SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America.
SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America; SUNY Upstate Medical University, Syracuse, NY 13210, United States of America.
Am J Emerg Med. 2023 Dec;74:135-139. doi: 10.1016/j.ajem.2023.10.002. Epub 2023 Oct 2.
Hypotension is a common problem in the emergency department (ED) and intensive care unit (ICU) and can increase risk for poor outcomes. Many EDs/ICUs utilize epinephrine and phenylephrine to treat hypotension and these medications are most often administered as a continuous infusion (CI). Push-dose (PD) is the administration of small medication doses as intermittent intravenous pushes (IVPs). There is limited information comparing the time required to prepare and administer PD versus CI and errors have been reported when preparing and administering these medications at bedside. This simulation study sought to estimate preparation and administration times and preparation and errors with PD and CI epinephrine and phenylephrine when prepared by an ED/ICU pharmacist.
This crossover simulation study took place in a simulation center at an academic medical center and utilized a multi-venous intravenous training arm kit equip with an 18-gauge intravenous line, an extension tubing set, and a luer-lock adapter. The primary outcome was total preparation and administration time in seconds. The secondary outcome was major preparation and administration errors, defined as errors causing a five-fold or greater overdose.
In total, 16 pharmacists participated, including nine ED and seven ICU pharmacists. PD had faster total preparation and administration time and administration time, but not preparation time; PD showed an approximate 70 s decrease in total preparation and administration time versus CI. PD had more major preparation and administration errors and six PD preparations (18.8%, 6/32) had at least one major preparation and administration error. CI, on the other hand, had no major preparation and administration errors.
This simulation found faster total preparation and administration time with PD versus CI epinephrine and phenylephrine, but also found that PD had more major preparation and administration errors. Dilutional errors during medication preparation were the cause of 83.3% (5/6) of our overdoses.
This simulation study showed that ED/ICU pharmacists had faster median total preparation and administration times for PD epinephrine and phenylephrine versus CI, but PD also had more preparation and administration errors.
低血压是急诊科（ED）和重症监护病房（ICU）的常见问题，会增加不良预后的风险。许多 ED/ICU 利用肾上腺素和去甲肾上腺素来治疗低血压，这些药物通常作为连续输注（CI）给予。推注剂量（PD）是间歇性静脉推注（IVP）给予小剂量药物。比较 PD 和 CI 肾上腺素和去甲肾上腺素准备和给药所需时间的信息有限，并且在床边准备和给药时已经报告了错误。这项模拟研究旨在估计 ED/ICU 药剂师准备和给药时 PD 和 CI 肾上腺素和去甲肾上腺素的准备和给药时间以及准备和错误。
这项交叉模拟研究在学术医疗中心的模拟中心进行，使用了带有 18 号静脉内管线、延长管套件和鲁尔锁适配器的多静脉静脉培训臂套件。主要结局是秒的总准备和给药时间。次要结局是主要的准备和给药错误，定义为导致五倍或更大过量的错误。
共有 16 名药剂师参与，包括 9 名 ED 药剂师和 7 名 ICU 药剂师。PD 具有更快的总准备和给药时间以及给药时间，但不是准备时间；与 CI 相比，PD 总准备和给药时间减少了约 70 秒。PD 有更多的主要准备和给药错误，并且 6/32 个 PD 制剂（18.8%）有至少一个主要准备和给药错误。另一方面，CI 没有主要的准备和给药错误。
这项模拟研究发现，与 CI 肾上腺素和去甲肾上腺素相比，PD 具有更快的总准备和给药时间，但也发现 PD 有更多的准备和给药错误。药物准备过程中的稀释错误是我们 83.3%（5/6）的过量的原因。
这项模拟研究表明，与 CI 相比，ED/ICU 药剂师对 PD 肾上腺素和去甲肾上腺素的中位总准备和给药时间更快，但 PD 也有更多的准备和给药错误。
