Desmopressin prescription safety in adult inpatients: a real-world tertiary centre experience.

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Omissions or delays in desmopressin can result in serious patient harm in patients with Arginine-Vasopressin Deficiency (AVP-D), formally known as Cranial Diabetes Insipidus (CDI). Desmopressin administration practice in hospitals has not been thoroughly investigated previously. This study evaluated desmopressin prescription and administration practice at a large tertiary centre. A retrospective electronic case notes review of all admissions (≥24 hours) with AVP-D between 2018-2021 at Sheffield Teaching Hospitals was undertaken. The outcomes were defined as: total number of missed and delayed doses, time to prescription and administration from admission, and incidence of dysnatraemias. A qualitative survey to determine knowledge of AVP-D and desmopressin among staff members was also carried out. Total 102 admissions were identified, of which 38% of admissions were via emergency department (ED). The total number of missed and delayed doses were 132/1315 (10.0%) and 139/1283 (10.9%), respectively. 33% of admissions had ≥1 missed doses while ≥1 doses were delayed in 54% admissions. ED rates of desmopressin prescription were low at 5%. The most common reasons documented for missed or delayed doses were unavailability of desmopressin followed by inability of patient to take the medication. Median [IQR] prescription and administration times from admission were 5.6 [2.7-10.7] and 15.1 [8.7-27.0] hours, respectively. The incidence of inpatient hypernatraemia and hyponatraemia was 7.6% and 30.4%, respectively. The staff survey showed below-average knowledge of the condition, advocating for an urgent need for education.