Abstract
Intravenous admixture (IV admixture) preparation is one of the most important
pharmaceutical services provided for patients in hospitals. Currently, the increasing and varying
demand for IV admixture items according to the medical prescriptions are observed. Automated
solutions for IV admixture preparations in hospitals have been introduced to improve medication
safety and workflow efficiency. However, there has been no study on situation of IV admixture in
Thai hospitals. This resulted in the difficulties in determining the workflow problems and
identifying the readiness for hospitals in introducing the automated solutions. Thus, this study
aims to study the most recent situation of IV admixture preparations in the Thai hospitals and to
preliminarily consider their readiness for introducing automated intravenous admixture solutions.
The cross-sectional survey with self-administered questionnaire developed by the
research team (COA.No.MU-DT/PY-IRB 2022/031.3006 approved on 30 June 2022) was conducted
during August-December 2022. The questionnaires were distributed to 210 government hospitals
in Thailand via post-mails. One hundred and twelve forms were returned (53.3% response rate).
However, 13 hospitals (6.2%) could not fill the form due to the requirement of the hospital ethical
committee approval, so this group was omitted from the survey. The other 96 hospitals
completed the forms (response rate was 45.7% when considered the response from this group).
Of these, 66 hospitals (68.8%) had IV admixture preparations in their hospitals and completed the
forms, while the remaining 30 hospitals (31.2%) stated that they did not prepare IV admixture in
their hospitals.
From the total 66 hospitals with IV admixture preparations, cytotoxic drugs were the most
common IV admixture items prepared in the hospitals (90.9%), followed by Total Parenteral
Nutrition (TPN) (72.7%), extemporaneous IV admixture preparations (40%), and IV admixture
prepared in large scale (14%), respectively. Average number of items prepared in the hospitals
was 30 items per day for cytotoxic drugs, and 17 items per day for TPN. These number depends
on the size of the hospitals (the more hospital-beds, the greater number of items prepared). More
than half of the 66 hospitals reported that they prepared cytotoxic drugs more than a round per
day. The workforce in the sterile production department (including the 4 categories of IV admixture preparations) of each hospital was around 2-3 full-time equivalent. All of them were
trained prior to work in this department. For the IV admixture preparation working space, the
largest area was for preparing cytotoxic drugs (27.9±23.7 m2), and this was around 29±28.4% of
the total production area. From their reported IV admixture preparations, the top 5 cytotoxic
preparations in hospital were 5-Fluorouracil, Cyclophosphamide, Doxorubicin, Oxaliplatin and
Paclitaxel. The top extemporaneous IV admixture preparations were antibiotic group (e.g.,
Cefotaxime, Ceftazidime and Gentamicin) and high alert drugs (e.g., Heparin and Morphine). In
addition, high alert drug group was reported as the top IV admixture prepared in large scale.
According to the medication errors, inappropriate preparation, including wrong concentration and
wrong dose, was the most commonly reported errors. However, the error incidents were reported
less than 1% of the total IV admixture preparations. Almost all hospitals indicated their
destruction protocols for the IV admixture prepared by their hospitals. During the survey, there
has been one hospital using a robot for cytotoxic preparation and the other hospital was during
the trial of using a robot for cytotoxic preparation in a closed system.
There were a number of limitations of this study’s findings due to the scope of this study
(the survey did not include the large community hospitals or M2-leveled hospitals, and did not
include IV admixture preparation in the hospital in-patient wards), the misunderstanding nature
of self-administered questionnaire used in this study, and the differences in the record,
monitoring, and reporting systems of those hospitals.
