PP-019 Centralised iv compounding: A pre-feasibility study in clinical practice

Background In clinical practice, intravenous injectable drugs (IV) are typically administered after extemporaneous reconstitution and preparation performed by nurses. This process can lead to undetected medication errors and microbial contamination. CIVAS Unit (Central IntraVenous Additive Services), centralised production facility that satisfies the quality and safety requirements of sterile medications, is a key solution developed to improve the safety of this process. Purpose This work represents a preliminary study to investigate the prescribing habits of different departments as a first step in the goal to centralise and automate the IV production process. Material and methods All medical records of patients admitted in June 2014 to various clinical departments (orthopaedics, infectious diseases division, cardiac surgery department) were inspected. All of the intravenous therapies were examined, focusing on class of drug, molecules prescribed, related dosage, dilution, posology and chemical stability. Results Within this sample, 5285 intravenous administrations were prescribed to 266 different patients (144 orthopaedics, 38 infectious disease, 84 cardiac surgery). Antibiotics were the most commonly prescribed class (36.6%), followed by diuretics (22.6%), painkillers (16.4%) and proton pump inhibitors (7.6%). Of these administrations, 16.1% were commercially available in ready to administer formulations, while 42.7% were available in solution for injection, and 41.2% as lyophilic drugs for reconstitution. The majority of these drugs were compounded prior to administration with a bag as a final container (90.9%), while the remaining 9.1% were administered in a syringe. The medications consisted of 84 different molecules. Of these, 20 molecules represented 83% of total administrations with furosemide (20.1%) being the most utilised, followed by cefazoline (10.7%) and paracetamol (9.8%). Dosages were mainly standard and single, with some exceptions. For example, furosemide was available in 4 different dosages. Comparing international scientific studies and official data, the 10 most common medications showed a stability longer than 24 h, ranging from 24 h to 10 days. Conclusion The goal of centralising and automating IV production is reasonable and promising given that the most used molecules are limited in number and utilised in a standard way. Moreover, drug stability demonstrated the feasibility of centralised production in advance and in creating dedicated storage. Next steps include evaluation of the economic aspects. No conflict of interest.