Evaluation of drug incompatibilities in intravenous drug administrations in intensive care unit of the department of internal medicine

Incompatibility is a physical and/or chemical reactions that occurs between two or more drugs when some parenteral drugs or mixtures are combined in the same syringe, tubing or bottle. Patients hospitalized in intensive care units usually have a limited number of venous accesses and they use a number of drugs intravenously. This situation increases the risk of drug incompatibility. The aims of this study are to identify the frequency of possible drug incompatibilities in the intensive care unit and to develop pharmaceutical guidelines for the prevention of possible drug incompatibilities to health professionals by all data obtained at the end of the study. This single-center, cross-sectional and prospective study was conducted between August 17-November 30, 2022 in the Division of Intensive Care of the Department of Internal Medicine at Ankara University. Drug request lists that include at least two intravenous drugs of patients aged 18 and over with an intensive care unit stay period equal to or longer than 24 hours were evaluated. Possible incompatibilities of intravenous drugs administered to patients were assessed using the IBM Micromedex® and Stabilis 4.0 databases. 338 drug request lists of a total of 67 patients were included. The presence of at least one possible incompatibility was detected in 68.3% of the drug request lists. Possible incompatibilities most frequently included pantoprazole, insulin and meropenem while insulin-pantoprazole was the most frequent incompatible pair. The analysis of the type of intravenous administration showed that possible incompatibilities most commonly occurred between one drug administered via continuous infusion and another via bolus (25%). Insulin(infusion)-pantoprazole(bolus) incompatibility was detected most frequently among these type of intravenous administration. 40.6% of the drugs that cause possible drug-drug incompatibilities implicated extreme drugs. When all the drug request lists included in our study were examined, there was a moderate positive correlation between the number of antimicrobials and possible incompatibilities (rho:0.404; p:0.001). A poor degree of agreement (cohen kappa:0.112) was found between IBM Micromedex® IV Compatibility and Stabilis according to the compatibility category (p<0.001). A total of 567 suggestions were stated to prevent possible drug incompatibility during the study process. Of these suggestions, 532 of them were related to Y-site incompatibility, 32 of them were related to drug-diluent incompatibility and three of them consisted of obtaining a new venous access to the patient. All of these suggestions have been accepted and implemented. In the Y-site drug-incompatibility chart developed with 52 drugs at the end of the study, 13.5% incompatible, 8% variable and 33% untested of the 1326 drug pairs. Additional studies are needed for a significant number of untested drug combinations. Pharmaceutical interventions performed by clinical pharmacists an important role in preventing and reducing the occurrence of possible drug incompatibilities.