RESIDUAL VOLUME OF AMPOULE-VIALS AND UNDERDOSING OF MEDICATIONS PREPARED BY A NURSING STAFF

Witkouskas, Francine Rodrigues; Magnabosco, Patricia; Alves, Luana Gabriele Souza; Godoy, Simone de; Marchi-Alves, Leila Maria

doi:10.5380/ce.v27i0.86908

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ORIGINAL ARTICLE • Cogitare Enferm. 27 • 2022 • https://doi.org/10.5380/ce.v27i0.86908 copy

RESIDUAL VOLUME OF AMPOULE-VIALS AND UNDERDOSING OF MEDICATIONS PREPARED BY A NURSING STAFF

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Identify the residual volume in ampoule-vials after the preparation of injectables, associating the errors related to underdosing with the classes of drugs.

Method:

This is a descriptive study with a quantitative approach. Data were collected between December 2020 and September 2021, in a private outpatient service located in a Brazilian municipality in the northeast of the state of São Paulo. A total of 562 ampoule-vials of medications prepared by a nursing staff were analyzed. A form was used containing the commercial name of the medication, therapeutic class/indication, reconstitution date and time, volume used to reconstitute the medication and residual volume of each vial. The data were tabulated and analyzed using descriptive statistics and the ANOVA test.

Results:

the residual volume of 462 (82.2%) ampoule-vials varied between 0.1 ml and 1.5 ml, whereas 165 (29.4%) ampoule-vials had 0.2 ml of residual volume, with a mean loss of 4.5% of the solution. There was no difference in the loss of solution between the different classes of drugs.

Conclusion:

The findings highlight the need for interventions to reduce failures in the medication preparation phases, with emphasis on errors associated with therapeutic underdosing.

DESCRIPTORS:
Nursing; Medication Therapy Management; Nursing Care; Medication Errors; Drug-Related Side Effects and Adverse Reactions

Drug class	n	%
Antimicrobial	298	53
Anti-inflammatory	221	39.3
Immunoglobulin	17	3
Antiviral	10	1.8
Hormone	6	1.1
Antineoplastic antibody	6	1.1
Volume expander	3	0.5
Granulocyte colony-stimulating factor	1	0.2
Total	562	100

Residual volume (ml)	N	%
0	100	17.8
0.1	90	16
0.2	165	29.3
0.3	105	18.7
0.4	57	10.1
0.5	25	4.4
0.6	11	2
0.7	4	0.7
0.8	2	0.4
1.0	1	0.2
1.1	1	0.2
1.5	1	0.2
Total	562	100

Drug class	Mean	Median	Minimum	Maximum	Standard deviation	^* * ANOVA Test. Source: Prepared by the authors, 2021 p
Antimicrobial (n=298)
Reconstitution volume (ml)	7.6	5	2	20	4.8
Residual volume (ml)	0.2	0.2	0	1.5	0.2
Solution loss (%)	4.2	0.3	-	33.3	4.3
Anti-inflammatory (n=221)
Reconstitution volume (ml)	5.7	5	2	20	3.1
Residual volume (ml)	0.2	0.2	0	0.7	0.1
Solution loss (%)	5	4	-	20	4.1
Other (n=43)						0.064
Reconstitution volume (ml)	4.4	4	1	10	2.9
Residual volume (ml)	0.1	0.1	0	0.6	0.2
Solution loss (%)	3.8	3	-	26.7	5.3
Total (n=562)
Reconstitution volume (ml)	6.6	5	1	20	4.2
Residual volume (ml)	0.2	0.2	0	1.5	0.2
Solution loss (%)	4.5	4	-	33.3	4.3

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[1] Role of Authors:

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work - Witkouskas FR, Magnabosco P, Alves LGS, Marchi-Alves LM; Drafting the work or revising it critically for important intellectual content - Magnabosco P, Alves LGS, Godoy S de, Marchi-Alves LM; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved - Magnabosco P, Alves LGS, Godoy S de, Marchi-Alves LM. All authors approved the final version of the text.