Compatibility Problems and Prescribing Pattern of Injectable Drugs at the Hospital
Condition: IV Injection
Study type: Observational

Summary: 
      Drug safety is always a national, as well as international, patient safety goal.
      Administration of injection, especially intravenous infusion, is an extremely complicated and
      dangerous process, which includes reconstitution, dilution, selection of diluent and volume,
      verification of concentration of final solution, check for stability, sterility and
      compatibilities, and the selection of intravenous (IV) set, peripheral or central route, and
      the rate of infusion. Due to its inherent complexity, errors occur easily during these
      procedures. Literatures indicated that the incidence of injection administration errors
      ranged from 13% to 84%, which included errors in dosage, diluents, and volumes; excessive
      administration rate; and incompatible IV admixture.

      In the U.S.A., pharmacists provide comprehensive clinical services. They ensure the
      appropriateness of every step in the process from prescription and dosage verification, drug
      reconstitution and dilution, selection of diluents and concentration, to the rate of
      administration. Even more, they provide the final IV products that are ready to administer to
      the patients (IV admixture services). Therefore, many common administration errors can be
      avoided. In Taiwan, nevertheless, pharmacists have limited role in IV services due to our
      health-care system. There are no studies on the administration pattern of injections. There
      is still room for improvement in the assurance of injection safety.

      To ensure the safety of injection, we not only have to oversee the accuracy of drugs and
      dosage, but also take the compatibilities among drugs and diluents seriously.

      Because diluent is not a mandatory claim data, the National Health Insurance data base cannot
      provide the related information for drug compatibility epidemiology study. The application
      for reimbursement of injections is based on total amount used instead of daily usage; it is
      therefore difficult to find drug incompatibility problems in this data base. Hospital data
      base analysis, questionnaire survey and chart review are more feasible for such study.

      This study will analyze the prescriptions of IV injection in the intensive-care units and
      pediatric units to determine the prescribing pattern. High risk IV admixtures and Y-site
      administrations will be explored by questionnaire survey and literature review. Laboratory
      experiments will be done on some indicator drugs to find the reasons, categories and
      severities of the compatibilities. A list of incompatible drugs shall be generated for
      computerized intervention. We hope the results of the study can be used as a reference for
      guideline, policy and procedure for health care system and government.
    


Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        nurse in ICU
      
Keywords: Drug incompatibility; injections; infusion, intravenous; medication errors