Decision‐support tools to manage drug incompatibilities: evaluation by nurses

Liliane Gschwind1, Laure-Zoé Kaestli1, Isabella De Giorgi 2, Claude Guegueniat-Dupessey3, Caroline Fonzo-Christe1, Pascal Bonnabry1,4

1Pharmacy, Geneva University Hospitals (HUG); 2Pharmacy, Lausanne University Hospital (CHUV); 3Nursing directorate, G 4S f f G f SHUG; 4School of pharmaceutical sciences, University of Geneva, University of Lausanne, Switzerland

INTRODUCTIONPreventing drug incompatibilities has a high impact on the safety of drug therapy. Although there are no international guidelines tomanage drug incompatibilities, different decision-support tools such as handbooks, cross-tables and databases are available. In aprevious study, two decision-support tools have been pre-selected by pharmacists as fitting nurses’ needs on the wards1. Theobjective of this study was to have these both tools evaluated by nurses to determine which would be the most suitable for theirdaily practice.

MATERIALS & METHODS

1. Cross‐table of drug pairs (CHUV V9.0 du 18.5.2006) (http://files.chuv.ch/internet‐docs/pha/medicaments/pha_phatab_compatibilitessip.pdf )

MATERIALS & METHODSAssessment of two tools (fig.2) by 48 nurses in 5 units (PICU, adultand geriatric intensive care, surgery, onco-hematology) using astandardized form1.

Scientificaccuracy

Evaluation by determining the compatibility of fivedrugs pairs (fig.2): rate of correct answersaccording to the Trissel’s Handbook on InjectableDrugs 15th ed, chi-square test.

2. Colour‐table

A colour for each drug according to the pH: 

red = acid; blue = basic; yellow = neutral; black = to be infused alone2 

ErgonomicsApplicabilityDesignReliability

CONCLUSION

Evaluation using visual analogue scales (VAS 0-10; 0 = null, 10 = excellent). Results areexpressed as the median and interquartile range(IQR) for 25% and 75% (Wilcoxon rank sum test).

CONCLUSIONBoth tools showed the same accuracy to assess drugcompatibility. In terms of ergonomics and applicability thecross-table was better than the colour-table, and waspreferred by the nurses for their daily practice. Thecross-table will be implemented in our hospital asdecision-support tool to help nurses to manage drugincompatibilities

Fig.2: Drugs pairs and tools assessed

RESULTSThe rate of correct answers was above 90% for both

tools (cross-table 96.2% vs colour-table 92.5%, p >0.05).

The ergonomics (fig.3) and the applicability (fig.4) incompatibilities.g ( ) y ( )were higher for the cross-table [7.1 (IQR25 4.0, IQR75 8.0) vs5.0 (2.7 - 7.0), resp. 8.3 (7.4 - 9.2) vs 7.6 (5.9 - 8.8)].

The design (fig.5) of the colour-table was judgedsignificantly better [4.6 (2.9 - 7.1) vs 7.1 (5.4 - 8.4)].

No significant difference was observed in terms ofreliability (fig.6) [7.3 (6.5 - 8.4) vs 6.7 (5.0 - 8.6)].

The cross-table was globally preferred by 65% of thenurses (fig.7) and 68% would like to have this decision-

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Fig.4: Applicability

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Fig.3 : ErgonomicsCross-table Colour-table Cross-table Colour-table

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Fig.7: Nurses’ global preferences

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Fig.6: ReliabilityFig.5: DesignCross-table Colour-tableCross-table Colour-table

39th European Symposium on Clinical PharmacyLyon 21.‐ 23.10.2010

This poster can be downloaded and printed at following address: http://pharmacie.hug-ge.ch/rd/posters.html

References : 1De Giorgi I et al. Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units. Pharmacy World & Science 2010; 32(4): 5202Vogel Kahmann I et al. Inkompatibilitätsreaktionen auf der Intensivstation. Anaesthesist 2003; 52: 409-412

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