Nurses´ perceptions of automated dispensing cabinets - an observational study and an online survey.

BACKGROUND: Thirty-two automated dispensing cabinets (ADCs) were introduced in May 2015 in Kuopio University Hospital, Finland. These medication distribution systems represent relatively new technology in Europe and are aimed at rationalising the medication process and improving patient safety. Nurses are the end-users of ADCs, and it is therefore important to survey their perceptions of ADCs. Our aim was to investigate nurses' perceptions of ADCs and the impacts of ADCs on nurses' work. METHODS: The study was conducted in the Anaesthesia and Surgical Unit (OR) and Intensive Care Unit (ICU), of a tertiary care hospital, in Finland. We used two different research methods: observation and a survey. The observational study consisted of two 5-day observation periods in both units, one before (2014) and the other after (2016) the introduction of ADCs. An online questionnaire was distributed to 346 nurses in April 2017. The data were analysed using descriptive statistics including frequencies and percentages and the Chi-Square test. RESULTS: The majority (n = 68) of the 81 respondents were satisfied with ADCs. Attitudes to ADCs were more positive in the ICU than in the OR. Nearly 80% of the nurses in the ICU and 42% in the OR found that ADCs make their work easier. The observational study revealed that in the OR, time spent on dispensing and preparing medications decreased on average by 32 min per 8-h shift and more time was spent on direct patient care activities. The need to collect medicines from outside the operating theatre during an operation was less after the introduction of ADCs than before that. Some resistance to change was observed in the OR in the form of non-compliance with some instructions; nurses took medicines from ADCs when someone else was logged in and the barcode was not always used. The results of the survey support these findings. CONCLUSIONS: Overall, nurses were satisfied with ADCs and stated that they make their work easier. In the ICU, nurses were more satisfied with ADCs and complied with the instructions better than the nurses in the OR. One reason for that can be the more extensive pilot period in the ICU.

Opioid-Induced Bowel Dysfunction in Patients Undergoing Spine Surgery: Comparison of Oxycodone and Oxycodone-Naloxone Treatment.

INTRODUCTION: Opioids are needed for postoperative pain in spine surgery patients, but opioid-induced constipation is a harmful adverse event. The aim of this clinical trial was to compare the use of a controlled-release oxycodone-naloxone combination product with oxycodone controlled-release tablets in these patients. The main outcome measure was the prevalence of constipation at 7 days postoperatively assessed with a Bowel Function Index questionnaire. A follow-up assessment at 21 days after surgery was also included. METHODS: A total of 180 patients undergoing spine surgery, 91 having preoperative opioids in use and 89 opioid-naïve, were randomized to receive twice-daily oxycodone 10 mg or oxycodone-naloxone 10/5 mg controlled-release tablets for the first 7 postoperative days. Patients were followed-up for 21 days after surgery. RESULTS: At baseline, prevalence of constipation was common both in the opioid-naïve-25/87 (29%) and on-opioid groups 43/90 (48%) (P = 0.009). This increased at 7 days postoperatively with no difference between the groups, 54/89 with oxycodone and 54/88 with oxycodone-naloxone had constipation. At 21 days, constipation was less than in the baseline in both groups, in the opioid-naïve group the prevalence of constipation was 3/43 (7%) in patients with oxycodone-naloxone compared to 9/44 (21%) with oxycodone (effect size 0.68; P = 0.068). Both study compounds provided similar pain relief and were well tolerated. CONCLUSION: In patients presented for back surgery, the prevalence of constipation was significantly higher than that in the community. In opioid-naïve subjects, oxycodone-naloxone was beneficial concerning constipation; but this was not distinguishable in subjects with chronic opioid use. The analgesic efficacy of oxycodone and oxycodone-naloxone was similar. TRIAL REGISTRATION: European Clinical Trials Database (EudraCT no. 2012-001816-42) and ClinicalTrials.gov database (Identifier: NCT02573922).

[Drug therapy for cough]. / Yskän Iääkehoito.

An efficient therapy for cough usually requires identification and treatment of the underlying disease, like asthma. However an underlying disease in cough is not found in all cases and conventional treatment of the underlying disease is ineffective against cough. Drug therapy options are available also for these situations. Honey or menthol can be tried for cough associated with respitatory infections, antihistamines for cough associated with allergic rhinitis, blockers of the leukotriene receptor or muscarinic receptor for asthma-associated cough and morphine for cough associated with a malignant disease. Menthol, blockers of the muscarinic receptor, or dextrometorphan can be tried for prolonged idiopathic cough. Codeine is not necessary in the treatment of cough. Refraining from drug treatment should always be considered.

Stability of sufentanil and levobupivacaine solutions and a mixture in a 0.9% sodium chloride infusion stored in polypropylene syringes.

We have evaluated the chemical and microbiological stability of sufentanil citrate, levobupivacaine hydrochloride and a mixture in a 0.9% sodium chloride infusion in order to provide background information on the storage of a sufentanil-levobupivacaine mixture in polypropylene (PP) syringes. Chemical assays were performed by HPLC on days 0, 1, 2, 3, 8, 14, 23, 28 and 30 after storage at 4, 21, and 36 degrees C. Microbiological stability was evaluated under aseptic conditions using a laminar air flow station, with a grade A environment and a B background. The samples taken for microbiological analysis were collected immediately after preparation of the solutions and then after 7, 14, 21 and 28 days storage. At 4 degrees C the sufentanil citrate solution was stable for 23 days. At 21 degrees C the sufentanil citrate solution maintained chemical stability for 3 days, but thereafter the concentration of sufentanil decreased 15% from day 3 to day 8. At 36 degrees C a similar decrease was noticed from day 1 to day 3. On the contrary, the levobupivacaine hydrochloride solution maintained chemical stability for 28 days at 4 and 21 degrees C and for 23 days at 36 degrees C. The sufentanil-levobupivacaine mixture maintained chemical stability for 28 days at 4, 21 and 36 degrees C. The sufentanil and levobupivacaine solutions and the mixture studied maintained microbiological stability for 28 days. According to the chemical and microbiological stability studies, the sufentanil-levobupivacaine mixture in PP syringes could be stored for 28 days at 4 and 21 degrees C.

pH Stability of Injectable Fentanyl, Bupivacaine, or Clonidine Solution or a Ternary Mixture in 0.9% Sodium Chloride in Two Types of Polypropylene Syringes.

The pH stability of injectable fentanyl, bupivacaine, or clonidine solution or a ternary mixture in 0.9% sodium chloride, all of which were stored in polypropylene syringes, was determined. Two different types of polypropylene syringes were tested: one (Omnifix, B. Braun, Melsungen, Germany) had a synthetic latex-free polyisoprene piston and the other (Terumo, Leuven, Belgium) did not contain natural rubber or synthetic rubber. Forty-eight Omnifix 50-mL syringes and 120 Terumo 20-mL syringes were tested. The syringes were filled with a fentanyl citrate solution 35 microgram/mL (stored in 12 Omnifix and 30 Terumo syringes), a bupivacaine hydrochloride solution 1mg/mL (12 Omnifix and 30 Terumo syringes), a clonidine hydrochloride solution 9 micrograms/mL (12 Omnifix and 30 Terumo syringes), or a ternary mixture in 0.9% sodium chloride (12 Omnifix and 30 Terumo syringes). The syringes were stored for 30 days at 4 deg C, 21 deg C, and 35 deg C. Duplicate samples were prepared, observed for precipitation and color change, and measured for pH immediately after preparation and at 1, 2, 5, 7, 9, 12, 16, 23, and 30 days of storage. There was no color change or precipitation in any sample during 30 days of storage at any of the temperatures studied. There was no change in the pH of the fentanyl, bupivacaine, or clonidine soltuions or in the ternary mixtrue stored in Terumo syringes for 30 days of storage at 4 deg C, 21 deg C, and 35 deg C. Omnifix syringes performed differently with different drug solutions. No siginicant change in the pH of the fentanyl bupivacaine, or clonidine solutions or of the ternary mixture stored in the Omnifix syringes was observed during 30 days of storage at 4 deg C, 21 deg C, and 35 deg C, except for the clonidine solutions stored at 21 deg C and 35 deg C.