A multi-centre comparison of nursing staff time required for the preparation and administration of liposomal amphotericin B and amphotericin B deoxycholate to voriconazole

Abstract number: p1500

Flynn  E., Oppenheim  B.A., Ribaud  P., Barbabietola  G., Démarez  V., Marciniak  A., Roberts  C., Barker  K.

Objective: 

To describe and compare the nursing labor time required for preparation and administration of liposomal amphotericin B (L-AmB), amphotericin B deoxycholate (AmBd), and voriconazole (VOR).

Methods: 

Activities associated with nurse preparation and administration of the three study drugs were timed by trained observers at five hospitals (one in Italy, three in France, and one in the United Kingdom). Target tasks were classified as those likely to be affected by the difference between the drugs and excluded those tasks likely to differ because of site-specific factors (e.g., travel time to a patient room in different hospitals). Target tasks included: obtain supplies and medications; prepare medications; educate patient; administer medications; monitor for adverse events; and prepare follow-up medications. The mean times for administration of a single day of study drug were summarised and compared, accounting for a single daily dose of L-AmB and AmBd and 2 daily doses of VOR IV or oral.

Results: 

Sixty-nine patients were observed receiving 256 doses of study medications at the five hospitals. Time of administration in minutes per day was 20, 16, 14, and 3 for L-AmB, AmBd, VOR IV, and VOR oral, respectively. Administration time was significantly lower for VOR IV compared with L-AmB (P < 0.05) and for VOR oral compared to all IV regimens (P < 0.05). The task of preparation of medications required the most time for IV formulations, and was longer in the L-AmB group than the others (L-AmB: 12 mins vs AmBd: 7 mins; VOR IV: 9 mins). AmBd required more time for patient monitoring and administration of follow-up drugs than other formulations (AmBd: 7 mins vs L-AmB: 4 mins; VOR IV: 2 mins).

Conclusion: 

VOR IV required significantly less time to prepare and administer on a daily basis compared to L-AmB. Measurements of IV antifungal versus oral VOR administration suggest the opportunity to save 10–17 minutes per day by switching to oral therapy when possible.