. Also, there was a positive correlation between medication calculation errors (P = 0.03, r = 0.22) and wrong medication (P = 0.00, r = 0.31) with the nursing care complexity. CONCLUSION: Regarding the irrefutable impact of working conditions on the occurrence of errors, it appears that the study and complete recognition of nurses’ working conditions and their adjustment would lead to a reduction in medication errors.

Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics

ABSTRACTFrench guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of drug incompatibility under multidrug infusion conditions.