Drug Administration To Critically Ill Children: Frequency, Diversity And Compatibility
CCCF ePoster library. Gaetani M. Oct 31, 2016; 150907; 29
Melany Gaetani
Melany Gaetani
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Topic: Quality Assurance & Improvement

DRUG ADMINISTRATION TO CRITICALLY ILL CHILDREN: FREQUENCY, DIVERSITY AND COMPATIBILITY


Gaetani, Melany1,10  
Frndova,Helena 5,8,10
Seto, Winnie3, 5,7, 10 
Parshuram, Christopher2,3,4,5,6,7,8,9,10
 
1Medstar Georgetown University Hospital, Department of Pediatrics
2Institute of Medical Science,
3Departments of Health Policy, Management, and Evaluation,
4Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
5Department of Critical Care Medicine,
6Department of Pediatrics,
7Department of Pharmacy
8Center for Safety Research,
9Interdepartmental Division of Critical Care Medicine
10Child Health Evaluative Sciences, The Research Institute Hospital for Sick Children, Toronto, Ontario, Canada
 
 



Abstract:

INTODUCTION/BACKGROUND: Despite the ubiquitous role of pharmacotherapy in the care of critically ill children, descriptions of the extent of pharmacotherapy in critical illness are limited1-5. Critically ill children also have limited vascular access and receive many drugs requiring concurrent intravenous (IV) administration6. Drug-drug incompatibility must be considered prior to drug administration to optimize effectiveness of drug therapy avoid clinical complications 7-10.  

OBECTIVES: The two objectives of this study were: To describe the diversity and volume of enteral and parenteral pharmacotherapy in critically ill children and assess patterns of drug administration. To evaluate the frequency and compatibilities of concurrent intravenous drug administration in critically ill children.

METHODS: A single center retrospective study was performed in two ICUs. Eligible patients were admitted to the ICU for at last 6-hours and received at >1 IV or enteral drug administration. Main outcomes were the number of drugs administered per patient, the number of drug administrations per patient day and the ranking of each drug in terms of administration. Drug administration was characterized as either enteral or parenteral and parenteral was further sub-classified as injection or infusion.

The numbers of concurrent IV-drug administrations and the drug-drug compatibilities of concurrently administered drug-drug pairs were also studied. Concurrent administration of a drug-drug pair was defined as documented administration of both IV-injections within one hour, of injection during an infusion, and of concurrent infusions. Concurrent administrations were counted and the duration of concurrent IV-infusions was reported.

Compatibilities were classified as incompatible, compatible, requiring pharmacist consultation, or unknown.
 
RESULTS: The 17,199 eligible patients were admitted to ICU for 2,208,475 hours, received 1,954,171 administrations, 3,664,667 concurrent administrations and a total of 515 various drugs. Infusions ran for a total of 4,476,538 hours and ran concurrently for 6,263,600 hours. There were 894,709 (45%) enteral doses; 60,972 (3%) continuous infusions and 998,490 (51%) injections administered over the ten year study period. Each patient had a median (IQR) of 17(7-50) administrations throughout ICU stay with a median (IQR) of 9(5-15) different drugs.
 
2284066 (62%) concurrent intravenous administrations were rated as compatible, 334144 (9%) as incompatible, 293856 (8%) required pharmacist consultation, and 752601 (21%) had ‘unknown’ compatibility information. A quarter of patients received more than either 30 concurrent injections, 5 concurrent infusions or 74 concurrently administered injections and infusions. The most commonly concurrent administered drugs were morphine and furosemide.
 
CONCLUSIONS: This large cohort demonstrates the volume and complexity of pediatric pharmacotherapy, suggests significant work load associated with oversight and administration of drug therapy, and the potential for clinical problems associated with poly-pharmacy. Limited vascular access in critically ill children, and the significant proportion of concurrent administrations with unknown compatibilities further complicates routine bedside management. Prospective studies are required to identify clinical complications, address gaps in current knowledge of drug-drug compatibility, and the utility of more compatible intravenous formulations.  


References:

REFERENCES:

  1. McDonnell C, Hum S, Frndova H, Parshuram CS. Pharmacotherapy in Pediatric Critical Illness. Pediatr Drugs. 2009;11(5):323-331. doi:10.2165/11310670-000000000-00000.
  2. Steadman E, Raisch DW, Bennett CL, et al. Evaluation of a Potential Clinical Interaction between Ceftriaxone and Calcium . Antimicrob Agents Chemother. 2010;54(4):1534-1540. doi:10.1128/AAC.01111-09.
  3. Bradley JS, Wassel RT, Lee L, Nambiar S. Intravenous Ceftriaxone and Calcium in the Neonate: Assessing the Risk for Cardiopulmonary Adverse Events. Pediatrics. 2009;123(4):e609-e613. http://pediatrics.aappublications.org/content/123/4/e609.abstract.
  4. NAKAI Y, TOKUYAMA E, YOSHIDA M, UCHIDA T. Incompatibility of Ceftriaxone Sodium with Calcium-containing Products. YAKUGAKU ZASSHI. 2009;129(11):1385-1392. doi:10.1248/yakushi.129.1385.
  5. NAKAI Y, TOKUYAMA E, YOSHIDA M, UCHIDA T. Prediction of Incompatibility of Ceftriaxone Sodium with Calcium Ions Using the Ionic Product. YAKUGAKU ZASSHI. 2010;130(1):95-102. doi:10.1248/yakushi.130.95.


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