Extemporaneous Compounding: A Possible Trigger Tool to Detect potentially health incidents

Abstract

Background: Extemporaneous compounding (EC) involves preparation of a therapeutic product to a specific-patient need. However, there is a potential relation between this procedure and the occurrence of health incidents (HI). The use of triggers tool increases HI identification. Objective: This study assessed the performance of EC as trigger to detect potentially health incidents arising from this procedure. Method: A one-month observational and cross-sectional study was performed in internal medicine ward and intensive care unit of medium-sized hospital. Data collection was carried out in 5 stages: all triggered patients with dysphagia or enteral feeding tube with prescription of EC were included; it was observed all EC executed in standardized drugs prescribed; the procedure was compared with the hospital guide and scientific literature; HI monitoring and their evaluation using WHO and NCC MERP algorithms; a search for pharmaceutical alternatives (PA) that would avoid the observed EC. Results: 197 patients were recruited. Almost half of them were triggered by EC from 84 standardized drugs. 48 patients met inclusion criteria. It was identified 28 adverse drug reactions, 01 therapeutic ineffectiveness and 29 medication errors. EC as trigger tool showed a PPV value of 0.38. Finally, only 24 drugs have PA available in the market, that could avoid one third of all observed EC. Conclusion: It was possible to detect potentially HI in one of two patients with enteral feeding tube using EC as trigger tool. The use of EC as a trigger tool contributes to identify potentially HI arising from drugs, which have not gotten pharmaceutical alternatives to be administered via enteral feeding tube.