Concurrent intravenous drug administration to critically ill children: Evaluation of frequency and compatibility

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Purpose:To evaluate the frequency of concurrent drug administration and drug-drug incompatibility of concurrently administered drugs in critically ill children based on available references.Materials and methods:We retrospectively evaluated concurrent intravenous drug administration in children admitted to a single centre. Eligible patients included those admitted to the critical care unit for at least 6-hours in the ten-year period ending 30 July 2015 and received two or more IV drug administrations. Compatibilities were classified using local reference documents.Results:The 16,863 eligible patients were admitted to ICU for 2,212,326 h and received 3,664,667 concurrent administrations. Concurrent infusions ran for 6,263,600 h. There were 2,284,066 (62%) concurrent administrations; 334,144 (9%) were compatible, 293,856 (8%) were incompatible, 293,856 (8%) required pharmacist consultation, and 752,601 (21%) had ‘unknown’ compatibility. Individual patients received a median (IQR) of 33 (10 − 132) concurrent administrations, comprised of 7 (1 − 30) concurrent injections 1 (0–5) concurrent infusions and 13 (0–74) concurrently administered injections and infusions.Conclusions:Concurrent IV-drug administration is frequent in critically ill children. Known incompatible concurrent administration occurs, however the compatibilities of many drug-drug pairs were unknown - adding complexity to routine bedside management and identifying information gaps for future research.HIGHLIGHTSIntravenous-drug administration and concurrent administration are frequent in critically ill children.Important knowledge gaps that affect more than a third of concurrent drug administration in critically ill children exist.Drug administration is complex, and has significant clinical implications on line, lumen and patient complications.

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