Bundeswehr Hospital, Hamburg, Germany.
Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstraße 32, Leipzig, 04103, Germany.
Eur J Clin Pharmacol. 2023 Aug;79(8):1081-1089. doi: 10.1007/s00228-023-03509-0. Epub 2023 Jun 7.
In a critical care setting, we aimed to identify and solve physico-chemical drug incompatibilities in central-venous catheters considering the staffs' knowledge and assumptions about incompatibilities.
(i) After positive ethical vote, an algorithm to identify incompatibilities was developed and applied. The algorithm was based on KIK database and Stabilis database, the drug label, and Trissel textbook. (ii) A questionnaire was created and used that asked staff for knowledge and assumptions about incompatibilities. (iii) A 4-step avoidance recommendation was developed and applied.
(i) At least one incompatibility was identified in 64 (61.4%) of 104 enrolled patients. Eighty one (62.3%) of 130 incompatible combinations affected piperacillin/tazobactam and in 18 (13.8%) each furosemide and pantoprazole. (ii) 37.8% (n = 14) of the staff members participated in the questionnaire survey (median age: 31, IQR: 4.75 years). The combination of piperacillin/tazobactam and pantoprazole was incorrectly judged to be compatible by 85.7%. Only rarely felt the majority of respondents unsafe in administering drugs (median score: 1; 0, never to 5, always). (iii) In those 64 patients with at least one incompatibility, 68 avoidance recommendations were given, and all were fully accepted. In 44 (64.7%) of 68 recommendations "Step 1: Administer sequentially" was suggested as a avoidance strategy. In 9/68 (13.2%) "Step 2: Use another lumen", in 7/68 (10.3%) "Step 3: Take a break", and in 8/68 (11.8%) "Step 4: Use catheters with more lumens" were recommended.
Although incompatibilities were common, the staff rarely felt unsafe when administering drugs. Knowledge deficits correlated well with the incompatibilities identified. All recommendations were fully accepted.
在重症监护环境中，我们旨在考虑医护人员对药物配伍禁忌的知识和假设，通过识别和解决中心静脉导管中的理化药物不相容性。
（i）经过积极的伦理投票，开发并应用了一种识别不相容性的算法。该算法基于 KIK 数据库和 Stabilis 数据库、药物标签和 Trissel 教科书。（ii）创建并使用了一份问卷，询问工作人员有关不相容性的知识和假设。（iii）制定并应用了 4 步避免建议。
（i）在纳入的 104 名患者中，至少有 1 种不相容性在 64 名（61.4%）患者中被识别。81 种（62.3%）不相容组合影响哌拉西林/他唑巴坦，18 种（13.8%）每种呋塞米和泮托拉唑。（ii）37.8%（n=14）的工作人员参与了问卷调查（中位数年龄：31，IQR：4.75 年）。哌拉西林/他唑巴坦和泮托拉唑的组合被错误地判断为相容，比例为 85.7%。只有少数受访者认为在给药时感到不安全（中位数评分：1；0，从不至 5，总是）。（iii）在 64 名至少有 1 种不相容性的患者中，共提出了 68 项避免建议，且均被完全接受。在 68 项建议中的 64 项（68.7%）中，建议“第 1 步：顺序给药”作为避免策略。在 9/68（13.2%）项建议中，建议“第 2 步：使用另一个管腔”；在 7/68（10.3%）项建议中，建议“第 3 步：休息一下”；在 8/68（11.8%）项建议中，建议“第 4 步：使用多腔导管”。
尽管不相容性很常见，但医护人员在给药时很少感到不安全。知识缺陷与识别出的不相容性密切相关。所有建议都得到了完全认可。
