ประสิทธิผลของการใช้ตารางปรับขนาดยา norepinephrine และการเกิดอาการไม่พึงประสงค์จากการบริหารยา norepinephrine

Abstract

Background: Norepinephrine (NE) is categorized as high-alert drug that has high number of use and cost in Phraphutthabat hospital. It has been found that prescribing and titration of NE were different among patient wards. All the prescriptions were at high concentration, i.e. 40 μg/mL. Only 7.65% of the prescriptions specified the starting dose (μg/kg/min. or mL/hr). As there are no clear guidelines of how to prescribe NE, the improper use and different dose resulted with the incidence rate of phlebitis at 5.73%.
Objective: To study the efficacy of applying NE infusion guide (NIG) in clinical practice and adverse effect related to the administration of NE.
Method: A prospective, single-arm quasi-experimental study in patients of Phraphuthabat hospital who received NE between 1 Mar 2017 and 31 May 2017. Data were analyzed by descriptive statistics and Z-test for proportions.
Results: During the study period, 187 patients received NE infusion where 92.51% of this use were in medicine ward, intermediate care ward, and intensive care ward. The 76.47% of prescriptions indicated to follow the NIG. Among patients who were dosed in titrated pattern following the NIG, 80.74% were dosed with standard concentration at 32 μg/mL and 19.26% were dosed with higher concentration at 40 μg/mL. Phlebitis were found in 1.6% of patients and this was significantly lower compared with before applying the NIG (p-value = 0.03). The satisfaction survey performed in 65 nurses showed that they all followed the NIG and satisfied at high to very high rate (32% and 68% respectively).
Conclusion: Using NIG helps in ordering/titration dose to be in the same pattern, and provides convenience to practice. Practitioners satisfied with NIG and NIG reduces the incidence of phlebitis from NE.