S. ODUYALE (1), F. Fillippidou (1), M. Borthwick (2), N. Patel (1).
1University of Reading, Pharmacy Practice, Reading, United Kingdom.
2John Radcliffe Hospital – Oxford University Hospitals NHS Foundation Trust, Critical Care, Oxford, United Kingdom.
Co-administration of multiple intravenous (IV) medicines down the same line usually occurs in the intensive care units (ICUs) of hospitals due to the numerous amounts of prescribed medicines and limited venous access. Ensuring medicine compatibility before co-administration is therefore a critical element for the safe delivery of intravenous medicines to patients, as medicine incompatibility has the potential to compromise therapeutic efficacy or cause an adverse effect.
The aim of the study was to identify types of medicines co-administered via Y-site, determine the frequency of this practice and how medicine compatibility is checked before co-administration. This information could inform on strategies to improve safer co-administration practice within ICUs.
Material and methods
An inception cohort study was conducted across 4 ICUs (2 Adult, 1 Cardiothoracic and 1 Neuro ICU) in a large teaching hospital. A data collection tool was designed, piloted and used on the ICUs to record the use of catheters and connectors, types and frequency of co-administrations and means by which medicine compatibility was checked. Patients were followed for a period of 7 days or until discharged.
Forty-nine patients were included in the study and all received at least 1 or more infusions. Twenty-nine had 2 or more co-infusions through the same catheter via a Y site connector. There were 114 cases of medicine co-administration, of which propofol and fentanyl were the most frequently administered medicine combination (39%). Compatibility was checked for 90 out of the 114 cases (78.9%), with the remainder either not being verified or not done/checked. Of the 90 checked cases, 41.1% (37/90) were based on nurses’ experience and 21.1% (19/90) on the Thames Valley compatibility chart.
Co-administration of multiple IV medicines via a Y site connector seems to occur frequently in ICUs. Although compatibility was checked most of the time, nurses’ experience was found to be the most common means of deciding compatibility. Further work is needed to explore the rationale behind nurses’ decision making process regarding the administration of 2 or more medicines down the same line and how this may affect patients.
References and/or Acknowledgements
University of Reading’s Undergraduate Research Opportunity Placement for funding Foteni Fillippidou.