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Abstract
Intravenous admixtures are the preparations consisting of sterile drug products added to an IV fluid (s) for medication purposes. Especial concerns are required for such drugs since the reversal of toxicity and/or unwanted effects following incompatibilities are cumbersome to deal with. Concern drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures. The ultimate goal of this assessment was to figure out the actual practices on the ground in IV medications administered in NRH with IV fluids emphasizing on incidence and prevalence of incompatibility between drugs themselves or with IV fluids. This study was a cross-sectional prospective observational study which investigated the potential incompatibilities associated with IV admixture, & the incidence of IV drug administration errors using available evidence-based medicine sources at Nekemte Referral Hospital in West Ethiopia. The data was collected from patient medication Charts and prescription papers for patients treated within a period of 2 months. The study period was from February 2017 to April 2017 at the medical and pediatrics wards of NRH. About patients using IV admixtures were followed within this study period. The prevalence of identified incompatibility among IV admixtures ingredients was 28.94%. The identified compatibility was only 25.43%, while 38.59%were undocumented combinations, and 7.01% were variable. The most commonly encountered incompatible drug-solute combinations were Ringer lactate (61.8%), Insulin + DNS (29.4) and Ceftriaxone + Phenytoin + 0.9% NaCl (8.8%). Also, the incompatible drug-drug combinations detected in this study were Ceftriaxone+ heparin and clopidgrel+cimetidine combinations. Based on the findings of this study, the following can be concluded; there is a high prevalence of incompatibilities among IV admixtures. The types of incompatibilities were both drug-solute and drug-drug incompatibilities. Prescribers and administrators of IV admixtures were recommended to check plausibility before administration to prevent such incompatibilities which can compromise the treatment outcome of patients.
Highlights
An Intravenous NRH (IV) admixture is a preparation of a pharmaceutical mixture of two or more drugs into a large bag or bottle of IV fluids mainly Normal Saline Solution (0.9% Sodium Chloride DNS (NaCl)) or Dextrose (5%) alone or in combination under the direction of a doctor monitored by nurses and controlled by trained pharmacists
The types of incompatibilities associated with intravenous administration are physical (Phase separation and precipitation due to a change of the relation between ionization and non-ionization, and solubility) and chemical [1]
Balisa Mosisa et al.: Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia with inappropriate IV solutions; drug-drug incompatibilities when they are mixed together
Summary
An IV admixture is a preparation of a pharmaceutical mixture of two or more drugs into a large bag or bottle of IV fluids mainly Normal Saline Solution (0.9% NaCl) or Dextrose (5%) alone or in combination under the direction of a doctor monitored by nurses and controlled by trained pharmacists This is to be sure that no one is accidentally overdosed, or given the wrong medications [1]. A Physical incompatibility (PI) occurs when a drug combination produces a visible change in the appearance of a solution [3]. PIs are observed more and can be detected by changes in the appearance of admixtures such as a change in color, the formation of a precipitate, or the evolution of gas This renders the solution unsafe for administration [5]. Drug-drug interactions occur in the body when one drug disrupts the absorption, metabolism, action, or excretion of the other drug or when the pharmacologic effects of one drug increase or decrease the pharmacologic effects of the other drug
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