Administration Of Injectable Drugs Research Articles

Nicolau syndrome with pemphigus vulgaris: a rare case report and review of literature

BackgroundNicolau syndrome is a rare adverse drug reaction clinically presented with painful erythema and tissue necrosis often accompanied by intramuscular injections of NSAIDS (diclofenac), penicillin, corticosteroids and local anesthetics.Case presentationThis case report describes a 29-year-old male patient who was repeatedly hospitalized for the treatment of recalcitrant pemphigus vulgaris. When the patient visited for the fourth time to our hospital, he complained of unusual sharp pain over the right gluteal region ever since the administration of diclofenac 75 mg intramuscular injection for persistent back pain during his previous stay. On physical examination, the right gluteal region showed a globular swelling with erythema and pus filled necrosed tissue. The CT scan did not show any presence of hematoma, ruling out any possibility of compartment syndrome. Based on this clinical evidence he was diagnosed with Nicolau Syndrome secondary to diclofenac injection. The tissue injury necessitated surgical debridement and after a span of 2 months, it healed leaving a permanent scar. In addition, this case report highlights the treatment of recalcitrant pemphigus vulgaris with rituximab therapy.ConclusionClinical pharmacist plays a vital role in educating healthcare professionals about following right protocol for administration of injectable drugs, early detection and management of the ADR. Similarly, patient receiving injections should be educated about warning signs and symptoms of such adverse drug reaction.

Recent updates on transdermal drug delivery approaches for the management of gout and its clinical perspective.

Oral and injectable drug administration have recently been replaced with transdermal drug delivery (TDD) approaches, which are less intrusive, less likely to be rejected by patients, and easier to administer. There is still room for improvement in the treatment of gout with the use of a TDD system. Gout has become a worldwide epidemic and a severe threat to human beings. Gout treatment can be accomplished in various ways, including orally and intravenously. Several traditional options are still useless, cumbersome, and potentially dangerous. Hence, gout therapeutic options are desperately required for more effective and less toxic drug delivery methods. Anti-gout medications using TDD could substantially influence obese people in the future, even if most trials are still in the animal stages. Thus, this review aimed to provide a concise overview of recent TDD technologies and anti-gout medication delivery methods that improved therapeutic efficacy and bioavailability. Moreover, clinical updates on investigational drugs have been discussed to address the potential findings against gout.

Y-site compatibility of intravenous medications commonly used in intensive care units: laboratory tests on 75 mixtures involving nine main drugs

Abstract Objectives Patients hospitalized in intensive care units often require multiple drug infusions. Due to limited intravenous accesses, concomitant administration of drugs in the same infusion line is often necessary. Compatibility studies of Y-site administration are available in the literature, but data of several combinations are lacking. Previous work from d’Huart et al. have performed an observation of the administration of injectable drugs in three adults ICUs and identified a list of Y-site administration without compatibility data. The objective of this study was to test the physical compatibility of the main drugs of this list used in pairs in Y-site infusions in critical care units, in order to provide new compatibility data to the literature, and to secure the administration of intravenous drugs. Methods The physical compatibility in Y-site of nine drugs with other drugs commonly used in intensive care units has been tested. Examinations were performed on 75 mixtures after their preparation, after 1 and 4-h storage. This evaluation included a visual examination with a search for precipitation formation, color change, gas formation, and a subvisual evaluation: absorbance measurements by UV-visible spectrophotometry at 350, 410 and 550 nm, and Light Obscuration Particle Count Test. The pH evaluation was performed at each time of analysis. Results Laboratory tests led to an overall compatibility of 68.0% for all mixtures obtained in this study. Nefopam was found to be quite compatible with other drugs (95.0%). Amiodarone hydrochloride (84.6%), acetylsalicylic acid (80.0%), clonidine hydrochloride (75.0%) and insulin (71.4%) were compatible with other drugs too. Atenolol (42.9%), furosemide (25.0%), heparin sodium (25.0%) showed less compatible results. Pantoprazole sodium (0.0%) was not at all compatible with the other drugs analyzed. Conclusions By the results of these laboratory tests, missing compatibility data are now available, providing additional information to the literature.

Safety in the administration of injectable medications: Scoping review

Objective: to raise scientific evidence on technologies for the safe administration of injectable drugs in hospitalized adult patients. Method: this is a study of the Scoping Review type, using the crossing of the descriptors Patient Safety, Medication Errors and Technology in the following databases: Medical Literature Analysis and Retrieval System Online Electronic Library Online, Science Direct, Virtual Health Library, Pubmed, Web of Science and Scopus. The choice of studies included in the sample and data extraction occurred in a paired manner by independent researchers. Results: 14 studies were classified as eligible. The interventions found were medication administration using a barcode, patient identification by plates, bracelets, radiofrequency and/or biometrics, personal digital assistants, mobile nursing carts, electronic medication administration record, safety syringe system based on key-lock adapters, smart infusion pumps, drugs organizer kits, storage bag, trays with dividers, adhesive in different colors for separating medicines by class, and double checking. Final considerations: The implementation of technologies, professionalism, changes in the organization and in the workplace linked to the empowerment of the patient and family/companion enables the quality of the injectable medication administration processes. It is considered an advantageous investment in technologies for the culture of safety.

Pharmaceutical Service for Multiple Sclerosis Carriers in Brazil: A State Model

The Specialized Component of Pharmaceutical Care is the Brazilian Unified Health System strategy that aims to ensure comprehensive drug treatment at an outpatient level and improve access to high complexity, high cost treatments, such as multiple sclerosis. Given the diversity of treatments available and the differences in financing and dispensing in different countries, the objective of this study was to present the workings of the model of care for patients with multiple sclerosis through the public health system in Brazil in the state of Mato Grosso do Sul. In Campo Grande, the registration and dispensation of drugs for the treatment of multiple sclerosis is the responsibility of the Pharmacy School Professor Ana Maria Cervantes Baraza of the Federal University of Mato Grosso do Sul. In this center, all patients receive pharmaceutical advice on the administration of injectable drugs and oral medications; the storage, preservation, and transportation of refrigerated drugs; and information on the disease and management of adverse reactions. Clinical pharmacy services are also available to patients in a pharmaceutical office, ensuring patient privacy and comfort and enabling the creation of a bond with the pharmacist. The model of care provided by the Pharmacy School allows for the development of pharmaceutical services, encourages the rational use of medicines, and emphasizes the importance of self-care, adherence to therapy, and the co-responsibility of patients and their families.

Cardiac, Energy and Hormonal Blood Markers, and Lactatemia in Cows with Displaced Abomasum

Background: Displaced abomasum (DA) is a common and economically important disorder that affects dairy cattle. Nutritional factors and adaptive responses that occur in the peripartum play a central role in the pathogenesis. The measurement of blood metabolites represents a useful tool for monitoring and prognostic determination in affected animals. Therefore, the objective was to evaluate cardiac, energy and hormonal blood markers, lactatemia, and insulin sensitivity in cows diagnosed with right displaced abomasum (RDA) and left displaced abomasum (LDA), comparing them with each other.Materials, Methods & Results: Nineteen cases of abomasum displacement in cows were studied, including 9 cases of RDA and 10 cases of LDA. The diagnosis was established by means of physical examination and measurement of the concentration of chlorides in the ruminal fluid (> 30mEq/L). After diagnosis, clinical-surgical therapeutic management was instituted. At the time of diagnosis (M1) and at the resolution of the case (M2), blood samples were collected to assess the variables: non-esterified fatty acids (NEFA), beta hydroxybutyrate (βHB), L-lactate, creatine kinase (CK), creatine kinase MB (CK-MB), cardiac troponin I (cTnI), lactate dehydrogenase (LDH), glucose, insulin, and cortisol. In addition, insulin sensitivity was estimated using the Revised Quantitative Insulin Sensitivity Check Index (RQUICKI) and RQUICKI-βHB. The means of the variables were compared, separating the effects of groups (RDA and LDA) and moments (M1 and M2), at the level of 5% probability. The concentrations of NEFA, CK-MB, L-lactate, glucose, insulin, and cortisol were higher at M1 and the RQUICKI and RQUICKI-βHB indices were lower at this moment. L-lactate, CK, and CK-MB were higher in the RDA group, while cTnI, βHB, and LDH did not present a group or moment effect. Cardiac markers correlated with the energy profile metabolites, L-lactate, and cortisol.Discussion: The high concentrations of NEFA at M1 reflected the condition of negative energy balance. βHB concentrations were stable, that may be related to the number of days postpartum in which the animals were diagnosed. The hyperglycemic condition and the increase in serum cortisol concentrations found at M1 can be induced by the condition of metabolic stress resulting from the disease. Hyperinsulinemia were recorded in the present study could be an important factor related to the pathogenesis of DA, since there seems to be a correlation between hyperinsulinemia and decreased abomasal emptying rate. The RQUICKI and RQUICKI-βHB indices was significantly lower at M1, which may indicate lower sensitivity of peripheral tissues to insulin at this time. Changes in serum activity of LDH and CK may result from tissue damage due to organ displacement, in addition to damage associated with surgery and the administration of injectable drugs, mainly intramuscularly. The elevation in plasma L-lactate at M1 and in the RDA group may be associated with abomasal hypoperfusion. The high positive correlations found between L-lactate and the variables glucose, insulin, and cortisol reinforcing the association between the concentration of L-lactate and the moment of greatest stress. The increase in cardiac biomarkers may be related to the occurrence of ischemia/reperfusion injury in the abomasum, which involves oxidative stress and the production of inflammatory mediators. The hyperglycemic condition and the higher concentrations of NEFA can also contribute to the occurrence of myocardial injury. The correlations found between cardiac biomarkers and plasma L-lactate, strengthen the idea that there is a relationship between L-lactate and myocardial injury. In this sense, the measurement of blood concentrations of cTnI, CK-MB, and L-lactate could contribute as severity markers and prognosis indicators in cattle with DA.

Vibration associated with cryotherapy to relieve pain in children

BACKGROUND AND OBJECTIVES: The administration of intramuscular drugs and peripheral venous puncture are procedures that use needles cause pain, especially in children. This painful experience generates distress, phobia, tachycardia, refusal to further treatments, anxiety, and sadness in parents. The use of non-pharmacological methods such as vibration and cold for pain relief in children has become a reliable alternative. The objective of this study was to evaluate the association between vibration and cryotherapy as a strategy for the relief of pain in children undergoing procedures with the use of needles. CONTENTS: This is an integrative review, in which articles were searched in the Pubmed, Medline, BDENF and LILACS databases, using the descriptors: “Child”, “Vibration”, “Cryotherapy” and “Pain” associated with the Boolean operator “and”. After the selection and reading of the articles in full, they were systematically synthesized and classified with a level of scientific evidence 2. Studies have shown that the association between vibration and cryotherapy is effective in reducing pain in children with or without cognitive alterations, also reducing their and parents’ anxiety during procedures performed with needles. CONCLUSION: The implementation of vibration associated with cryotherapy during the administration of injectable drugs and the installation of a peripheral venous device can reduce the fear, anguish, and anxiety in children, calming the parents and benefiting health professionals.

Community pharmacists' evolving role in Canadian primary health care: a vision of harmonization in a patchwork system.

Canada’s universal public health care system provides physician, diagnostic, and hospital services at no cost to all Canadians, accounting for approximately 70% of the 264 billion CAD spent in health expenditure yearly. Pharmacy-related services, including prescription drugs, however, are not universally publicly insured. Although this system underpins the Canadian identity, primary health care reform has long been desired by Canadians wanting better access to high quality, effective, patient-centred, and safe primary care services. A nationally coordinated approach to remodel the primary health care system was incited at the turn of the 21st century yet, twenty years later, evidence of widespread meaningful improvement remains underwhelming. As a provincial/territorial responsibility, the organization and provision of primary care remains discordant across the country. Canadian pharmacists are, now more than ever, poised and primed to provide care integrated with the rest of the primary health care system. However, the self-regulation of the profession of pharmacy is also a provincial/territorial mandate, making progress toward integration of pharmacists into the primary care system incongruent across jurisdictions. Among 11,000 pharmacies, Canada’s 28,000 community pharmacists possess varying authority to prescribe, administer, and monitor drug therapies as an extension to their traditional dispensing role. Expanded professional services offered at most community pharmacies include medication reviews, minor/common ailment management, pharmacist prescribing for existing prescriptions, smoking cessation counselling, and administration of injectable drugs and vaccinations. Barriers to widely offering these services include uncertainties around remuneration, perceived skepticism from other providers about pharmacists’ skills, and slow digital modernization including limited access by pharmacists to patient health records held by other professionals. Each province/territory enables pharmacists to offer these services under specific legislation, practice standards, and remuneration models unique to their jurisdiction. There is also a small, but growing, number of pharmacists across the country working within interdisciplinary primary care teams. To achieve meaningful, consistent, and seamless integration into the interdisciplinary model of Canadian primary health care reform, pharmacy advocacy groups across the country must coordinate and collaborate on a harmonized vision for innovation in primary care integration, and move toward implementing that vision with ongoing collaboration on primary health care initiatives, strategic plans, and policies. Canadians deserve to receive timely, equitable, and safe interdisciplinary care within a coordinated primary health care system, including from their pharmacy team.

Abscesso subcutâneo por Trueperella pyogenes em bovino na Amazônia Ocidental: relato de caso

Trueperella pyogenes is a pathogenic bacterium that causes suppurative infections in domestic and wild animals as well as humans. This paper describes a clinical case of subcutaneous abscess by T. pyogenes in a bovine in the Western Amazon, Brazil. During anamnesis, intramuscular injectable drug administration in the middle third of the left gluteal biceps muscle and the practice of reusing needles were reported. The clinical examination revealed edema, hyperthermia and high pain sensitivity to the touch in the region. A sample was collected through a puncture incision for the bacterial culture, during which T. pyogenes was isolated. The therapeutic approach was the use of a systemic antimicrobial and topical care, with a good prognosis. This report is the first description of infection by T. pyogenes in cattle in the Western Amazon and underscores the importance of appropriate sanitary management in herds, especially the use of disposable needles and hygiene at the site of parenteral drug application.

Physical Compatibility of Intravenous Drugs Commonly Used in Intensive Care Units: An Observational Study and Physical Compatibility Laboratory Tests on Anti-Infective Drugs

Abstract Background The objectives were to perform an observation of the administration of injectable drugs in three ICUs, to identify injectable drugs administered by Y-site infusion or mixed in the same container, to compare with physical compatibility data available in the literature and to test the physical compatibility for missing data. Methods An observational study was realised over two weeks and patients receiving more than one injectable drug in the same line simultaneously were included. Physical compatibilities were assessed in pairs by comparing with three databases. For some missing data, three tests were realised for pairs including an anti-infective drug. Visual and subvisual evaluations were performed after the preparation, 1 and a 4-hour storage. Results A total of 389 combinations between two injectable drugs was observed for Y-site infusions and 31 mixtures in the same container. According to the literature, 21.1 % associations were physically compatible, 1.8 % as physically compatible potentially, 8.0 % as physically incompatible, 6.4 % have divergent data according to the databases and 62.7 % have no data. Two mixtures were documented. 37 pairs were tested and 70.3 % were physically compatible, 8.1 % were physically incompatible after visual evaluation and 21.6 % after subvisual evaluation. Conclusions In the majority of cases, no compatibility data are available in the literature. Laboratory tests give additional information.

Effect of multi-lumen perfusion line on catheter-related bacteremia in premature infants: study protocol for a cluster-randomized crossover trial

BackgroundCatheter-related bacteremia (CRB) is the most frequent nosocomial infection in neonatal intensive care unit (NICU) patients, especially in very low-birth-weight infants. Administration of injectable drugs in premature newborn infants has many particularities and several types of infusion incidents have been reported. The Edelvaiss® Multiline NEO device is a novel multi-lumen access infusion device adapted to the specificities of infusion in neonatology. This multicenter, randomized, controlled study was therefore designed to determine whether or not Edelvaiss® Multiline NEO reduces the risk of CRB in preterm newborn infants in an NICU.Methods/designThis is a multicenter, randomized, controlled trial, using a cluster-randomized crossover design. Four investigator centers (four clusters) will participate in the study and will be randomized into two groups, corresponding to two different sequences (either the Edelvaiss® Multiline NEO or standard infusion system sequence, then vice versa). A total of 280 patients will be recruited. Infants will be enrolled in the study at the time of placing a single-lumen central venous catheter. Three visits recording specific data are planned in the study protocol. The primary outcome measure is the incidence density (ID) of CRB. For each patient, the total number of catheters and CRB incidents as well as the duration of stay in the NICU will be computed and considered for analysis.DiscussionThe study will provide high-quality evidence to determine whether the Multiline NEO device reduces the risk of CRB in preterm newborns in NICUs or not.Trial registrationClinicalTrials.gov, NCT02633124. Registered on 7 December 2015.

CYCLOPHOSPHAMIDE ADMINISTRATION ROUTINE IN AUTOIMMUNE RHEUMATIC DISEASES: A REVIEW

Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare – but serious – side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

Performing a preliminary hazard analysis applied to administration of injectable drugs to infants.

Errors in hospitals during the preparation and administration of intravenous drugs to infants and children have been reported to a rate of 13% to 84%. This study aimed to investigate the potential for hazardous events that may lead to an accident for preparation and administration of drug injection in a pediatric department and to describe a reduction plan of risks. The preliminary hazard analysis (PHA) method was implemented by a multidisciplinary working group over a period of 5months (April-August 2014) in infants aged from 28days to 2years. The group identified required hazard controls and follow-up actions to reduce the error risk. To analyze the results, the STATCART APR software was used. During the analysis, 34 hazardous situations were identified, among 17 were quoted very critical and drawn 69 risk scenarios. After follow-up actions, the scenarios with unacceptable risk declined from 17.4% to 0%, and these with acceptable under control from 46.4% to 43.5%. The PHA can be used as an aid in the prioritization of corrective actions and the implementation of control measures to reduce risk. The PHA is a complement of the a posteriori risk management already exists.

Cyclophosphamide administration routine in autoimmune rheumatic diseases: a review

Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare – but serious – side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

Rotina de administração de ciclofosfamida em doenças autoimunes reumáticas: uma revisão

Cyclophosphamide (CPM) is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre‐chemotherapy (pre‐ChT), administration of cyclophosphamide, and post‐chemotherapy (post‐ChT), taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare–but serious–side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post‐chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

Évaluation des erreurs d’administration des médicaments injectables en néonatologie

Use of injectable drugs in newborns represents more than 90% of prescriptions and requires special precautions in order to ensure more safety and efficiency. The aim of this study is to gather errors relating to the administration of injectable drugs and to suggest corrective actions. This descriptive and transversal study has evaluated 300 injectable drug administrations in a neonatology unit. Two hundred and sixty-one administrations have contained an error. Data are collected by direct observations of administrative act. Errors observed are: an inappropriate mixture (2.6% of cases); an incorrect delivery rate (33.7% of cases); incorrect dilutions (26.7% of cases); error in calculation of the dose to be injected (16.7% of cases); error while sampling small volumes (6.3% of cases); error or omission of administration schedule (1% of cases). These data have enabled us to evaluate administration of injectable drugs in neonatology. Different types of errors observed could be a source of therapeutic inefficiency, extended lengths of stay or iatrogenic drug. Following these observations, corrective actions have been undertaken by pharmacists and consist of: organizing training sessions for nursing; developing an explanatory guide for dilution and administration of injectable medicines, which was made available to the clinical service. Collaborative strategies doctor-nurse-pharmacist can help to reduce errors in the medication process especially during his administration. It permits improvement of injectable drugs use, offering more security and better efficiency and contribute to guarantee ideal therapy for patients.

Creation of computer-assisted drug prescription in a pediatric hospital: the 8 years experience of the Children’s Hospital of Geneva

The University Hospitals of Geneva (HUG) had an institutional project to implement a computerised physician order entry (CPOE) system to replace verbal and handwritten prescriptions as well as transcription, in order to decrease errors and related adverse drug events. Development of CPOE was first intended for adult patients. A dedicated working group, PRESCO-PED, was created in 2006 for the development of the paediatric drug database. This group was in charge of evaluating the needs and building and maintaining a database of the most-prescribed drugs in paediatrics. PRESCO-PED included physicians representing most paediatric specialties, such as intensive care, neonatology, emergency, oncology, general paediatrics, surgery, orthopaedic surgery, anaesthesiology, infectious diseases and psychiatry, in cooperation with nurse representatives, pharmacists, and computer specialists. The drug database had to be specific to paediatrics, structured, validated by experts, and easy to update. Several drug datasets were available in the institution, such as the injectable drug administration guide of the pharmacy, nurses’ protocols, and different published references. However, all were incomplete, not structured or not directly exploitable for the database. All the variables required per drug first had to be defined: brand name, international nonproprietary name (INN), unit dose, interval, maximal unit dose, maximal daily dose, route of administration, flow rate, formulation, specific dosage according to patient’s age, gestational age, body weight, body surface index, etc. The most frequently used drugs, corresponding to 346 drug records, were each distributed to two experts in the group, chosen according to the specialty in which the drug was mainly used. After validation by both experts, a database was compiled and verified again by PRESCO-PED. The additional aim of this database was to allow the system to suggest standard prescriptions schemes and to trigger alerts, for example when maximal doses were exceeded. The prescription of drugs in the database was then tested with mock patients by a subgroup of members of PRESCO-PED in addition to regular users, prior to implementation in a clinical setting. In order to facilitate acceptance by the end-users, in addition to drug prescription, PRESCO-PED decided to work on order sets, which simplified and accelerated prescriptions by combining in a single interface multiple orders (patient monitoring, laboratory tests, radiology, drugs, feeding and IV fluids, among others) associated with a specific clinical setting. With the same quality standards, a paediatric enteral nutrition prescription interface was also created. After 20 sessions of PRESCO-PED over a period of 10 months, all drugs and several order sets were available, with the database completed and ready for use. Drugs specific to paediatrics were easily differentiated from adult drugs in the prescription interface thanks to a characteristic pictogram. CPOE with drug prescription was first implemented in January 2007 in the paediatric surgery department, after structured training of all healthcare workers, and on-site assistance by medical IT personnel and members of PRESCO-PED. Over two months it was progressively deployed throughout the entire Children’s Hospital. Since the implementation of CPOE, PRESCO-PED remains active with monthly meetings, regularly updating the database, increasing the number of order sets, correcting errors, and improving the use of drug prescription. We will review the challenges, the difficulties and successes of our programme and will put our plans in perspective for the future.

Pediatric News

Pediatric News

Prevention of Fatal Opioid Overdose

Prevention of Fatal Opioid Overdose

A Comparison of Electronic and Handwritten Anaesthetic Records for Completeness of Information

Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records. A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. A comprehensive scoring system, based on the Australian and New Zealand College of Anaesthetists' guideline PS6, was used to compare the completeness of information throughout the entire intraoperative record. There was no significant difference in the total score for completeness between electronic (78%) and handwritten (83%) records (P = 0.16). Handwritten records were more complete with respect to weight (P < 0.0001), American Society of Anesthesiologists' physical status score (P < 0.0001), the size and type of artificial airway used (P = 0.003) and a record of the surgeons involved (P = 0.0004). Electronic records were more complete with respect to a record of drug administration including intravenous drugs (P < 0.0001), vapour (P = 0.0001) and nitrous oxide/oxygen (P < 0.0001), a record of end-tidal carbon dioxide monitoring (P = 0.006) and the level of trainee supervision (P = 0.0002). There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.