Evaluation of The Utilization of Parenteral Preparations for Fluid, Electrolyte and Nutrition Management in Two Tertiary Hospitals in Southeast Nigeria
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 18, Issue 3
Abstract
Background: In this era of ongoing identification and analysis of medical errors, fluid and electrolyte management has trailed behind the medical decisions that have immediate obvious adverse consequences. This predicament may reflect a lack of understanding of the importance of considering individual volume and electrolyte abnormalities as a separate variable that can significantly alter a patient course and outcome. Objective: This study evaluated the utilization of parenteral preparations, fluids and electrolytes in two tertiary hospitals. Method: The study was a cross sectional descriptive survey which utilized the folders/medical records of patients’ that visited the hospitals within January 2017 and December 2018. Data was collected using structured observational check list for parenteral utilization, patient care and health facility indicators. Data regarding parenteral utilization was obtained from sampled medical records retrospectively and filled in structured check list accordingly with careful observation. The data was checked and analyzed using the SPSS software (ver. 20.0 for Windows, Inc., Chicago, IL, USA). Descriptive statistics of frequency, percentage, mean and standard deviation was used to summarize the data. Result: The study revealed that 242 (100.0%) drugs were prescribed to various patients, including anti-microbial drugs 129(53.3%) and infusions 57 (23.6%) appearing as the most commonly prescribed medications which were found in the first two (2) drugs prescribed to patients in Chukwu Emeka Odimegwu Ojukwu University Teaching Hospital (COOUTH). Similarly, at Saint Charles Boromeo Hospital (SCBH), a total of 250 (100%) drugs were prescribed to various patients, including anti-microbial drugs 113( 45.2%), infusions 68 (27.2%) and antimalarial 16 (6.4%) appearing as the most commonly prescribed medications which were found majorly in the first three (3) drugs prescribed to patients. At COOUTH, more generic drugs 214(88.1%) were prescribed than the branded drugs 29(11.9%). Similar trend occurred at SCBH, where higher number of drugs prescribed were generic 171(70) compared to branded prescriptions 74 (30.2). Chi-square test revealed significant association (χ2 = 15.873, p = 0.001) between total dosage frequency of drugs prescribed in both hospitals. The relationship between total number of brands and generic prescription in both hospitals was significand (χ2 = 9.765, p = 0.002). Conclusion: The generic prescription practices of parenteral drugs was prevalent in the two hospitals. Parenteral preparations were frequently used in the two hospitals.Parenteral nutrition is the intravenous administration of a nutritionally balanced and physicochemical stable sterile emulsion or solution. It is indicated when the GIT is inaccessible, inadequate or inappropriate to meet the patients on going nutritional needs or gut rest is indicated. Parenteral nutrition (PN) is a complex therapy containing more than 40 components, including dextrose, amino acids, fat emulsions, water, electrolytes, trace elements, and vitamins. To order PN appropriately, clinicians need to have a good understanding of body composition, fluid balance, electrolyte assessment, and acid-base balance. Human cells consist of 65% to 90% water, water and solutes pass through cell membranes both actively and passively, specific fluid and electrolyte concentrations are necessary in order for cell metabolism to occur, and these balances are affected by different stresses including trauma, surgery, and critical illness [1-4]. While fluid loss both measurable and insensible, occurs with these stressors, replacement and maintenance fluids are commonly administered without consideration of specific patient needs. Protocols and order sets allow for one size fits all fluid management that, though the time efficient, may not optimize patient recovery and may be detrimental. A patient fluid and electrolyte status affects all organ systems. Improper dosing can exacerbate already injured systems. The human body in a state of wellness has a remarkable capacity to make small and large adjustments in fluid and electrolyte intake and mobilization for specific needs. In a state of illness these compensatory mechanisms are disrupted, and recovery is dependent on restoration of an appropriate balance [4- 6].
Authors and Affiliations
Ogbonna Bo, Obiorah P, Ele Gn, Uzodinma SU, Iweh Mi, Ofomata PC, Ejim Ce, Orji Ec
Keywords
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- EP ID EP620630
- DOI 10.26717/BJSTR.2019.18.003158
- Views 189
- Downloads 0
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