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Drug Combinations in Palliative Care: A Compatibility Study

Kean, HL (2014) Drug Combinations in Palliative Care: A Compatibility Study. Masters thesis, Liverpool John Moores University.

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Abstract

End of life care often involves the use of combinations of more than one drug in a syringe for administration by a continuous subcutaneous infusion using a syringe driver or pump. This is considered to be an effective method of symptom management and can provide a good control of symptoms.
The combining of more than one drug however raises the question of compatibility. Even though many combinations of drugs have been successfully used in clinical practice in specialist areas without supporting laboratory data, the dangers of this practice are unknown and it is important to study the chemical and physical compatibilities of combining more than one drug for administration. The publication of National Patient Safety Alert 20: ‘Promoting safer use of injectable medicines’ by the NPSA in March 2007 addressed this issue.
Assessment of the Marie Curie Hospice database (Liverpool) has identified ten supportive drug combinations that have been used for continuous subcutaneous infusion and their associated dose. In this study the compatibility of these supportive drug combinations was assessed with each of the following opioids: morphine, diamorphine, hydromorphone, oxycodone and alfentanil.
The preparation of the combinations replicated clinical practice as close as possible. The combinations were prepared in BD syringes and a CME T34 syringe pump together with its administration set was used for the infusion of the prepared combinations at ambient temperature. Assessment of the combinations, including appearance, pH and compatibility assays, was performed at time zero, then 3 hours, 6 hours and 24 hours after the start of the infusion. High performance liquid chromatography (HPLC) was the principal technique for compatibility assessment.
This study proposed 50 combinations for compatibility assessment. Of the 45 combinations tested, the results identified 40 combinations as compatible. At the stated concentrations these 40 combinations were considered compatible with the diluents, the syringes and administration sets used. No incompatibility was evident in any of the combinations tested however the data obtained could not be used to confirm compatibility in five of the combinations tested.
The results from this study are a step in the right direction in providing healthcare professionals with data on compatibility of drug combinations used in end of life care. Further work in this area is required to fully support current and future practices where multiple drugs are combined in single administration forms to ensure effective treatment and patient safety.

Item Type: Thesis (Masters)
Subjects: R Medicine > RM Therapeutics. Pharmacology
R Medicine > RS Pharmacy and materia medica
Divisions: Pharmacy & Biomolecular Sciences
Date Deposited: 24 Oct 2016 10:35
Last Modified: 24 Oct 2016 10:35
Supervisors: Gaskell, Elsie and Evans, Andrew
URI: http://researchonline.ljmu.ac.uk/id/eprint/4434

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