Economic Evaluation of Ready-to-use Injectable Medications by Pharmacy Department Compared with the Traditional System of Individual Preparation by Nurse

Objective: To dispense medication in a form of ready to use (RTU) medication was recommended by the standards of Joint Commission International (JCI) and Standard Guidelines of Hospital Pharmacy for preventing the medication error. However, the cost and benefit were questionable. The costs may increase while benefits were unclear. Before making the implementation decision, the cost of investment and benefit between traditional (injectable medication is prepared by nurse) and RTU systems (injectable medication is prepared by pharmacy department) should be evaluated. Methods: This study compared the cost and benefit of injectable medication administration between the traditional system and the RTU system within a large academic hospital. The decision tree was designed to produce comparable data on the hospital’s perspective. The time horizon was 10 years thus all costs were discounted at 3% annually. Sensitivity analysis was performed to test the stability of the results. Results: The cost of investment at 10-year intervals of the RTU system was lower than the traditional system by about 18,710,160 baht. The benefit was decreased 19.32 full time equivalents (FTEs) of nurse when compared with the traditional system. The result showed that the five most sensitive variables were number of doses, mixing time per dose (prepared by nurse), space for production, salary and fringe benefits of pharmacists, and mixing time per dose (prepared by pharmacist). Conclusion: The RTU system saved 1,871,016 baht per year and 19.32 FTEs of nurse. Moreover, the RTU system enhanced the opportunity of nurses and pharmacists to play more professional role and promoted the efficient health care system

Economic Evaluation of Ready-to-use Injectable Medications by Pharmacy Department Compared with the Traditional System of Individual Preparation by Nurse

Objective: To dispense medication in a form of ready to use (RTU) medication was recommended by the standards of Joint Commission International (JCI) and Standard Guidelines of Hospital Pharmacy for preventing the medication error. However, the cost and benefit were questionable. The costs may increase while benefits were unclear. Before making the implementation decision, the cost of investment and benefit between traditional (injectable medication is prepared by nurse) and RTU systems (injectable medication is prepared by pharmacy department) should be evaluated. Methods: This study compared the cost and benefit of injectable medication administration between the traditional system and the RTU system within a large academic hospital. The decision tree was designed to produce comparable data on the hospital's perspective. The time horizon was 10 years thus all costs were discounted at 3% annually. Sensitivity analysis was performed to test the stability of the results. Results: The cost of investment at 10-year intervals of the RTU system was lower than the traditional system by about 18,710,160 baht. The benefit was decreased 19.32 full time equivalents (FTEs) of nurse when compared with the traditional system. The result showed that the five most sensitive variables were number of doses, mixing time per dose (prepared by nurse), space for production, salary and fringe benefits of pharmacists, and mixing time per dose (prepared by pharmacist). Conclusion: The RTU system saved 1,871,016 baht per year and 19.32 FTEs of nurse. Moreover, the RTU system enhanced the opportunity of nurses and pharmacists to play more professional role and promoted the efficient health care system

Severe anaphylaxis after pelvic examination: a case report of dual latex and chlorhexidine allergies

Abstract Background Natural rubber latex and chlorhexidine have previously been identified as causative substances in perioperative anaphylaxis. A pelvic examinations is generally considered noninvasive, however, this procedure is rarely associated with severe allergic reactions. We reported a rare case of dual latex and chlorhexidine allergies which caused anaphylaxis after pelvic examination in a woman with a history of latex-related fruits allergy. Case presentation A 54-year-old woman had severe anaphylaxis after a pelvic examination due to dual latex and chlorhexidine (CHX) allergies. The gynecologist used CHX for the vaginal preparation and wore latex-containing gloves with lubricating gel during the examination. In vivo and in vitro tests revealed CHX sensitization by a positive skin prick test to chlorhexidine at a very low concentration (0.002 mg/mL), and a positive basophil activation test to CHX. Latex allergy was confirmed by a positive specific IgE to latex and a positive glove-use test at 20 min. An analysis of specific IgE to latex component revealed positive results for Hev b 1, 5, 6.02, and 11. As she also had a past history of fruit allergy, prick-to-prick testing with latex-related fruits was performed. The results were positive for avocado, banana, jackfruit, kiwi, and longan. Conclusions Concomitant mucosal exposure of both natural rubber latex and CHX in highly sensitized patients during pelvic examinations can lead to severe anaphylaxis. Pre-procedural screening for an allergy to latex or CHX, or to any other allergen, should be performed in patients where there is suspicion of a specific allergy due to a previous allergic reaction. Increased awareness of these two allergens in all healthcare settings may improve patient safety