Nurses' knowledge and management of incompatibility issues in intravenous pharmaceutical preparations

  • Fita Rahmawati Faculty of Pharmacy, Universitas Gadjah Mada
  • Erna Prasetya Ningrum
  • Marlyn Dian Laksitorini
  • Endang Lukitaningsih
Keywords: IV preparation, nurses' knowledge, questionnaire, incompatibility

Abstract

Administering multiple intravenous (IV) preparations through a single catheter line can lead to incompatibility issues, such as precipitation. Precipitation can be avoided with sufficient knowledge by nurses during the administration of IV preparations to patients. This research aims to assess nurses' knowledge and management of incompatibility issues in IV pharmaceutical preparations. This non-experimental research collected data through interviews with healthcare professionals (nurses). The research was conducted at Sultan Agung Islamic Hospital, Semarang. A total of 14 healthcare professionals (nurses) who reconstituted and administered IV pharmaceutical preparations to patients in the Intensive Care Unit (ICU) participated in the research. The results revealed that 13 nurses (92.9%) encountered incompatibility incidents with seven types of drugs. Five nurses (29.4%) reported incompatibility issues with cefoperazone. The most frequently observed incompatibility was color change, reported by seven nurses (53.8%), such as white spots appearing during phenytoin reconstitution and discoloration in IV pharmaceutical preparations of cefoperazone and ceftriaxone. The most common approach to addressing incompatibility was replacing the preparation, reported by six nurses (46.2%). The management of incompatibility issues varied among nurses, even when dealing with the same pharmaceutical preparation. Therefore, training on sterile preparation incompatibility should be provided to all healthcare professionals to establish a standardized operational procedure (SOP) for handling incompatibility in IV pharmaceutical preparations.

References

Azni, M., Rahmawati, F., & Wiedyaningsih, C. (2021). Pengetahuan perawat mengenai faktor risiko sediaan intravena yang berkaitan dengan kejadian Flebitis. Jurnal Sains Farmasi & Klinis, 8(2), 174. https://doi.org/10.25077/jsfk.8.2.174-181.2021

Borgonovo, F., Quici, M., Gidaro, A., Giustivi, D., Cattaneo, D., Gervasoni, C., Calloni, M., Martini, E., La Cava, L., Antinori, S., Cogliati, C., Gori, A., & Foschi, A. (2023). Physicochemical characteristics of antimicrobials and practical recommendations for intravenous administration: a systematic review. Antibiotics, 12(8). https://doi.org/10.3390/antibiotics12081338

Caecilia, M., Munisih, S., & Mishanah. (2023). Profil inkompatibilitas sediaan obat intravena pada pasien intensive care unit di RS ‘ X ’ Semarang periode Januari – Juni tahun 2022. 12(2), 60–64.

Depkes RI. (1995). Farmakope Indonesia edisi IV. In Departemen Kesehatan Republik Indonesia.

Depkes RI. (2013). Farmakope Indonesia EDISI V (V). Kementrian kesehatan RI.

Dwijayanti, S., Irawati, S., & Setiawan, E. (2016). Profile of intravenous admixture compatibility in the intensive care unit (ICU) patients. Indonesian Journal of Clinical Pharmacy, 5(2), 84–97. https://doi.org/10.15416/ijcp.2016.5.2.84

Hanifah, S. (2019). Pengetahuan dan persepsi tenaga kesehatan tentang inkompatibilitas intravena: studi kasus di satu unit perawatan intensif. Kongres XX & Pertemuan Ilmiah Tahunan Ikatan Apoteker Indonesia, August, 978–979.

Hanifah, S., Ball, P., & Kennedy, R. (2018). Medication incompatibility in intravenous lines in a paediatric intensive care unit (PICU) of Indonesian hospital. Critical Care and Shock, 21(3), 118–127.

Leape, L. L. (2009). Errors in medicine. Clinica Chimica Acta, 404(1), 2–5. https://doi.org/10.1016/j.cca.2009.03.020

Lovia, S., Oktavia, Y., Almasdy, D., & Amelin, F. (2019). Studi Kualitatif Pengetahuan Perawat tentang Adverse Drug Reaction ( ADR ) di Bangsal Rawat. J u r n a l S a i n s F a r m a s i & K l i n i S, 2407–7062, 95–103.

Marsilio, N. R., Da Silva, D., & Bueno, D. (2016). Drug incompatibilities in the adult intensive care unit of a university hospital. Revista Brasileira de Terapia Intensiva, 28(2), 147–153. https://doi.org/10.5935/0103-507X.20160029

Moraes, K. D., Gomes, I. V., Lima, O. P., Reis, R. L., Souza, M. N., Freire, N. D., Barros, J. F., S., M. F., & Nunes, D. M. (2021). Analysis of drug compatibility in Y in intravenous therapy: preparation of a preventive tool for a university hospital in Petrolina – PE. Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 12(1), 521. https://doi.org/10.30968/rbfhss.2021.121.0521

Preslaski, C. R., Lat, I., MacLaren, R., & Poston, J. (2013). Pharmacist contributions as members of the multidisciplinary ICU team. Chest, 144(5), 1687–1695. https://doi.org/10.1378/chest.12-1615

Ribeiro, G. da S. R., Campos, J. F., & da Silva, R. C. (2022). What do we know about flushing for intravenous catheter maintenance in hospitalized adults? Revista Brasileira de Enfermagem, 75(5), 1–11. https://doi.org/10.1590/0034-7167-2021-0418

Rickard, C. M., Marsh, N., Webster, J., Playford, E. G., McGrail, M. R., Larsen, E., Keogh, S., McMillan, D., Whitty, J. A., Choudhury, M. A., Dunster, K. R., Reynolds, H., Marshall, A., Crilly, J., Young, J., Thom, O., Gowardman, J., Corley, A., & Fraser, J. F. (2015). Securing all intravenous devices effectively in hospitalised patients-the save trial: Study protocol for a multicentre randomised controlled trial. BMJ Open, 5(9), 1–7. https://doi.org/10.1136/bmjopen-2015-008689

Simoes, A. M. N., Vendramim, P., & Pedreira, M. L. G. (2022). Risk factors for peripheral intravenous catheter-related phlebitis in adult patients*. Revista Da Escola de Enfermagem, 56, 1–9. https://doi.org/10.1590/1980-220X-REEUSP-2021-0398EN

Syahbarni, S., Nanny Setiawati, M. C., & Ningrum, E. P. (2021). Gambaran kompatibilitas sediaan obat intravena dengan sediaan lain pada pasien di ICU. Media Kesehatan Politeknik Kesehatan Makassar, 16(1), 83. https://doi.org/10.32382/medkes.v16i1.1796

Valentin, A., Capuzzo, M., Guidet, B., Moreno, R., Metnitz, B., Bauer, P., & Metnitz, P. (2009). Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ (Online), 338(7700), 928–931. https://doi.org/10.1136/bmj.b814

Wagner, L. A. F., Neininger, M. P., Hensen, J., Zube, O., & Bertsche, T. (2023). Avoiding incompatible drug pairs in central-venous catheters of patients receiving critical care: an algorithm-based analysis and a staff survey. European Journal of Clinical Pharmacology, 79(8), 1081–1089. https://doi.org/10.1007/s00228-023-03509-0

Published
2025-10-13
How to Cite
Rahmawati, F., Erna Prasetya Ningrum, Marlyn Dian Laksitorini, & Endang Lukitaningsih. (2025). Nurses’ knowledge and management of incompatibility issues in intravenous pharmaceutical preparations. Media Farmasi Indonesia, 20(2), 107-115. https://doi.org/10.53359/mfi.v20i2.312