Aim In 2007 the National Patient Safety Agency issued an alert entitled ‘Safer Use of Injectable Medicines’. In response to this alert a number of hospitals have set up Centralised Intravenous Additive Services (CIVAS) to provide ready to use syringes for commonly prescribed intravenous (IV) medications to the wards. It offers a number of advantages including: saving nursing time, reducing risk of calculation and manipulation errors, improving infection prevention and control and leading to potential cost saving (vial sharing). A recent audit in our hospital identified 20% of wastage of ready to use syringes associated with significant cost. One way in which to address the issue is produce batches of ready to use syringes of dose banded antimicrobial. Also, the Peadiatric Sepsis 6 Initiative states that intravenous antibiotics should be given to the patients within the hour. Dose-banded antimicrobial preparation could also assist the paediatric emergency department to reduce the patient’s wait. The aims of the study was to review the current practice of other paedatric hospitals in order to analyze the feasibility of introducing batch production of dose-banded antimicrobials.
Method We conducted a 20-question survey sent from the 18th of February until the 7th of April 2021 to the Neonatal and Paediatric Pharmacy Group (NPPG), French Society of Clinical Pharmacy (SFPC), European Association of Hospital Pharmacy (EAHP) and other hospital pharmacists from Belgium and Switzerland.
Results Forty-eight pharmacists from 44 paediatric hospitals and 8 different country participated to the survey. Seventeen (36%) were from the United Kingdom, n=16 (32.7%) from France, n=7 (14.3%) from Belgium, n=4 (8.2%) from Switzerland, n=1 (2%) from Canada, n=1 (2%) from Finland, n=1 (2%) from Ireland and n=1 (2%) from Russia. Almost all the participants have heard about dose banding before (n=45; 94%). Only n=13 (31%) hospitals prescribed medications with dose bands such as IV chemotherapies (n=27; 64.3%), antimicrobials (n=9; 21.4%) and other type of drugs (n=6; 14.3%). The dose banded antimicrobials were cefotaxime, ceftriaxone, piperacillin/tazobactam and benzylpenicillin. Almost all of the participants agreed that it could reduce prescription errors (n=37; 77.1%), save nursing time (n=37; 77.1%) or reduce wastage by reassigning the syringe to another patient (n=32; 66.7%). On the other hand, n=13 (27.1%) participants thought dose banding can expose to risks of drug inefficacy or toxicity by not giving the exact dose (milligram-per-weight) and n=8 (16.7%) thought it can increase wastage (because of the batch production and the expiry date). Only 13 hospitals (29%) prepared some antimicrobial in the centralized aseptic unit with milligram-per-weight doses.
Conclusion Some paediatric hospitals have experienced dose banding for IV antimicrobials such as cefotaxime, ceftriaxone, piperacillin/tazobactam and benzylpenicillin. The participants of the survey thought that it was very attractive in order to reduce wastage and the prescription errors. On the other hand, there was no paediatric hospitals currently producing batches of IV antimicrobials in the CIVAS. Introducing batches of dose banded antimicrobials will needs further studies about time and cost saving as well as stability of some IV antimicrobials syringes.
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