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ENHANCING DRUG COMPATIBILITY MANAGEMENT IN THE ICU: A COLLABORATIVE APPROACH BETWEEN CLINICAL PHARMACISTS AND MEDICAL STAFF

European Statement

Clinical Pharmacy Services

Author(s)

Marco Gambera; Alessandra Grotto; Isabella Martignoni

Why was it done?

Periodic audits in hospital settings play a crucial role in identifying non-conformities and areas for improvement, ensuring that departments meet the required operational standards. During a routine inspection of the intensive care unit (ICU), the hospital pharmacy team discovered an outdated Y-site drug compatibility chart, which had not undergone prior review or approval. This non-conformity underscored the need for updated and reliable resources for managing drug compatibility in critical care settings. Addressing this issue became an opportunity to strengthen collaboration between the pharmacy and the ICU, with the aim of improving patient safety and clinical workflows

What was done?

The primary objective was to update and optimize the Y-site drug compatibility management in the ICU by revising the existing chart and educating the medical staff on real-time, evidence-based tools for accessing drug stability and interaction data integrating these tools into the daily practices of the ICU, ensuring that staff could access the most current information quickly and efficiently

How was it done?

ICU staff received dedicated training on using up-to-date software tools such as Stabilis, Micromedex, and Lexidrug. These tools provide real-time information on drug stability and interactions. Following the training, a comprehensive review of the ICU’s most frequently used medications was conducted and a new Y-site compatibility chart was developed, incorporating the latest stability data. The chart was tailored to meet the specific needs and operational practices of the ICU team, ensuring it was both practical and user-friendly

What has been achieved?

The revised chart and the associated training program significantly enhanced collaboration among healthcare professionals in the ICU, improving communication and awareness of each team member’s expertise. This project highlights the value of expanding the clinical role of hospital pharmacists, their expertise can directly improve patient care and support the management of complex drug therapies.

What next?

Further support measures will be implemented, such drug-specific tables outlining stability, interactions, storage, and handling instructions. These tables align with recommendations on medication management and provide an essential resource for clinical decision-making. The initiative not only enhanced the quality and safety of medication administration but also fostered a culture of continuous professional development and collaboration, ultimately benefiting the ICU’s clinical operations and patient outcomes

DESIGN OF AN ANTI-HAEMORRHAGIC AGENTS PROTOCOL FOR AN INTENSIVE CARE UNIT (submitted in 2019)

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European Statement

Clinical Pharmacy Services

Author(s)

Mercedes Gómez-Delgado, Marta Valera-Rubio, Margarita Carballo-Ruiz, José Luis Ortiz-Latorre, Isabel Moya-Carmona

Why was it done?

Blood coagulation factors and their adequate use can be of particular importance in the treatment of massive haemorrhage, especially in the ICU. This initiative was taken in order to improve uptake and to avoid errors in the administration, which can be difficult in emergency situations.

What was done?

To define an emergency procedure that ensures correct management in cases of massive bleeding in an intensive care unit (ICU).

How was it done?

The development of drug use protocols for emergency situations is a simple task that facilitates health workers to manage them. Prioritising the drugs to be included in a protocol by a previous survey in a multidisciplinary setting is important to consider the different points of view. We carried out a review of the pharmacy service to the ICU needs of antihaemorrhagic drugs. ICU staff (doctors and nurses) were informed to reach an agreement about eligible drugs for being included in the protocol. ICU staff requested the inclusion of four drugs in the protocol according to the prevalence of use and the difficulty of administration: human fibrinogen, tranexamic acid, eptacog alfa and human prothrombin complex. We created a protocol with four information sheets, one of each drug, made of schematic information about: 1. Physical location (fridge or room temperature, number of shelf) and minimum safety stock (3 units of human fibrinogen, 4 units of tranexamic acid and 3 units of human prothrombin complex). 2. Indications and dosage according to the clinical situation and the patient characteristics (dosage adjustment according to renal or hepatic impairment, weight or age when applicable). 3. Recommendations for intravenous administration (flow rate, bolus, loading dose, dilution, mixture stability).

What has been achieved?

Mapping the information and dividing it into sections is essential for its rapid understanding in a high-stress work environment. The implementation of this protocol was well embraced by all the staff involved, since it allowed a more efficient health care circuit for the ICU staff. It also optimises the consumption of this type of more monitored drugs.

What next?

We will monitor the compliance with this protocol, as well as possible updates that may be beneficial for a better understanding of the forms of administration.

HIGH-ALERT MEDICATIONS, A STEP FORWARD TO IMPROVE PATIENT SAFETY

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European Statement

Patient Safety and Quality Assurance

Why was it done?

The implementation of safe medication practices plays a key role to prevent medication errors (ME) in the hospital setting. High-alert medications (HAMs) are those that bear a heightened risk of causing significant patient harm when they are used in error. Institutions such as the Joint Commission requires that hospitals define institution-specific HAMs and implement good processes.
Our objective was to ensure safe medication hospital practices and to eliminate medication errors that may cause harm, which is a priority to achieve patient´s safety goals.

What was done?

A program for identifying and handle high-alert medications in a terciary hospital has been implemented.

How was it done?

The project was carried out in different stages:
-First of all, it was consulted the updated list (published in 2012) by the Institute for Safe Medication Practices. Therefore, a total of 186 drugs were HAMs.
-The second step was identified them using auxiliary red colour labels to warn health professionals of their potential danger.
-Finally, we defined general and specific strategies to take up with HAMs. In general strategies, plant kits were reviewed to remove unnecessary stock and limiting access to HAMs. It was also standardized HAM handling practices. In this way, specific strategies focused on: methotrexate, insulin and heparin. Regarding methotrexate administered orally, it was distributed a fact sheet indicating rules to promote it proper administration. Regarding insulin, a working group was formed to determine the available presentations, reserving the insulin pen for diabetic debuts. For the unfractionated heparin, a procedure for standardized dilution of 5% heparin was performed being the 1% heparin restricted to certain services.

What has been achieved?

A total of 186 medications were identifyed as HAMs and different strategies to prevent ME with those was defined. The main objective we have accomplished is becoming aware of their potential danger in case of error.

What next?

In the near future, our main objetives are asses the long-term impact of the implemented strategies, monitor ME involving HAMs and reassess the current list of HAMs to promote a needed safety culture in the hospital setting.

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