Standardization and Chemical Characterization of Intravenous Therapy in Adult Patients: A Step Further in Medication Safety

BACKGROUND

Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems.

AIM

The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access.

METHODS

The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases.

RESULTS

In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications.

CONCLUSIONS

Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.

[Therapeutic exchange of angiotensin II receptor antagonists in patients hospitalised in a traumatology unit]

OBJECTIVE

To analyse the proportion of patients whose blood pressure values have remained within the established therapeutic aim, so as to reduce cardiovascular risk following therapeutic exchange of angiotensin II receptor antagonists (AIIRA.)

METHODS

Analytical, observational, prospective, longitudinal study with pre-post analysis. Patients undergoing AIIRA treatment who were not included in the hospital's pharmaco-therapeutic guide were included in the study over those who had undergone a normalised therapeutic exchange of AIIRA. Variable response: proportion of patients whose blood pressure levels (BP levels) remained within the established therapeutic aim for the prevention of cardiovascular accidents. Other variables: systolic and diastolic blood pressure values (SBP and DBP) in the month prior to hospitalisation and after therapeutic exchange, antihypertensive medication, comorbidities.

RESULTS

37 patients were included in the study. Following therapeutic exchange, 81.08 % maintained BP values within the range established by the European Society of Hypertension-European Society of Cardiology Committee. SBP difference: 4.82 (confidence interval [CI] 95 %: 1.09 to 10.74; p = 0.107); DBP difference: 0.15 (CI 95 %: 3.27 to 2.97; p = 0.924), and therefore not clinically significant.

CONCLUSIONS

The normalised procedure for therapeutic exchange of AIIRA is effective and safe for patients in terms of maintaining BP, which allows for adequate control of BP during the hospital stay.

[Evaluation of patient satisfaction in outpatient pharmacy]

OBJECTIVE

To establish the level of satisfaction and dissatisfaction with the service received by patients attending the Outpatient Pharmacy regarding the care received.

METHOD

Two-month long cross-sectional study. The study included all patients who had attended the Outpatient Pharmacy (OP) and had given their consent. Satisfaction was measured using a previously validated survey (Likert-type scale), with 5 possible closed answers (1: Disagree and 5: Strongly agree) and the Satisfaction Index established by the Regional Ministry of Health for the Autonomous Community of Valencia. Dissatisfaction was assessed via the complaints received by the Patient Service Department over the last 10 years.

RESULTS

Patient satisfaction survey (nfinal=138). Overall Satisfaction Index (SI): 76% (95% CI: 72-80%). Greatest satisfaction: Pharmacists Skills (SI: 88%; 95% CI: 87-88%). Lowest satisfaction: dispensing area (SI: 63%; 95% CI: 60-66%) and dispensing process (SI: 68%; 95% CI: 67-70%). Complaints (n=22). Reasons for dissatisfaction: dispensing process (72%) and dispensing area (10%).

CONCLUSIONS

Although the Satisfaction Index is a useful indicator for identifying improvements, the reasons for dissatisfaction are also required as a complement to this information. Those aspects in need of improvement are the dispensing area and process and increased structural and human resources are required.

[Identifying improvement opportunities in the management of hepatitis C]

OBJECTIVE

Hepatitis C represents a public health concern with more than 170 million carriers. The goal of this study was to identify improvement opportunities in the management of hepatitis C, and the pharmaceutical actions performed for the prevention and solution of medication-related problems in patients seen at the Pharmaceutical Care Outpatient Unit.

METHOD

A longitudinal study (January to October 2005) with patients monoinfected by hepatitis C virus receiving ribavirin and peginterferon alfa (2a or 2b). Data collection took place during the interview at the time of antiviral dispensation. Adverse reactions were classified according to CTCEA v3.0 criteria. Iaser methodology was used to identify patients with improvement opportunities regarding treatment.

RESULTS

In all 109 patients and 201 improvement opportunities were identified. Pharmacotherapeutic morbidity was identified from adverse events (blood toxicity, pseudoflu syndrome, etc.) in 425 occasions; 388 pharmaceutical actions were performed, 41.23% to prevent adverse effects and 39.95% to provide patients or carers with information.

CONCLUSIONS

In all, 99.01% of patients had safety problems. Pharmacotherapeutic morbidity from adverse effects was less common than reported in clinical trials of these drugs. Most pharmaceutical actions were preventive in nature. Iaser methodology allows to identify patients with improvement opportunities regarding hepatitis C treatment and the prevention of pharmacotherapeutic morbidity.