Posted on 05/25/2023 3:12:24 PM PDT by ConservativeMind
Different methods of giving patients the same drug to prevent severe complications after a type of stroke lead to different outcomes.
Aneurysmal subarachnoid hemorrhage, a type of stroke, has an average mortality rate of 30 to 50 percent.
A drug called nimodipine is the only treatment proven to prevent this complication. It's recommended that all patients receive nimodipine for 21 days. However, there are different ways to administer the drug.
Patients who are able to swallow tablets or capsules receive a consistent dose. The issue arises with patients who are unable to swallow the medication.
In areas where nimodipine tablets are available, health-care professionals must crush them bedside and mix them with water to give to the patient through an enteral feeding tube. However, there are no guidelines.
"Nimodipine is a light-sensitive medication. If it stays in the light for a while it can actually break down," he notes.
Where gel capsules are available, the gel must be extracted from the capsules bedside, then given through a feeding tube. However, patients often don't receive the full capsule contents.
"There's a study with one of our collaborators that found drawing liquid from the capsule is very inconsistent. They're not drawing the whole drug, they're not getting all of the medication."
Mahmoud and his collaborators compared rates of delayed cerebral ischemia in groups of patients who received each formulation.
"We found there was a massive variation."
Of the patients, 31 percent experienced delayed cerebral ischemia. However, the prevalence was 59.1 percent among the patients who received crushed tablets and 45.8 percent among those who received liquid drawn from capsules at the bedside.
The lowest rate of delayed cerebral ischemia, just 13.5 percent, was observed in the group who received nimodipine that had been extracted at the hospital pharmacy rather than bedside.
(Excerpt) Read more at medicalxpress.com ...
Doctors and their staff do not know how to do this properly, it would appear.
It is intriguing that pharmacists do it so well, though.
The pharmacist is trained and does it on a regular basis.
Repetition is the key to becoming skilled.
I work in a hospital system.
It is much more expensive to pay a pharmacist to do or supervise this thus as much as possible is policy delegated to nursing without near the medication mixing compounding training. The wildly variable results from this described in the article are derived from this practice. No I dont have good alternative suggestions likely to be tried.
Perhaps the hospital pharmacist could do a quick class for some nurses on the proper way to do it, and have the nurses so trained be designated for this task.
The silly thing is that it is a liquid. Why don’t they just provide it in a vial to hospitals? There is absolutely no reason to put in a capsule just to take it back out.
of course the amount of drug is going to vary.....
all these pharmaceutical companies making billions but they care NOT if their drug is simple and efficient to give....they've made their money and they don't care.
Good suggestions.
No quick fix answers. The downside of drawing up/mixing/compounding medicines at the patient bedside while multiple distractors are continuously in play is that it is very challenging and people respond to such challenges very differently. I should think about this a bit as I don’t enjoy complaining without offering suggestions to improve.
Thanks.
Doctors have nothing to do with the administration. We order the drug and route. It is up to nursing to administer. Since these patients should all be in ICU in a primary stroke center (a nontraumatic subarachnoid hemorrhage is an absolute reason to fly a patient to such a center) I’m a little surprised at the variation. These should all be highly trained nurses in a neuro ICU. It would be interesting to see the comparison of patients in a fairly large city where such centers are available to those in a more remote setting. if pharmacy is better at handling the drug they should by all means do so. interesting study.
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