PS-065 Standardisation in the preparation of intravenous mixtures

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Abstract

Background

Following the indications issued by the National Institute for Occupational Safety and Health (NIOSH), it was compulsory to review the new recommendations for handling of hazardous drugs. Each hospital will use the NIOSH lists as a reference. Lack of resources and the increase in the assistance workload in the areas of elaboration are leading to the development of new systems to optimise production without reducing safety. One of the proposed strategies is the procedure of dose banding. This new approach standardises the doses in ranges or bands, accepting a percentage of maximum variation.

Purpose

To define the intravenous mixtures and the standardised optimal doses to be prepared in the pharmacy service according to the new regulations and available resources.

Material and methods

A review of all mixtures prepared in 2015 was carried out to find out the workload involved in the preparation of new mixtures. After review of the list 2 and 3 it was decided to prepare those drugs that provided added value (manipulator security, patient safety and cost optimisation). Possible theoretical doses were calculated based on the dosage of the drug (real weight/adjusted weight/ideal weight). We analysed whether the theoretical and the standardised dose was <10% and standardised doses were chosen. Results The new proposal implied a decrease of 20% in the number of intravenous mixtures carried out annually (5 intravenous mixtures less per day). We decided to carry out a total of 96 standardised mixtures corresponding to 15 drugs. 24% of the defined preparations provided safety to the manipulator (hazardous drugs). 76% improved patient safety and optimisation costs. No defined preparation presented a variation between the theoretical and the standardised dose higher than 10%.

Conclusion

Normalisation of intravenous mixtures allows more efficient management of the elaboration area. It is also expected that we will see a reduction in the errors in the production, a greater re-utilisation of the returned mixtures and, possibly, savings in direct and indirect costs.

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