Intravenous admixture service: implementation of service in the neonatal intensive care unit patient , Bumrungrad international Hospital

Objectives: Pharmacy Intravenous Admixture Service (IAS) provides service for patients at neonate intensive care unit (NICU), Bumrungrad international Hospital, to improve therapeutic outcomes, control expenses and develop pharmacist roles in the management of high-alert medications in NICU.

Methods: Standard concentration was created by IAS, Unit-specific formulary was created by Informatics pharmacist for the drug products used on NICU. Pharmacist detected Drug related problems (DRPs) and medication errors (MEs) of NICU patients during Jan 2011 to Jan 2012 by using the daily medical chart review. All identified DRPs and MEs were categorized into types of DRPs and medication use processes. Pharmacist interventions were provided and those acceptances were recorded.

Results: A total of 98 patients (64 male) with a mean gestational age of 34.7 weeks (26-40 weeks) were included. The mean length of hospitalisation was 31 days (2-88 days). On average, patients received 30 items (1-417 items). The majority of prescriptions were accounted for by antibiotics (n=1,515), which were received by 76% of all patients, followed by IV fluid and electrolytes(n=323) and GI drugs (n = 293). Of all the different drugs prescribed (n = 855). 24 DRPs were identified in 11 patients. DRP types included 5 drug incompatibility, 12 inappropriate dosage regimen, 3 concentration too high and 4 need additional drug therapy. The MEs were categorized by medication use process errors being 24 prescribing errors, 7 preparing errors, 1 administration errors and 5 transcribing error. A total of 24 pharmacist’s interventions were provided based on 24 DRPs. All of them were accepted by the health care team.

Conclusion: Although most DRPs did not cause harm to patient, the pharmacist had a role in management of DRPs and MEs. The success of implemented service was not only improve the quality of patient’s care but also decrease nurse workload and expenses (cost-saving 1.29 million Baht).