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Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia

Received: 28 September 2020    Accepted: 16 October 2020    Published: 23 October 2020
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Abstract

Intravenous admixtures are the preparations consisting of sterile drug products added to an IV fluid (s) for medication purposes. Especial concerns are required for such drugs since the reversal of toxicity and/or unwanted effects following incompatibilities are cumbersome to deal with. Concern drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures. The ultimate goal of this assessment was to figure out the actual practices on the ground in IV medications administered in NRH with IV fluids emphasizing on incidence and prevalence of incompatibility between drugs themselves or with IV fluids. This study was a cross-sectional prospective observational study which investigated the potential incompatibilities associated with IV admixture, & the incidence of IV drug administration errors using available evidence-based medicine sources at Nekemte Referral Hospital in West Ethiopia. The data was collected from patient medication Charts and prescription papers for patients treated within a period of 2 months. The study period was from February 2017 to April 2017 at the medical and pediatrics wards of NRH. About patients using IV admixtures were followed within this study period. The prevalence of identified incompatibility among IV admixtures ingredients was 28.94%. The identified compatibility was only 25.43%, while 38.59%were undocumented combinations, and 7.01% were variable. The most commonly encountered incompatible drug-solute combinations were Ringer lactate (61.8%), Insulin + DNS (29.4) and Ceftriaxone + Phenytoin + 0.9% NaCl (8.8%). Also, the incompatible drug-drug combinations detected in this study were Ceftriaxone+ heparin and clopidgrel+cimetidine combinations. Based on the findings of this study, the following can be concluded; there is a high prevalence of incompatibilities among IV admixtures. The types of incompatibilities were both drug-solute and drug-drug incompatibilities. Prescribers and administrators of IV admixtures were recommended to check plausibility before administration to prevent such incompatibilities which can compromise the treatment outcome of patients.

Published in American Journal of Health Research (Volume 8, Issue 5)
DOI 10.11648/j.ajhr.20200805.12
Page(s) 84-88
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

IV Admixtures, Incompatibilities, Intravenous, Drugs, Nekemte Referral Hospital

References
[1] Mohammad Albaz (2013). I. V. ADMIXTURE. https://prezi.com/rjzrxzawm__k/iv-admixture/. Retrieved on October 15, 2020.
[2] Small GA, Marshall I. Intravenous additives. In: Lawson DH, Richards RME. Clinical Pharmacy and Hospital Drug Management. 1st edition. Britain: The University-Press, Cambridge. 1982; 239-60.
[3] John F. Sterile Products. In: Shargel L, Souney PK, Mutnick AH, Swanson LN. Comprehensive Pharmacy Review. 8th edition. New Delhi: Wolters Kluwer Pvt Ltd., 2010; 348-357.
[4] Hankins, Judy, et al., the Infusion Nurses Society Infusion Therapy in Clinical Practice. 2nd edition. Philadelphia: WB Saunders, 2001.
[5] Scott SA. The Prescription. In: Alfonso RG. Remington the Science and Practice of Pharmacy. 20th edition, New York: Lippincott Williams and Wilkins. 2000; 1687-705.
[6] Peter Murney, et al To mix or not to mix-compatibilities of parenteral drug solutions: Aust. prescr. 2008 Aug; 31 (4): 91-101.
[7] Phillips, Lynn, Manual of IV Therapeutics. 4th edition. Philadelphia: Saunders, 2005.
[8] Tuan Tran, Thomas C. Kupiec, et al., Quality-Control Analytical Methods: Particulate Matter in Injections: What is it and what are the Concerns: International Journal of Pharmaceutical Compounding., 2006 May/June; 10 (3): 202-204.
[9] K. V. Ramanath, Hymavathi, et al., Assessment of intravenous admixtures in hospitalized patients of a rural tertiary care teaching hospital: American journal of pharma tech research, 2012; 2 (4): 534-543.
[10] British National Formulary 57th edition March., 2009.
[11] Micromedex® HealthCare Series (internet database) Version 2.0. Greenwood Village, Colorado: Thomson Healthcare Inc; 2013. [http://www.micromedexsolutions.com]; https://online.lexi.com.
[12] M. Giki, E. R. Di Paolo, et al. Evaluation of physicochemical incompatibilities during parenteral drug administration in a pediatric intensive care unit: Pharm World Science., 2002; 22 (3): 88-91.
[13] Valia HD, Pierre V, Laurent G, Rene C, Andre P. Evaluation of intravenous drugs compatibilities in an adult ICU. 35th European symposium on Clinical Pharmacy, 2006.
[14] Drug Interactions Checker - For Drugs, Food & Alcohol. https:www.drugs.com_interraction_.
[15] Modern Weng, D. O. and Rachel Nall, MSN, CRNA (2018). Dextrose. Healthline. Retrieved on October 15, 2020.
[16] Ceftriaxone and Heparin drug interactions. Ehealthme. Real-world drug outcomes. http://www.ehealthme.com/drug-interaction/ceftriaxone/heparin/.
[17] Medsafe. 2010. Clopidogrel and proton pump inhibitors - possible interaction. Prescriber Update 31 (1): 2. Retrieved on October 15, 2020.
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  • APA Style

    Balisa Mosisa, Bokasa Negeri, Getu Bayisa, Edao Sado, Ginenus Fekadu, et al. (2020). Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia. American Journal of Health Research, 8(5), 84-88. https://doi.org/10.11648/j.ajhr.20200805.12

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    ACS Style

    Balisa Mosisa; Bokasa Negeri; Getu Bayisa; Edao Sado; Ginenus Fekadu, et al. Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia. Am. J. Health Res. 2020, 8(5), 84-88. doi: 10.11648/j.ajhr.20200805.12

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    AMA Style

    Balisa Mosisa, Bokasa Negeri, Getu Bayisa, Edao Sado, Ginenus Fekadu, et al. Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia. Am J Health Res. 2020;8(5):84-88. doi: 10.11648/j.ajhr.20200805.12

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  • @article{10.11648/j.ajhr.20200805.12,
      author = {Balisa Mosisa and Bokasa Negeri and Getu Bayisa and Edao Sado and Ginenus Fekadu and Mohammed Gebre and Busha Gamachu and Sagaram Sudhakar},
      title = {Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia},
      journal = {American Journal of Health Research},
      volume = {8},
      number = {5},
      pages = {84-88},
      doi = {10.11648/j.ajhr.20200805.12},
      url = {https://doi.org/10.11648/j.ajhr.20200805.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20200805.12},
      abstract = {Intravenous admixtures are the preparations consisting of sterile drug products added to an IV fluid (s) for medication purposes. Especial concerns are required for such drugs since the reversal of toxicity and/or unwanted effects following incompatibilities are cumbersome to deal with. Concern drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures. The ultimate goal of this assessment was to figure out the actual practices on the ground in IV medications administered in NRH with IV fluids emphasizing on incidence and prevalence of incompatibility between drugs themselves or with IV fluids. This study was a cross-sectional prospective observational study which investigated the potential incompatibilities associated with IV admixture, & the incidence of IV drug administration errors using available evidence-based medicine sources at Nekemte Referral Hospital in West Ethiopia. The data was collected from patient medication Charts and prescription papers for patients treated within a period of 2 months. The study period was from February 2017 to April 2017 at the medical and pediatrics wards of NRH. About patients using IV admixtures were followed within this study period. The prevalence of identified incompatibility among IV admixtures ingredients was 28.94%. The identified compatibility was only 25.43%, while 38.59%were undocumented combinations, and 7.01% were variable. The most commonly encountered incompatible drug-solute combinations were Ringer lactate (61.8%), Insulin + DNS (29.4) and Ceftriaxone + Phenytoin + 0.9% NaCl (8.8%). Also, the incompatible drug-drug combinations detected in this study were Ceftriaxone+ heparin and clopidgrel+cimetidine combinations. Based on the findings of this study, the following can be concluded; there is a high prevalence of incompatibilities among IV admixtures. The types of incompatibilities were both drug-solute and drug-drug incompatibilities. Prescribers and administrators of IV admixtures were recommended to check plausibility before administration to prevent such incompatibilities which can compromise the treatment outcome of patients.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia
    AU  - Balisa Mosisa
    AU  - Bokasa Negeri
    AU  - Getu Bayisa
    AU  - Edao Sado
    AU  - Ginenus Fekadu
    AU  - Mohammed Gebre
    AU  - Busha Gamachu
    AU  - Sagaram Sudhakar
    Y1  - 2020/10/23
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajhr.20200805.12
    DO  - 10.11648/j.ajhr.20200805.12
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 84
    EP  - 88
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20200805.12
    AB  - Intravenous admixtures are the preparations consisting of sterile drug products added to an IV fluid (s) for medication purposes. Especial concerns are required for such drugs since the reversal of toxicity and/or unwanted effects following incompatibilities are cumbersome to deal with. Concern drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures. The ultimate goal of this assessment was to figure out the actual practices on the ground in IV medications administered in NRH with IV fluids emphasizing on incidence and prevalence of incompatibility between drugs themselves or with IV fluids. This study was a cross-sectional prospective observational study which investigated the potential incompatibilities associated with IV admixture, & the incidence of IV drug administration errors using available evidence-based medicine sources at Nekemte Referral Hospital in West Ethiopia. The data was collected from patient medication Charts and prescription papers for patients treated within a period of 2 months. The study period was from February 2017 to April 2017 at the medical and pediatrics wards of NRH. About patients using IV admixtures were followed within this study period. The prevalence of identified incompatibility among IV admixtures ingredients was 28.94%. The identified compatibility was only 25.43%, while 38.59%were undocumented combinations, and 7.01% were variable. The most commonly encountered incompatible drug-solute combinations were Ringer lactate (61.8%), Insulin + DNS (29.4) and Ceftriaxone + Phenytoin + 0.9% NaCl (8.8%). Also, the incompatible drug-drug combinations detected in this study were Ceftriaxone+ heparin and clopidgrel+cimetidine combinations. Based on the findings of this study, the following can be concluded; there is a high prevalence of incompatibilities among IV admixtures. The types of incompatibilities were both drug-solute and drug-drug incompatibilities. Prescribers and administrators of IV admixtures were recommended to check plausibility before administration to prevent such incompatibilities which can compromise the treatment outcome of patients.
    VL  - 8
    IS  - 5
    ER  - 

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Author Information
  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

  • School of Pharmacy, Wollega University, Nekemte, Ethiopia

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