Infusion medication concentrations in UK’s critical care areas: Are the Intensive Care Society’s recommendations being used?

Abstract

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.

A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom

“…With modern, reliable and accurate infusion systems now a standard of care in infusion practice, and automated prescribing processes becoming universal, the continued use of weight‐based infusions lacks credibility in the 21st century. Weight‐based infusions have been shown to be prone to error, with 27% of infusion orders found to contain a prescribing error and 65% of prepared infusions being >10% variant from the prescribed concentration . By introducing SCI both of these error modes can be reduced by 50% or more …”

“…In adult intensive care units, a survey in 2007 identified that for 20 specified medications there were 372 presentations and an average of 12 concentrations (range 2–23) per drug . This landmark study drove the development and adoption of a consensus on common medication concentrations which approximately 90% of adult ICUs are now using …”

Standardkonzentrationen für Dauerinfusionen – Ergebnisse einer bundesweiten Befragung auf deutschen Erwachsenenintensivstationen

“…Medikationsfehler können aus fehlerhaften Berechnungen der Dosis, fehlerhafter Zubereitung (u. a. falsche Menge, falsches Volumen, falsches Zubehör, Hygienefehler) und fehlerhaften Einstellungen der Infusionspumpen resultieren. Das Risiko von Medikationsfehlern wird durch die Applikation in einheitlichen Standardkonzentrationen und Steuerung der patientenindividuellen Dosis über das applizierte Volumen pro Zeit deutlich reduziert [3,14,19]. Dies ist besonders relevant beim Einsatz von Zeitarbeitskräften, von neuen Mitarbeitern oder bei Aushilfe durch Mitarbeiter von anderen Stationen [16].…”

“…In den USA, Großbritannien und Spanien sind für Hochrisikoarzneimittel, die als (Dauer-)Infusion appliziert werden, nationale Standardkonzentrationen definiert und deren Nutzung empfohlen [1,2,11,14,15]. Auch in Australien und Neuseeland wird eine nationale oder zumindest regionale Standardisierung der Parenteraliaapplikation bei Intensivpatienten angestrebt, um die Sicherheit, Effektivität und Wirtschaftlichkeit zu verbessern [10].…”

What’s in that syringe? Standard drug concentrations in critical care

“…Anthony N Thomas In 2009, the Intensive Care Society (ICS) published guidelines recommending standard drug concentrations for infusions in critical care. 1 In this issue of JICS, Titiesari et al 2 publish the results of a survey reviewing the adoption of these concentrations across critical care units in the UK. Although the study has limitations found in many such surveys, 3 the results suggest that there has been an increase in the adoption of the ICS standard concentrations but that they have not yet been adopted in all units.…”