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외과계 중환자실의 약물-영양 상호작용과 배합적합성에 대한 처방 현황 및 약물 조정의 영향 평가

Interaction and Compatibility Between Parenteral Administration of Drugs and Nutrient in the Surgical Intensive Care Unit: Effects of Clinical Pharmacist Interventions

병원약사회지 2021년 38권 1호 p.41 ~ 51
이경화, 허은정, 김윤희, 이정화, 이은숙, 김은경, 송인애,
소속 상세정보
이경화 ( Lee Kyung-Hwa ) - Seoul National University Bundang Hospital Department of Pharmacy
허은정 ( Heo Eun-Jeong ) - Seoul National University Bundang Hospital Department of Pharmacy
김윤희 ( Kim Yoon-Hee ) - Seoul National University Bundang Hospital Department of Pharmacy
이정화 ( Lee Jung-Hwa ) - Seoul National University Bundang Hospital Department of Pharmacy
이은숙 ( Lee Eun-Sook ) - Seoul National University Bundang Hospital Department of Pharmacy
김은경 ( Lee Euni ) - Seoul National University College of Pharmacy
송인애 ( Song In-Ae ) - Seoul National University Bundang Hospital Department of Anesthesiology and Pain Medicine

Abstract


Background : Patients in surgical intensive care unit (SICU) commonly receive numerous intravenous drugs and are supported by parenteral nutrition. Thus, patients are often exposed to drug-nutrient interactions and incompatibilities. Compatibility issues with parenteral administrations are crucial for practitioners as it could impact clinical outcomes. The purpose of this study was to evaluate the appropriateness of drug administration by investigating drug-nutrient interactions and compatibility and to assess drug users’ recognition and experiences related with ICU pharmacist services.

Methods : A retrospective evaluation of drugs and nutrients in all prescriptions of patients admitted to the SICU during June 2017 was performed using electronic medical records. Then, in from September to October 2017, the drug administration routes were checked in patients who received total parenteral nutrition (TPN) in the ICU and drug adjustments were performed if the combination was inappropriate. Questionnaires were distributed to SICU nurses responsible for administering drugs for one week to assess the recognition and required pharmacy service regarding drug-nutrient compatibility.

Results : In this study, 247 intravenous drug-nutrient interactions were identified from 18,350 combinations between drugs and nutrients. Fifteen interactions were recorded as “consideration of therapeutic correction” by the Lexicomp online® standard and all were interactions between calcium and ceftriaxone. The drug route study revealed 18 incompatibilities in intravenous drug-nutritional combinations, of which were ‘no concomitant data’ on the basis of the Lexicomp online®. In the nurses’ questionnaire conducted after the pharmacists’ interventions, 86.7% were aware of Y-site incompatible drugs and 16.7% experienced witnessing sedimentation or foreign materials. The required clinical pharmacy service was easy access to acquire information regarding compatibility.

Conclusion : Findings from our study show that pharmacists’ interventions were necessary to determine drug modification of drugs or routes of drug administration. Additionally, the questionnaire confirmed the need for development of information access services regarding drug administration.

키워드

ical intensive care unit; Drug-nutrient interaction; Drug-nutrient compatibility

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