Melany Gaetani1, Helena Frndova2, Winnie Seto3, Christopher Parshuram4. 1. Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada. Electronic address: melany.gaetani@gmail.com. 2. Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada; Department of Critical Care Medicine, 555 University Ave, Toronto, ON M5G 1X8, Canada; Center for Safety Research, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada. Electronic address: helena.frndova@sickkids.ca. 3. Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada; Department of Critical Care Medicine, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Pharmacy, 555 University Ave, Toronto, ON M5G 1X8, Canada. Electronic address: winnie.seto@sickkids.ca. 4. Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada; Institute of Medical Science, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Departments of Health Policy, Management, and Evaluation, University of Toronto, 27 King's College Cir, Toronto ON M5S, Canada; Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Pediatrics, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Pharmacy, 555 University Ave, Toronto, ON M5G 1X8, Canada; Center for Safety Research, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning [PGCRL], 686 Bay Street, 11th floor, Toronto, Ontario M5G 0A4, Canada. Electronic address: christopher.parshuram@sickkids.ca.
Abstract
PURPOSE: To evaluate the frequency of concurrent drug administration and drug-drug incompatibility of concurrently administered drugs in critically ill children based on available references. MATERIALS AND METHODS: We retrospectively evaluated concurrent intravenous drug administration in children admitted to a single centre. Eligible patients included those admitted to the critical care unit for at least 6-hours in the ten-year period ending 30 July 2015 and received two or more IV drug administrations. Compatibilities were classified using local reference documents. RESULTS: The 16,863 eligible patients were admitted to ICU for 2,212,326h and received 3,664,667 concurrent administrations. Concurrent infusions ran for 6,263,600h. There were 2,284,066 (62%) concurrent administrations; 334,144 (9%) were compatible, 293,856 (8%) were incompatible, 293,856 (8%) required pharmacist consultation, and 752,601 (21%) had 'unknown' compatibility. Individual patients received a median (IQR) of 33 (10-132) concurrent administrations, comprised of 7 (1-30) concurrent injections 1 (0-5) concurrent infusions and 13 (0-74) concurrently administered injections and infusions. CONCLUSIONS: Concurrent IV-drug administration is frequent in critically ill children. Known incompatible concurrent administration occurs, however the compatibilities of many drug-drug pairs were unknown - adding complexity to routine bedside management and identifying information gaps for future research.
PURPOSE: To evaluate the frequency of concurrent drug administration and drug-drug incompatibility of concurrently administered drugs in critically ill children based on available references. MATERIALS AND METHODS: We retrospectively evaluated concurrent intravenous drug administration in children admitted to a single centre. Eligible patients included those admitted to the critical care unit for at least 6-hours in the ten-year period ending 30 July 2015 and received two or more IV drug administrations. Compatibilities were classified using local reference documents. RESULTS: The 16,863 eligible patients were admitted to ICU for 2,212,326h and received 3,664,667 concurrent administrations. Concurrent infusions ran for 6,263,600h. There were 2,284,066 (62%) concurrent administrations; 334,144 (9%) were compatible, 293,856 (8%) were incompatible, 293,856 (8%) required pharmacist consultation, and 752,601 (21%) had 'unknown' compatibility. Individual patients received a median (IQR) of 33 (10-132) concurrent administrations, comprised of 7 (1-30) concurrent injections 1 (0-5) concurrent infusions and 13 (0-74) concurrently administered injections and infusions. CONCLUSIONS: Concurrent IV-drug administration is frequent in critically ill children. Known incompatible concurrent administration occurs, however the compatibilities of many drug-drug pairs were unknown - adding complexity to routine bedside management and identifying information gaps for future research.