Analysis of the Risk of Injection Incompatibilities in the ICU and Pharmacistsʼ Contribution toward Avoiding Such Incompatibilities / 医薬品情報学

Objective: Avoiding injection incompatibilities is important. At our hospital, pharmacists are present at the intensive care unit (ICU),where they manage drip lines and use a lookup table for injection incompatibilities. We assessed the risk of injection incompatibilities in the ICU and the contribution of pharmacists toward their avoidance.Methods: We investigated the number of injections and main drip lines used for outpatients admitted to the general ward and ICU from an emergency setting. We further investigated inappropriate drip line conditions, subsequent interventions by pharmacists, and the actual number of injection incompatibilities. The investigation period lasted 1 year from April 2016 onward.Results: The number of injections and drip lines used in the ICU was significantly higher than that used in the general ward (p<0.001). Patients in the ICU received multiple continuous intravenous injections from one drip line despite the number of main drip lines being high. Even using the lookup table, 78.3% inquiries made by nurses were related to injection incompatibilities. Fourteen inappropriate drip lines selected by nurses were associated with a risk of injection incompatibility; these occurred during the absence of pharmacists and involved a combination of continuous intravenous injections to be administered from a side line. Subsequently,pharmacists intervened and avoided injection incompatibilities. There was no report of injection incompatibilities in the ICU.Conclusion: At ICU, the risk of injection incompatibilities is high and it is necessary to focus on the combination of injections to be administered from main drip lines and side lines as well as incompatibilities of multiple continuous intravenous injections to be administered from side lines. A lookup table is insufficient to avoid injection incompatibilities. Therefore, pharmacists can contribute to avoiding injection incompatibilities by maintaining constant presence in the ICU, designing drip line layouts, and proposing line selections.

Analysis on Rational Medication of TCM Patent Medicine Based on Incompatibility / 中国中医药信息杂志

TCM incompatibility means that the combinations of some Chinese materia medica would produce or enhance side effects, or even reduce or damage medicine efficacy. Therefore, clinical incompatibility should be avoided. The core idea of TCM incompatibility is "Eighteen Clashes" and "Nineteen Incompatibilities". China Pharmacopoeia clearly states that "Eighteen Clashes" and "Nineteen Incompatibilities" belong to incompatibility. This article summarized the incompatibility in TCM patent medicine used in Guang'anmen Hospital of Chinese Medicine Academy of Sciences, with a purpose to provide references for clinical doctors and pharmacists.

Análise de incompatibilidades de medicamentos intravenosos no centro de tratamento intensivo adulto do Hospital de Clínicas de Porto Alegre / Analysis of intravenous drug incompatibilities at the adult intensive care unit of Hospital de Clínicas of Porto Alegre

Introdução: As incompatibilidades medicamentosas quando ocorrem são consideradas erro de medicação, e o produto resultante pode afetar a eficácia e a segurança da terapia, sendo que conhecer seus fundamentos pode ajudar a prevenir sua ocorrência diminuindo, assim, seus riscos. Objetivos: Identificar e quantificar as incompatibilidades físico-químicas entre medicamentos administrados através da via intravenosa em pacientes internados no Centro de Tratamento Intensivo (CTI) do Hospital de Clínicas de Porto Alegre (HCPA), observar a possibilidade de orientações farmacêuticas para a administração dos medicamentos incompatíveis. Métodos: Estudo transversal, no qual foram avaliadas as prescrições de Março a Maio de 2010, a partir dos prontuários eletrônicos, verificando a ocorrência de incompatibilidades medicamentosas entre as formas farmacêuticas intravenosas. Foi realizada uma intervenção farmacêutica por meio de orientações quanto à administração dos medicamentos identificados como incompatíveis. Resultados: Foram analisadas 65 prescrições médicas, destas 51 apresentaram incompatibilidade entre os medicamentos. A média de medicamentos intravenosos foi de sete (DP±1,6) por prescrição. Foram identificadas 177 incompatibilidades entre 35 medicamentos diferentes, que levaram a 71 possibilidades de interação. Os medicamentos mais envolvidos nas incompatibilidades foram o Midazolam (18,1%) e a Insulina (10,5%). As incompatibilidades mais encontradas foram entre Midazolam e Piperacilina+Tazobactam (9,6%) e entre Insulina e Noradrenalina (7,9%). Das 51 prescrições que geraram orientação farmacêutica, 13 destas puderam ser realizadas pela equipe de enfermagem. Conclusão: As incompatibilidades medicamentosas podem ser identificadas e evitadas com a presença do farmacêutico na unidade de internação, diminuindo a ocorrência de efeitos indesejáveis ao paciente.

Background: Drug incompatibilities are considered medication errors and their result may affect the effectiveness and safety of treatment. Knowing the reasons for drug incompatibilities can help prevent their occurrence, thus reducing their risks. Aims: To identify and quantify physical-chemical incompatibilities between medications administered intravenously to patients admitted to the Intensive Care Unit (ICU) of Hospital das Clínicas of Porto Alegre (HCPA), and to observe the possibility of pharmaceutical instructions for the administration of incompatible drugs. Methods: Cross-sectional study in which prescriptions from March to May 2010 were evaluated using electronic medical charts, verifying the occurrence of medication incompatibilities between intravenous pharmaceutical forms. A pharmaceutical intervention was conducted using instructions for the administration of those medications identified as incompatible. Results: Sixty-five medical prescriptions were analyzed, 51 of which with incompatibility between drugs. The mean number of intravenous medications was seven (SD±1.6) per prescription. A total of 177 incompatibilities were identified among 35 different drugs, which led to 71 possibilities of interaction. The drugs most often involved in incompatibilities were midazolam (18.1%) and insulin (10.5%). The most common incompatibilities found were between midazolam and piperacillin + tazobactam (9.6%) and between insulin and noradrenalin (7.9%). Of the 51 prescriptions that generated pharmaceutical instructions, 13 could be performed by the nursing team. Conclusion: Drug incompatibilities can be identified and avoided with the presence of the pharmacist at hospital admission units, reducing the occurrence of undesirable effects on patients.

Cambio tecnológico, condiciones de trabajo y perfiles de salud / Technological change: conditions of work and profile of health

Se realizó un estudio descriptivo en una industria química productora de pinturas y resinas, con el propósito de identificar los riesgos y los perfiles presuntivos de salud y la aparición de padecimientos vinculados a las nuevas formas de organización del trabajo introducidas. El perfil patológico y de riesgos se elabora a partir de una metodología que privilegia la percepción de los trabajadores. Para ello, se aplicó a 112 trabajadores la encuesta Autoadministrada del Programa Simplificado automatizado para el estudio de la Salud en el Trabajo y la identificación de los riesgos en el trabajo; y la elaboración, por parte de los trabajadores, de los mapas de riesgo en algunos departamentos del área de producción. Las encuestas revelaron que en términos generales los principales padecimientos reportados por los trabajadores estaban asociados a las incompatibilidades ergonómicas y a los riesgos vinculados a la organización y división del trabajo(AU)

She/he was carried out a descriptive study in an industry chemical producer of paintings and resins, with the purpose of identifying the risks and the appearance of suffering linked to the new forms of organization of the introduced work. The pathological profile and of risks it is elaborated starting from a methodology that privileges the perception of the workers. For it, it was applied 112 workers the survey auto administrate of the automated simplified program for the study of the health in the work and the identification of the risks in the work; and the elaboration, on the part of the workers, of the maps of risk in some departments of the production area. The surveys revealed that in general terms the main sufferings reported by the workers were associated to the ergonomic incompatibilities and to the risks linked to the organization and division of the work(AU)