A total of 152 pharmacists from 9 provinces and 1 territory participated in the survey (Figure 1). Prince Edward Island, the Northwest Territories, and Nunavut were not represented. The largest proportion of respondents was from Ontario (64/152 [42.1%]), followed by Alberta (22/152 [14.5%]), British Columbia, and Nova Scotia (17/152 each [11.2%]). The majority of participants represented individual hospitals (114/152 [75.0%]), evenly divided between teaching or tertiary care and community or general hospitals. Two participants commented that they represented pediatric hospitals. Since some respondents did not answer all of the survey questions, the denominator for some of the questions was less than 152.

When asked about their level of concern regarding the Health Canada and manufacturer warnings, the vast majority of respondents (149/152 [98.0%]) indicated that they had an opinion, with responses ranging from “unconcerned” to “very concerned”. Of the 129 (84.9%) respondents who had concerns, 43 (33.3%) were very concerned and 86 (66.7%) were somewhat concerned. However, only 39 (25.7%) of the 152 respondents agreed that the 48-h window for calcium avoidance described in the Health Canada Notice to Hospitals should be strictly heeded (Figure 2). Of these 39 respondents, 24 (61.5%) agreed and 15 (38.5%) strongly agreed with strict adherence to the 48-h window. In contrast, about half (77 [50.7%]) of the respondents thought that the 48-h window for calcium avoidance did not require strict adherence. The remaining 36 respondents (23.7%) were undecided.
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Figure 1. Responses to a survey

Figure 1. Responses to a survey about warnings of interactions between ceftriaxone and calcium in IV solutions, according to geographic location and institutional affiliation.

More than half of the respondents (93 [61.2%]) stated that they had or would have a direct role in influencing their respective institution’s official position on this issue. Within this subgroup, fewer respondents were undecided about the 48-h calcium avoidance window, with a greater proportion of participants (56/93 [60.2%]) in disagreement and a smaller proportion of participants (17/93 [18.3%]) in agreement.
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Figure 2. Respondents agreement

Figure 2. Respondents’ agreement with 48-h window for avoidance of administration of ceftriaxone and calcium (IV) (n = 152).

A majority of respondents (99/152 [65.1%]) reported that both ceftriaxone and cefotaxime were on their institutional formularies; 24 (15.8%) reported that ceftriaxone was the only third-generation cephalosporin on their institutional formularies. About two-thirds of respondents (98/145 [67.6%]) reported a change in policy regarding the administration of ceftriaxone as at least one of the ways in which their institutions had addressed the potential risk of ceftriaxone—calcium interactions; slightly fewer respondents reported the issuance of warning memoranda (84/145 [57.9%]) and the implementation of a computerized alert system for pharmacists (79/145 [54.5%]) (Figure 3). Only 21 (14.7%) of 143 respondents described their institution’s official position regarding the administration of ceftriaxone and calcium-containing IV solutions within 48 h of one another as an absolute contraindication. Conversely, 88 (61.5%) participants described their institution’s official position on this scenario as a relative contraindication, where­by the benefit may outweigh the risk in individual cases. Almost one-fourth (32/143 [22.4%]) of respondents indicated that their institutions did not have a clear position on this issue.
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Figure 3. Institutional response

Figure 3. Institutional response to warnings issued by manufacturer and Health Canada (n = 145).