pharmaceutical aspects of iv medicine administration
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Pharmaceutical Aspects of IV Medicine Administration. September 2009. Contents of Session. The 5 Rights of Medicines Administration The 5 Components of Medicines Administration Practitioner Responsibilities. The Five Rights of Medicine Administration. Right patient Right medicine - PowerPoint PPT PresentationTRANSCRIPT
February 2009 1
Pharmaceutical Aspects of IV Medicine Administration
September 2009
February 2009 2
Contents of Session
The 5 Rights of Medicines Administration The 5 Components of Medicines
Administration Practitioner Responsibilities
February 2009 3
The Five Rights of Medicine Administration
1. Right patient2. Right medicine3. Right route4. Right dose5. Right time
……everytime!
February 2009 4
The Five Components of Medicine Administration
1. Selection2. Prescribing3. Preparation4. Administration5. Monitoring
February 2009 5
Why IV?
Oral or other route of administration not suitable or available eg vomiting, diarrhoea, malabsorption, resting gastro-intestinal tract, low muscle mass
Where rapid effect or high/predictable concentrations essential
Medicine not effective via other routes eg gentamicin, benzylpenicillin
February 2009 6
Advantages of IV
Medicine gets into the circulation quickly Rapid effect achieved Predictable concentrations achieved i.e. 100%
reaches systemic circulation Some medicines cannot be given by another
route eg gentamicin
February 2009 7
Prescribing Prescription is clear, unambiguous and legal Medicine is essential and appropriate for
patient The patient is not allergic to medicine Dose, route and rate essential and appropriate Medicine is compatible with flush and infusion
fluid
February 2009 8
Medicines Characteristics
Cytotoxics, TPN – outsourced or made in pharmacy Diazepam – must only be administered with extreme
caution and competence IV paracetamol reduced dose in patients weighing less
than 50Kgs (dose 15mg/Kg in 40kg patient = 600mg)
February 2009 9
Dose, Route and Rate
Is route suitable for medicine?eg vincristine given intrathecally causing death, cytotoxics given peripherally causing severe extravasation and loss of limbs
Is route suitable for required rate?
Properties of the medicine? eg osmolarity, pH
What routes are available?
February 2009 10
Concentration Check that the concentration of the drug is within the
recommended range for safety and efficacyeg erythromycin must be between 1-5mg/ml
Diluent and Vehicle Not always the same! Check!
eg clarithromycin must be reconstituted with water but diluted in sodium chloride 0.9%
Concentration, Diluent and Vehicle
February 2009 11
Instability – modification of the preparation due to storage conditions resulting in unsuitable product
Incompatibility – two or more products mixed with resulting preparation unsuitable for administration
Results: product becomes toxic, precipitates or ineffective
Never add medicines to fluid unless compatibility assured Never mix medicines together unless compatibility assured
Compatibility and Stability
February 2009 12
Compatibility and stability
• Heparin / Aminoglycosides• Hydrocortisone / flucloxacillan• Co-amoxiclav - stability when
reconstituted
February 2009 13
Factor Effect Action Example
Light rate of degradation
Ensure appropriate storage
TPN, Pabrinex®
Temperature rate of degradation / microbial growth
Ensure appropriate storage
Aciclovir, insulin, TPN
pH rate of degradation
Add buffer Amphotericin
Concentration Less stable at changes in concentration
Check volume Amiodarone, amphotericin
Adsorption Drug loss into plastic/glass
Avoid or minimise contact
GTN, insulin
3. Preparation: Factors Affecting Stability
February 2009 14
Displacement volume volume of fluid displaced by a powder when reconstituted Important when part-vials are used Mainly only relevant to paediatricspH Most medicines are stable at a specific pH Rate of degradation often pH dependent
eg amphotericin requires glucose pH>4.2
Displacement Volumes and pH
February 2009 15
All products must be labelled fully Complete label before preparing injection A record must be kept of all injections
prepared and administered (kardex, infusion chart or both)
Bolus drugs …must be administered immediately on preparation, do not prepare in advance!
Labelling
February 2009 16
Sources of Information
IV Drug Monographs/ Medusa website BNF/BNFC Product Information Leaflet Medicines Information Pharmacist On-call Pharmacist University College London Hospitals
Injectable Medicine Administration Guide
February 2009 17
Red Man Syndrome
February 2009 18
Rate of Administration
Most IV bolus injections over at least 3-5 minutes Ensure device is capable of accurate delivery and desired
infusion rate 95% of IV bolus injections given too fast
Systemic damage Furosemide ototoxicity Phenytoin arrhythmias Ranitidine bradycardia Vancomycin red man
Local damage Pain Extravasation Phlebitis
February 2009 19
IV Error Potential Article in BMJ 2003 - Errors identified in 49% of doses surveyed - 8% wrong diluent/solvent - 3% wrong dose prepared - 3% of doses omitted - 38% of bolus doses given too fast - 3% incompatibility
February 2009 20
Professional Responsibility
Prescriber and Administrator Prescription is clear, unambiguous and legal Medicine is essential and appropriate Dose, route and rate is essential and appropriate Medicine is compatible with infusion fluid Appropriate monitoring requirements are in place
eg ECG machine for potassium infusions
February 2009 21
Professional Responsibility
Nurse Must have completed IV Medicines Training Package,
be certified competent and be aware of own limitations Training must be recognised by NHSGGC Must not administer a drug if doubtful about any aspect
of IV medicine prescription / calculation / preparation / compatibility / administration / monitoring
Must ensure that appropriate and current information sources used
February 2009 22
Professional Responsibility
Pharmacist Specialist knowledge Access to specialist information Can advise and provide support on any aspect of IV
medicine use ie dose, calculations, method and rate of administration, diluents, stability and incompatibilities
Can provide advice 24 hours a day via ward pharmacist, medicines information or on-call pharmacist
February 2009 23
Remember
If in doubt, don’t administer!
Most important consideration is the PATIENT
They have to suffer the consequences