4CPS-016 Inappropriate use of human albumin in a teaching hospital

Background and importance Albumin is a widely used medication for the treatment of critically ill patients, such as those with cirrhosis, burns patients and neonatal patients. However, its management is still a real challenge because of its high cost and controversial uses. Aim and objectives The aim of the study was to determine the frequency of inappropriate albumin prescriptions according to guidelines and scientific data in a teaching hospital. Material and methods Over a 4 month period, each prescription of human albumin in our teaching hospital was reviewed according to guidelines and recommendations. Data collected were: indication, clinical healthcare unit, patient sex and age, dosage and treatment times, and albuminaemia. Statistical analysis was performed by PSPP software. Results A total of 230 prescriptions were studied during the 4 month period coming from 10 healthcare units. Among them, 201 prescriptions were included in this work concerning 80 patients with a sex ratio of 1.10 and mean age of 45.85±25.84 years. Mean albuminaemia was 20.84±5.14 g/L. The mean dosage was 3±2 vial/day. Median duration of treatment was 2 days (IQI 4). The gastroenterology service ordered the most, with 92 orders (46%), followed by the paediatric service with 38 orders (19%). Seventy prescriptions (35%) were judged as inappropriate. The most frequent inappropriate indication was nephrotic syndrome with albuminaemia >20 g/l without hypovolaemia or pulmonary oedema (19 prescriptions, 9.5%) followed by major surgery indication with serum albumin >20 g/L (15, 7.5%). In total, 1694 vials of human albumin were consumed: 822 vials (48.5%) were consumed according to inappropriate indications. The estimated cost of inappropriate use was 15 000€ for a 4 months period. Conclusion and relevance This study suggests that inappropriate use of human albumin is quite common with high costs. Hence adoption of comprehensive guidelines may reduce the inappropriate use and healthcare costs. In addition, audit and educational feedback might strengthen the results. References and/or acknowledgements 1. Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Recommendations for the use of albumin and immunoglobulins. Blood Transfus 2009;7:216–234. No conflict of interest.