Clinical severity of drug incompatibilities in critically ill patients
DOI:
https://doi.org/10.33448/rsd-v9i6.3533Keywords:
Drug incompatibility; Patient safety; Critical care; Infusions; Intravenous; Nursing care.Abstract
Objective: Analyze the severity of drug incompatibilities in an intensive cardio unit. Methods: Observational study, with cross-sectional design and quantitative in nature. Study based on two steps: verification of the prescriptions and direct observation of the infusion in the patient, to identify the incompatibility in loco. Data collection took place from September 2018 to May 2019 using an own collection instrument, performed in the intensive cardio unit of a University Hospital in Rio de Janeiro. Results: 161 drug prescriptions were observed, with the identification of 2,227 drugs, of which 858 (38.52%) were administered intravenously. Among these, 631 (73.54%) medications were administered simultaneously. Among these drugs, 893 doses were administered simultaneously, of which they were analyzed for incompatibility and the severity of the incompatibility. 271 compatibilities were identified (30.35%); 94 incompatibilities (10.52%), and 528 untested combinations (59.13%). Conclusions: The combinations of medications identified as the most frequent serious ones were: Midazolam with Imipenem (8.51%), Midazolam with Hydrocortisone (8.51%), Fentanyl with Amiodarone (7.44%) and Polymyxin B with Furosemide (6.38 %). Critical patients are the most vulnerable to the occurrence of drug incompatibilities, highlighting the need for further studies, in order to provide greater safety for the administration of intravenous drugs.
References
Amiconi, S., Hirl, Bertrand. (2014). A combination of predispositions and exposures as responsible for acute eosinophilic pneumonia. Multidisciplinary Respiratory Medicine, 9(1), 7-14. doi:10.1186/2049-6958-9-7
Brunton, L. L., Hilal-Dandan, R., & Knollmann, B. C. (2012). As bases farmacológicas da terapêutica de Goodman & Gilman. (12ªed). São Paulo, Brasil: AMGH Editora
Centers for Disease Control and Prevention. (2014). Central Line Associated Bloodstream Infection: Bloodstream infection event. Atlanta, Estados Unidos da América.
Retrieved march 16, from https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
Brasil (2017). Agência Nacional de Vigilância Sanitária. Medidas de Prevenção de Infecção Relacionada à Assistência à Saúde. Brasília, Brasil: Recuperado de: http://portal.anvisa.gov.br/documents/33852/3507912/Caderno+4+-+Medidas+de+Preven%C3%A7%C3%A3o+de+Infec%C3%A7%C3%A3o+Relacionada+%C3%A0+Assist%C3%AAncia+%C3%A0+Sa%C3%BAde/a3f23dfb-2c54-4e64-881c-fccf9220c373
Fontanela, M. A., Taffarel, M. O. & Lazari, G. (2017). Fentanil Intranasal–Revisão De Literatura. Revista de Ciência Veterinária e Saúde Pública, 4(2),1-5. doi: 10.4025/revcivet.v4i0.39781
Ferreira, J. M. (2017). Incidência de infecção primária da corrente sanguínea relacionada a cateter venoso central e os cuidados de enfermagem na unidade de terapia intensiva do hospital regional Dr. Homero de Miranda Gomes (TCC) na Faculdade de Enfermagem, da Universidade do Sul de Santa Catarina. Santa Catarina.
Gabriel, S. A., Antonangelo, L., Capelozzi, V. L., Beteli, C. B., Júnior, O. C., Aquino, J. L. & Caffaro, R. A. (2015). Hydrocortisone reduces serum concentrations of inflammatory biomarkers in patients subjected to carotid endarterectomy. Jornal Vascular Brasileiro. 14(3),1-10 doi: 10.1590/1677-5449.0022
Leal, K. D., Leopoldino, R. W., Martins, R. R. & Veríssimo, L.M. (2016). Potential intravenous drug incompatibilities in a pediatric unit. Einstein. 14(2), 185-9. doi: 10.1590/S1679-45082016AO3723.
Leopoldino, R. W., Costa, H. T., Costa, T. X., Martins, R. R. & Oliveira, A. G. (2018). Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach. BMC Pharmacology and Toxicology. 19(1),83. doi: 10.1186/s40360-018-0265-7
Malta, M., Cardoso, L., Bastos, F., Magnani, M. & Silva, C. (2010). Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Revista de Saúde Pública. 44(3), 559-65. doi: 10.1590/S0034-89102010000300021
Marsílio, N. R., Silva, D. & Bueno, D. (2016). Drug incompatibilities in the adult intensive care unit of a university hospital. Revista Brasileira de Terapia Intensiva. 28(2), 147-153. doi: 10.5935/0103-507X.20160029
Mendes, J. R., Lopes, M. C., Vancini-Campanharo, C. R., Okuno, M. F. & Batista, R. E. (2018). Types and frequency of errors in the preparation and administration of drugs. Einstein.16(3)eAO4146. doi: 10.1590/s1679-45082018ao4146.
Montanha, F. P. & Azevedo, M. G. P. (2013). Drug administration: advantages and disadvantages of different ways. Revista Científica Eletrônica de Medicina Veterinária. 11(20). Recuperado em: http://faef.revista.inf.br/imagens_arquivos/arquivos_destaque/aKogti4uNzM2EtQ_2013-6-21-16-16-23.pdf
Narimatsu, F. C., Lima, S. M. R., Ueda, Y., Carramão, S. S, & Gamberini, M. T. (2019). In vitro evaluation of drug association between crude Allium sativum L (garlic) extract and Imipenem and Meropenem against sensible Escherichia coli strains. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 64(3), 179-83. doi: 10.26432/1809-3019.2019.64.3.179
Neves, J. F., Araújo, M. M., Araújo, F. P., Ferreira, C, M., Duarte, F. B., Pace, F. H., Ornellas, L. C., Baron, T. H. & Ferreira, L. E. (2016). Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam. Revista Brasileira de Anestesiologia. 66(3)231-6. doi: 10.1016/j.bjan.2014.09.004
Nóbrega, R. C., Batista, L. M., & Ribeiro, N. K. (2012). Use profile of anti-infective agents and potential interactions in an intensive care unit of a public teaching hospital in João Pessoa - PB. Revista Brasileira Farmacologia Hospital e Serviço em Saúde. 3(3), 28-32. Retrieved march 11, from: https://rbfhss.org.br/sbrafh/article/view/138/140
Oliota, A. F., Reis, C. B., Silva, E. A., & Sanches, A. C. (2016). Use and Safety Profile on Use of Antimicrobial Polymyxin B in a public hospital. Boletim Informativo Geum. 7(3), 56-62. Retrieved march 11, from: https://revistas.ufpi.br/index.php/geum/article/view/5065/3835
Oliveira, F., Ferreira, M., Araújo, S., Bessa, A., Moraes, A. & Stipp, M (2017). Positive deviance as a strategy to prevent and control bloodstream infections in intensive care. Revista da Escola de Enfermagem da USP, 51:e03212. doi: 10.1590/s1980-220x2016182303212
Oliveira, F., Paes, O., Mesquita, M., Souza, V., Carlos, E., & Martins, C. (2014). Assistance algorithm of nursing for amiodarone intravenous infusion. Rev Rene. 15(5), 878-87. doi: 10.15253/2175-6783.2014000500018
Gaetani, M., Frndova, H., Seto, W. & Parshuram, C. (2017). Concurrent intravenous drug administration to critically ill children: Evaluation of frequency and compatibility. Journal of Critical Care. 41:198-203. doi: 10.1016/j.jcrc.2017.05.027.
Paes, G. O., Moreira, S.O., Moreira, M. B. & Martins, T. G. (2017). Drug incompatibility in the ICU: review of implications in nursing practice. Revista Eletrônica de Enfermagem. 19:a20, 1-12. doi: 10.5216/ree.v19.38718
Pereira, F. G. F., Chagas, A. N. S., Freitas, M. M. C., Barros, L. M., & Caetano, J. A. (2016). Description of Infections Related to Health Care (IRAS) of patients in an Intensive Care Unit. Vigilância Sanitária Em Debate: Sociedade, Ciência & Tecnologia, 4(1), 70-7. https://doi.org/10.3395/2317-269x.00614
Plaza, J., Álamo, M., Torres, P., Fuentes, A., & López, F. (2010). Drug interactions and adverse events induced by drugs used in an intensive care unit. Revista Médica de Chile. 138(4), 452-60. doi: 10.4067/S0034-98872010000400009
Prelhacoski, D., Silva, D. M., & Comarella, L. (2015). Incompatibilidade medicamentosa em unidade de terapia intensiva pediátrica. Rev. Uniandrade. 16(2), 73-81. doi: 10.18024/1519-5694
Rocha, I. T. (2019). Incompatibilidade de Medicamentos em Unidade de Terapia
Intensiva Pediátrica (UTIP). (TCC). Faculdade de Farmácia, do Centro Universitário do Planalto Central Apparecido dos Santos, Brasília. Acessado em 23 março de 2020. Recuperado de: https://dspace.uniceplac.edu.br/bitstream/123456789/211/1/Lorrane_Rocha_0001369.pdf
Santos, S. F., Viana, R. S., Alcoforado, C. L. G. C., Campos, C. C., Matos, S. S., & Ercole, F. F. (2014). Nursing actions in the prevention of central venous catheter-related infections: an integrative review. Rev. SOBECC. 19(4), 219-25. doi: 10.5327/Z1414-4425201400040008
Tavares, M. B., Motta, P. R., Barros, V. F., Cezana, C., Ferreira, L. B., Saar, S. M., & Brandão, C. D. (2016). Thyroid function disorders induced by amiodarone. Revista Salus Journal of helath sciences. 2(2), 39-47. doi: 10.5935/2447-7826.20160015
Vasco, R. F. V. (2019). Efeitos dos diuréticos furosemida e hidroclorotiazida sobre o distúrbio mineral e ósseo da doença renal crônica. (Tese de Doutorado), Faculdade de Medicina, Universidade de São Paulo, São Paulo. doi:10.11606/T.5.2019.tde-29102019-093422.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
