Interaction and Compatibility Between Parenteral Administration of Drugs and Nutrient in the Surgical Intensive Care Unit: Effects of Clinical Pharmacist Interventions
Kyunghwa Leea, Eunjeong Heoa, Yoonhee Kima, Jeongwha Leea, Eunsook Leea, Euni Leeb and Inae Songc,†
Department of Pharmacy, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, Republic of Koreaa College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Koreab Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, Republic of Koreac
Correspondence to: †교신저자 송인애 Tel:031-787-7511 E-mail:sia1@snubh.org
Received May 18, 2019; Revised August 7, 2019; Accepted December 16, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Abstract
- Background : Patients in surgical intensive care unit (SICU) commonly receive numerous intravenous drugs and are supported by parenteral nutrition. Thus, patients are often exposed to drug-nutrient interactions and incompatibilities. Compatibility issues with parenteral administrations are crucial for practitioners as it could impact clinical outcomes. The purpose of this study was to evaluate the appropriateness of drug administration by investigating drug-nutrient interactions and compatibility and to assess drug users’ recognition and experiences related with ICU pharmacist services.
Methods : A retrospective evaluation of drugs and nutrients in all prescriptions of patients admitted to the SICU during June 2017 was performed using electronic medical records. Then, in from September to October 2017, the drug administration routes were checked in patients who received total parenteral nutrition (TPN) in the ICU and drug adjustments were performed if the combination was inappropriate. Questionnaires were distributed to SICU nurses responsible for administering drugs for one week to assess the recognition and required pharmacy service regarding drug-nutrient compatibility.
Results : In this study, 247 intravenous drug-nutrient interactions were identified from 18,350 combinations between drugs and nutrients. Fifteen interactions were recorded as “consideration of therapeutic correction” by the Lexicomp online® standard and all were interactions between calcium and ceftriaxone. The drug route study revealed 18 incompatibilities in intravenous drug-nutritional combinations, of which were ‘no concomitant data’ on the basis of the Lexicomp online®. In the nurses’ questionnaire conducted after the pharmacists’ interventions, 86.7% were aware of Y-site incompatible drugs and 16.7% experienced witnessing sedimentation or foreign materials. The required clinical pharmacy service was easy access to acquire information regarding compatibility.
Conclusion : Findings from our study show that pharmacists’ interventions were necessary to determine drug modification of drugs or routes of drug administration. Additionally, the questionnaire confirmed the need for development of information access services regarding drug administration. - Keywords : Surgical intensive care unit, Drug-nutrient interaction, Drug-nutrient compatibility
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