신생아 중환자실 사용 약물의 비호환성 정보로 구성하는 이차원 표 개발
Development of a Two-Dimensional Compatibility Table for Intravenous Y-Site Drug Administration in a Neonatal Intensive Care Unit
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : The majority of drugs used in the Neonatal Intensive Care Unit (NICU) are unlicensed and off-label, exposing infants to greater risk of medication error in the intravenous drug co-administration process. Methods : A cross-sectional analytical study was conducted in the NICU of a university hospital in Korea. Data on prescribed orders May-July 2019 were collected. Medications including intramuscular injection instruction were excluded. Prescription orders were classified in percentages according to WHO-ATC (anatomical therapeutic chemical). When two drugs were administered at the Y site at the same time, the compatibility information was investigated using the Micromedex and then classified in percentages for each drug group. A two-dimensional table with the 43 intravenous drugs prescribed was rendered based on a review of the Micromedex database. Results : The largest drug distribution in the Neonatal Intensive Care Unit (NICU) is anti-infective for systemic use (37.2%), and the drug group with the highest incompatibility comprising the nervous system drugs (28.1%). The prescription of Phenytoin, Ampicillin sodium, and Furosemide with high incompatibility were risk factors for potential incompatibility. Conclusion : It is expected potential drug incompatibility is common in the NICU. Clinical pharmacists thus must practice special monitoring when drugs are co-administered. The two-dimensional table can be a valuable tool for intervention. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.
Abstract
Background : The majority of drugs used in the Neonatal Intensive Care Unit (NICU) are unlicensed and off-label, exposing infants to greater risk of medication error in the intravenous drug co-administration process. Methods : A cross-sectional analytical study was conducted in the NICU of a university hospital in Korea. Data on prescribed orders May-July 2019 were collected. Medications including intramuscular injection instruction were excluded. Prescription orders were classified in percentages according to WHO-ATC (anatomical therapeutic chemical). When two drugs were administered at the Y site at the same time, the compatibility information was investigated using the Micromedex and then classified in percentages for each drug group. A two-dimensional table with the 43 intravenous drugs prescribed was rendered based on a review of the Micromedex database. Results : The largest drug distribution in the Neonatal Intensive Care Unit (NICU) is anti-infective for systemic use (37.2%), and the drug group with the highest incompatibility comprising the nervous system drugs (28.1%). The prescription of Phenytoin, Ampicillin sodium, and Furosemide with high incompatibility were risk factors for potential incompatibility. Conclusion : It is expected potential drug incompatibility is common in the NICU. Clinical pharmacists thus must practice special monitoring when drugs are co-administered. The two-dimensional table can be a valuable tool for intervention. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.
참고문헌 (20)
- McDowell SE, "Where errors occur in the preparation and administration of intravenous medicines : a systematic review and Bayesian analysis", BMJ Quality & Safety, 19(4), pp.341~345 (2010)
- G. Castells Lao, "Compatibilidad de los fármacos administrados en «Y» en las unidades de cuidados intensivos: revisión sistemática", Medicina Intensiva, 44(2), pp.80~87 (2020), Elsevier BV[DOI]
- Wedekind CA, "Compatibility of commonly used intravenous infusions in a pediatric intensive care unit", Critical care nurse, 21(4), pp.45~51 (2001)
- Kanji S, "Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units", Critical care medicine, 38(9), pp.1890~1898 (2010)
- Kalikstad B, "Compatibility of drug infusions in the NICU", Arch Dis Child, 95(9), pp.745~748 (2010)
- Bradley JS, "Intravenous ceftriaxone and calcium in the neonate : assessing the risk for cardiopulmonary adverse events", Pediatrics, 123(4), pp.e609~ (2009)
- Sherwin CM, "Intravenous drug delivery in neonates : lessons learnt", Archives of disease in childhood, 99(6), pp.590~594 (2014)
- 배혜정, "단일기관 신생아중환자실에서의 허가외 약물 사용 현황", 병원약사회지, 36(3), pp.325~334 (2019), 한국병원약사회[DOI]
- Trissel LA, "Everything in a compatibility study is important", American journal of health-sstem pharmacy, 53(24), pp.2990~ (1996)
- Bertsche T, "Prevention of intravenous drug incompatibilities in an intensive care unit", American Journal of Health-System Pharmacy, 65(19), pp.1834~1840 (2008)
- Manrique-Rodriguez S, "Development of a compatibility chart for intravenous Y-site drug administration in a pediatric intensive care unit", J Infus Nurs, 35(2), pp.109~114 (2012)
- Leopoldino RW, "Potential drug incompatibilities in the neonatal intensive care unit : a network analysis approach", BMC Pharmacol Toxicol, 19(1), pp.83~ (2018)
- Leal KD, "Potential intravenous drug incompatibilities in a pediatric unit", Einstein(Sao Paulo), 14(2), pp.185~189 (2016)
- Fox LM, "Physical compatibility of various drugs with neonatal total parenteral nutrient solution during simulated Y-site administration", Am J Health Syst Pharm, 70(6), pp.520~524 (2013)
- "Klinische Padiatrie", 2007, 37~43
- 우지윤, "국내 한 상급종합병원의 의약정보실 내 질의응답 사례 분석", 병원약사회지, 36(4), pp.486~497 (2019), 한국병원약사회[DOI]
- Ji Eun Choi, "Improvement of the Multidisciplinary Team-based Critical Care Service for Patient in the Surgical Intensive Care Unit: A Qualitative Exploration of Healthcare Professional Needs JKSHP", 36(2), pp.173~188 (2019)
- Perez M, "Compatibility of medications during multi-infusion therapy : A controlled in vitro study on a multilumen infusion device", Anaesthesia, critical care &pain medicine, 34(2), pp.83~88 (2015)
- Nemec K, "Standardization of infusion solutions to reduce the risk of incompatibility", Am J Health Syst Pharm, 65(17), pp.1648~1654 (2008)
- Maison O, "Drug incompatibilities in intravenous therapy : evaluation and proposition of preventive tools in intensive care and hematology units", European journal of clinical pharmacology, 75(2), pp.179~187 (2019)