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Letters to the Editor
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Procurement
Instant magnesium sulphate infusion bags
From Mr U. M. Chouhan, MRPharmS
Magnesium sulphate infusion has many therapeutic indications, including
arrhythmia, hypomagnesaemia and eclampsia. However, when it comes to
prescribing the drug the doses are expressed differently. For arrhythmia,
the British National Formulary (number 54) states the dose in millimoles
while for prevention of seizures in eclampsia the dose is given in grams.
The matter is further complicated because the ampoules are labelled as a percentage
of magnesium sulphate. Consequently, it is not surprising that errors in calculation
occur. In addition, preparation of infusions in clinical areas is a major contributor
in incorrect dosing as exemplified by preparation of opiates and acetylcysteine.
The National Patient Safety Agency patient safety alert 20 issued in March
2007 recommends that a risk assessment of each injectable product be done together
with the clinical area it is prepared in. Based on the risk assessment, the
Welsh Aseptic Services and Production Pharmacists Group gave a high score for
magnesium sulphate, suggesting there is a high risk that it could cause harm.
To overcome the problem, the pharmacy at Glan Clwyd Hospital has provided ready-to-use
intravenous infusion bags since 2004, containing 80mmol (20g) of magnesium
sulphate in 250ml sodium chloride 0.9 per cent. The bags are produced commercially
and have a shelf-life of 18 months. Our commitment is to purchase the whole
batch over the 18 months. However, due to increased production costs the price
of the next batch will more than double.
The cost of each bag can be reduced by increasing the batch size. Our current
usage level means the whole batch cannot be used within its shelf-life. At
a batch size of 2,960 bags, the cost per bag would be £2.95 plus VAT.
Glan Clwyd Hospital would use about 1,000 bags per year.
If there is a trust that would be interested in committing to purchase the
balance of the prepared batch directly from the company, it can contact me
at uttam.chouhan@cd-tr.wales.nhs.uk
Uttam M. Chouhan
Principal Pharmacist (Clinical Services),
Glan Clwyd Hospital,
Rhyl, Denbighshire |
The
Pharmaceutical Journal