Medication Administration through Enteral Feeding Tubes in Mechanically Ventilated Critically Ill Patients: Evaluation of the Potential Medication Errors
Background: Oral medication administration through enteral feeding tubes is a challenging issue in critically ill patients, which can lead to medication error. Patients admitted to the intensive care unit may not have the ability to swallow oral medications for various reasons such as lack of consciousness, or the need for mechanical ventilation. Improving the quality of drug administration through enteral feeding tubes is essential.
Objectives: The present study aimed at evaluation of the prevalence of medication errors that occur during the administration of oral medications through enteral feeding tubes in mechanically ventilated critically ill patients.
Methods: This study was a cross-sectional observational study conducted in Golestan Educational Hospital, Ahvaz, Iran. Oral medication administration was evaluated in 50 patients within three months; information about each patient was examined. The errors were measured according to the Handbook of Drugs Administration via enteral feeding tubes.
Results: Errors occurred in percentage of total prescriptions as follows: Drug-drug interaction 26%, wrong preparation 22.28%, wrong form 12.09%, wrong time 11.57%, drug-food interaction 6.73%, wrong dose 5.53%, wrong route 3.8%, extra dose 0.86%, omission 0.18%, deteriorated drug 0.18%, and unordered drug 0.0%. In our study, it was found that most of the drugs were administered in solid dosage forms, and almost 33% of them could be substituted for injection or oral liquid formulations.
Conclusion: Our study indicated the high frequency of drug administration and preparation errors in mechanically ventilated critically ill patients. Close teamwork between pharmacists or pharmacotherapists, physicians, and nurses can result in the appropriate administration of medications by an enteral feeding tube.
2. Gorzoni LG, Della Torre A, Pires SL. Drugs, and feeding tubes. Rev Assoc Med Bras 2010;56(1):17-21.
3. Bankhead R, Boullata J, Brantley S, et al. Enteral nutrition practice recommendations. J Parenter Enteral Nutr 2009;33(2):122-67.
4. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT. Recommendations for the use of medications with continuous enteral nutrition. Am J Health Sys Pharm 2009;66 (16):1458-67.
5. Matsuba CST, Gutiérrez MGR, Whitaker IY. Development and Evaluation of Standardized Protocol to Prevent Nasoenteral Tube Obstruction in Cardiac Patients Requiring Enteral Nutrition with Restricted Fluid Volumes. J Clin Nurs 2007;10(16):1872-77.
6. Wick JY. The ins and outs of medication delivered by enteral tube. Consult Pharm 2006; 21(8):659-62.
7. Catalán E, Padilla E, Hérvas F,et al. Fármacosoralesque no debensertriturados. Enferm Intensiva 2001;3(12):146- 50.
8. Boullata JI. Drug administration through an enteral feeding tube. Am J Nurs 2009;109(10): 34-42.
9. Sánches AIG, Almagro CGM, Aranzana MC, et al. Atenciónfarmacéutica en pacientes con nutrición enteral. Farm Hosp 2006;30(1):44-8.
10. Van den Bemt PMLA, Cusell MBI, Overbeeke PW, et al. Quality improvement of oral medication administration in patients with enteral feeding tubes. Qual Saf Health Care 2004;1(15):44-7.
11. Barbosa AP, de Paula SL, Barbosa DS, da Cunha DF. Oral drug administration by enteral tube in adults at a tertiary teaching hospital. E SPEN J. 2012;7:e241–4.
12. Silva MJ, Cava CE, Pedroso PK, Futuro DO. Evaluation of the profile of drug therapy administered through enteral feeding tube in a general hospital in Rio de Janeiro. Braz J Pharm Sci 2011;47:331–7.
13. Emami S, Hamishehkar H, Mahmoodpoor A, Mashayekhi S, Asgharian P. Errors of oral medication administration in a patient with enteral feeding tube. J Res Pharm Pract 2012;1:37–40.
14. Presoti AR, do Nascimento MM, Marques LA. Prescription of drugs to be administered through feeding tubes in a Brazilian hospital: Profile and qualification. J Gen Pract 2013;1: 112.
15. Heineck I, Bueno D, Heydrich J. Study on the use of drugs in patients with enteral feeding tubes. Pharm World Sci 2009;31:145–8.
16. Bauer LA. Interference of oral phenytoin absorption by continuous nasogastric feedings. Neurology 1982;32:570–2.
17. White R, Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. London: Pharmaceutical Press; 2015.
18. McAuley JW, Lott RS, Alldredge BK. Seizure disorders. In: Alldredge BK, Corelli RL, Ernst ME, Guglielmo BJ, Jacobson PA, Koda-Kimble MA, et al., editors. Applied Therapeutics: The Clinical use of Drugs. Philadelphia, PA: Wolters Kluwer/Lipincot William and Wilkins; 2013. pp. 1387–418.
19. Dashti-Khavidaki S, Badri S, Eftekharzadeh SZ, Keshtkar A, Khalili H. The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses. Int J Clin Pharm 2012;34:757–64.
20. Abbasinazari M, Zareh-Toranposhti S, Hassani A, Sistanizad M, Azizian H, Panahi Y. The effect of information provision on reduction of errors in intravenous drug preparation and administration by nurses in ICU and surgical wards. Acta Med Iran 2012;50:771–7.
21. Sohrevardi SM, Jarahzadeh MH, Mirzaei E, Mirjalili M, Tafti AD, Heydari B. Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit. Journal of Research in Pharmacy Practice 2017;6(2):100-105.
22. White, R. and V. Bradnam, Handbook of drug administration via enteral feeding tubes. 2015: Pharmaceutical Press.
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