CIVAS Unit
Al-Salama Centralized Intravenous Additives Service Unit:
In hospitals, a large proportion of drugs are administered by the intravenous route and the majority of the reconstitution of injectable drugs is carried out immediately before administration to the patient by the nursing staff. The risks and errors related to the preparation and administration of injectable drugs are numerous. The standardization and centralization of preparation and reconstitution by the hospital pharmacy make it possible to reduce these various risks and errors.
Centralized intravenous additive services (CIVAS) are becoming an essential component of hospital pharmacy services inside which parental nutrition formulations and other medications such as antibiotics, antiemetic and pain are prepared under a special standard aseptic technique that reduce the preparation risks and errors to its minimal values and increase medication efficacy to its maximum values.
Why CIVAS:
- Reducing the contamination rate:
A prospective study of six ICUs reported that syringes filled from 10‐mL ampoules had contamination rates of up to 44% for nurse‐prepared versus 1% for those prepared by pharmacy staff in clean room environment. (1)
- Decrease medication incidents:
One in four medication incidents reported to the National Patient Safety Agency (NPSA) in the United Kingdom involved injectable medications.(2)
- Preparing TPN preparations important for critical patients :
TPN is the practice of feeding a patient – usually in ICU - without using the gut by a group of nutrients is added to a patient's intravenous drip. It is normally used during surgical recoveries; in case that intestine is obstructed it is also used when the bowels problems and individuals with coma, severe burns, multiple fractures. TPN required to achieve electrolytes balance that necessary for patient life.
Al-Salama Hospital become through CIVAS provides its patients with such important formulas tailored for each patient according to its case and needs.
- Prevent nosocomial infections:
Some nosocomial infections can be “seeded” from products prepared improperly in the pharmacy. An estimated 12% of hospitalizations are complicated by nosocomial infections that extend treatment from 4 to 7 days. (3)
- Decrease neonatal sepsis rate:
In a study conducted in Cairo, Egypt,
On admission, all neonates received glucose containing iv fluids; iv bottles (500 ml) were divided among multiple infants. The IV fluids were prepared at the bedside; poor hand hygiene and poor adherence to aseptic techniques were observed. K. pneumonia was isolated from 65% in‐use glucose‐containing iv fluids (could have been avoided by CIVAS).(4)
- Improve medication efficacy and reduce dose errors:
Standardizing I.V. concentrations through implementing a pharmacy based preparation program has been shown to significantly improve the efficacy reduce the incidence of wrong concentration and wrong dose errors. (5)
- Decrease the mortality rate:
An Institute of Medicine (IOM) study indicated that almost 98,000 patients die annually in the United States from preventable medical errors. (6)
Since 1996, the centralized preparation of I.V. medications is a prerequisite for JCI accreditation (7)
References:
1) Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive care units Critical Care Medicine: April 2002 ‐ Volume 30 ‐ Issue 4 ‐ pp 833‐836 Clinical Investigations © 2002 Lippincott Williams & Wilkins, Inc.
2) National Patient Safety Agency (NPSA). Safety in doses: medication safety incidents in the NHS. www.npsa.nhs.uk/patientsafety/ alerts‐and‐directives/directives‐guidance/safety‐in‐doses
3) Stafylaraki A, Kalofissudis I. Nursing science in prevention and control of nosocomial infections. ICUS and Nursing Web Journal. ISSN1108‐7366. 2000; 1. Available at: http://www.nursing.gr/article1.htm.
4) Neonatal Sepsis in Egypt Associated With Bacterial Contamination of Glucose‐Containing Intravenous Fluids, the Pediatric Infectious Disease Journal: July 2005 ‐ Volume 24 ‐ Issue 7 ‐ pp 590‐594 © 2005 Lippincott Williams &
Wilkins, Inc.
5) Bullock J, Jordan D, Gawlinski A et al. Standardizing IV infusion medication concentrations to reduce variability in medication errors. Crit Care Nurs Clin North Am. 2006; 18:515–21.
6) Kohn, LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine/National Academy of Sciences; 2000:26.
7) Clarification: Joint Commission expectations related to USP‐NF Chapter 797 on Compounding Sterile Preparations. Jt Comm Perspect. 2006:26(5)
