There is wide variation in infusion practice in UK critical care units. Standardising infusion concentrations may lead to efficiency gains through reduced training burdens, common nomenclature, reductions in error rates and mass production of ready-to-use products by the pharmaceutical industry. A proposed list of standard concentrations for 20 medications given by infusion was produced. Critical care units were surveyed to assess the acceptability of the list for adoption as a national standard; 164 critical care units responded (63% of UK NHS trusts). High acceptance of the list has been shown, with the exception of concentrations of adrenaline, potassium and phosphate where further work is required. The proposed concentrations of the remaining 17 medications should be adopted as a national standard.
Following two studies done in 2007 and 2009, a follow-up of the adherence to the suggested guidelines on drug standardisation has been performed with a suggestion for future standards that can be achieved, to complement the recently published Carter report. The Intensive Care Society (ICS) introduced recommendations for infusion concentrations of 16 medications commonly used in critical care areas. The importance being improvement in patient safety and rationalised use of available critical care resources. Five years after publication of these recommendations, a further audit has been undertaken to assess the level of acceptance and application. This revealed that 89.5% of the 133 surveyed units (representing 42.49% critical care units across the UK) have adopted the recommendations. There are further medication concentrations which could also be standardised.
Background: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. Development of the VHP 2020 Framework: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. Findings: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the ‘A-DIVA scale’ to predict the likelihood of difficult venous access; and a study that incorporated an ‘I-DECIDED tool’ for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. Conclusion: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.
Local infusion practice within critical care has evolved over time, and one example of this is the wide variation in concentrations of drug infusions within critical care. While there are many similarities between critical care units, there are also many differences. Often drug infusions are used outside their product licence and, because of the diversity in practice, manufacturers are unlikely to license multiple preparations of even the most commonly used infusions. Critical care nurses spend many hours every day preparing and administering intravenous infusions. Much time could be saved if the infusions were available as a ready-to-use solution. This would also reduce the risk of errors that occur during the preparation and administration of medication infusions. This article describes a national project to achieve consensus on the strengths of drug infusions used within UK critical care units. Having agreed on standard solutions, it is hoped that manufacturers will seek licences for commonly used infusions and work towards mass production of these products. Off the shelf, ready-to-use infusions of commonly used medications could become a reality.
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