Extravasations of non-cytotoxic drugs: A survey on pharmacist involvement in Spanish hospitals.

Abstract

Objective: This study aims to evaluate the involvement of hospital pharmacists in the protocolization, management and clinical follow-up of non-cytotoxic drug extravasations in Spanish hospitals.

Methods: A survey was distributed through the SEFH email list using the REDCap® web platform. The characteristics of the participating hospitals, the availability of a protocol for managing non-cytotoxic drug extravasations, the healthcare professionals involved in developing the protocol, and the pharmacists' involvement and clinical follow-up in response to these incidents were investigated.

Results: A total of 89 complete responses were obtained from hospitals across 14 Autonomous Communities. Only 12 centers (13.5%) had a protocol that included recommendations for the extravasation of non-cytotoxic drugs, and in 11 (91.7%) of these, the pharmacist had participated in its development. The recommendations for extravasation management were mainly based on intrinsic drug properties such as pH and osmolarity, specific properties like vasoconstrictor drugs, or the classification of drugs as vesicants, irritants, or non-irritants. Wide variability was observed in recommendations regarding the application of cold or heat and hyaluronidase dosage. The decision to consult with pharmacy service regarding the management of extravasation depended largely on the individual nurse or physician's judgment, but 20 centers (22.5%) reported that they never received such consultations. A large proportion of Pharmacy Services (73.0%) reported that they participate in extravasation management by providing information by telephone, but 21 centers (23.6%) indicated that the pharmacist never participates in these adverse events. Limited involvement was also noted in the clinical assessment of the patient, follow-up of the extravasation, and documentation in the patient's medical history.

Conclusion: The results of this survey reflect the limited standardization in the management of non-cytotoxic drug extravasations, as well as significant heterogeneity in the level of involvement of hospital pharmacists in these adverse events across hospitals in our country. The need to establish a national guideline or document on the management of non-cytotoxic drug extravasations is highlighted, along with the importance of promoting interdisciplinary collaboration to improve patient safety.