Appropriateness of requests for human serum albumin at the University Hospital of Palermo, Italy: a prospective study

Abstract OBJECTIVE: First, to assess the appropriateness of requests for albumin using current guidelines; second, to evaluate physicians' compliance with this protocol. DESIGN: Descriptive, prospective study. SETTING: 'Paolo Giaccone' University Hospital in Palermo (Italy). PARTICIPANTS: The six departments with the highest orders for albumin. INTERVENTION: An experimental, pharmacist-driven process for daily orders of albumin was activated over a period of 1 month. Pharmacy personnel handed out order forms on six different wards. Physicians were required to select one of a number of intended uses listed on the form. MAIN OUTCOME MEASURES: Data on albumin and serum protein levels; number of vials and grams of albumin requested/day; number of vials and grams of albumin/day needed to normalize serum albumin levels; informed consent; indications and appropriateness of use. RESULTS: A total of 126 forms were collected. Mean serum albumin and protein levels of patients in the different wards were close to normal (2.5 and 5 g/dl, respectively). The albumin doses requested by the various wards were 2 to 7 times higher than expected. 37.3% of the requests were for appropriate indications, 40.5% were for occasionally appropriate indications and 18.2% were inappropriate. According to current guidelines, 83.3% of requests were appropriate. 45% of orders from the Intensive Care ward were for inappropriate indications. CONCLUSIONS: The introduction of a well-defined, flexible pharmacist-driven ordering process for albumin could reduce omissions in albumin indications and aid request assessment. It would allow pharmacists to collaborate with physicians in verifying whether requests are appropriate and whether prescriptions comply with current guidelines.