Prevalence and Drivers of Drug Incompatibility, based on Hospital-wide Drug Prescription and Administration Data: A Retrospective Descriptive Study (Preprint)

Abstract

Drug incompatibility, a major subset of medication errors, threatens patient safety during the medication administration phase. Despite the undeniably high prevalence of drug incompatibility, it is currently poorly understood because previous studies are focused predominantly on intensive care unit (ICU) settings. To enhance patient safety, it is crucial to expand our understanding of this issue from a comprehensive viewpoint.

This study aims to investigate the prevalence and mechanism of drug incompatibility by analyzing hospital-wide prescription and administration data.

This retrospective cross-sectional study, conducted at a tertiary academic hospital, included data extracted from the clinical data warehouse of the study institution on patients admitted between January 1, 2021, and May 31, 2021. Potential contacts in drug pairs (PCs) were identified using the study site clinical workflow. Drug incompatibility for each PC was determined by using a commercial drug incompatibility database (Trissel’s 2 IV Compatibility Database). Drivers of drug incompatibility were identified, based on a descriptive analysis, after which, multivariate logistic regression was conducted to assess the risk factors for experiencing one or more drug incompatibilities during admission.

Among 30,359 patients (representing 40,061 hospitalizations), 24,270 patients (32,912 hospitalizations) with 764,501 drug prescriptions (1,001,685 IV administrations) were analyzed, after checking for eligibility. Based on the rule for determining PCs, 5,813,794 cases of PCs were identified. Among these, 25,108 (0.4%) cases were incompatible PCs: 391 (1.6%) PCs occurred during the prescription process and 24,717 (98.4%) PCs during the administration process. By classifying these results, we identified the following drivers contributing to drug incompatibility: incorrect order factor; incorrect administration factor; and lack of related research. In multivariate analysis, the risk of encountering incompatible PCs was higher for patients who were male (odds ratio [OR] 1.532, 95% confidence interval [CI] 1.399–1.678), older (OR 1.021, 95% CI 1.018–1.025), with longer lengths of stay (OR 1.020, 95% CI 1.016–1.025), with higher comorbidity (OR 1.075, 95% CI 1.030–1.122), and admitted to medical ICUs (OR 6.862, 95% CI 4.138–11.325).

We comprehensively described the current state of drug incompatibility by analyzing hospital-wide drug prescription and administration data. The results showed that drug incompatibility frequently occurs in clinical settings.