Safe implementation of standard concentration infusions in paediatric intensive care

Arenas-López, Sara; Stanley, Isabel M; Tunstell, Paul; Aguado-Lorenzo, Virginia; Philip, Jo; Perkins, Joanne; Durward, Andrew; Calleja‐Hernández, Miguel Ángel; Tibby, Shane M.

doi:10.1111/jphp.12580

Cited by 16 publications

(29 citation statements)

References 16 publications

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“…Nine studies have provided information on the medication infusions standardised in their practice with a variety of concentrations developed for each medication infusion. Dobutamine and dopamine were the most commonly standardised drugs, followed by adrenaline, fentanyl, midazolam, morphine, milrinone and noradrenaline; however, there were large variations in the concentrations for each drug . The lack of harmonisation among SCI in the literature has driven a call for standardisation on a national basis.…”

Section: Introductionsupporting

confidence: 90%

“…Approaches that have been suggested to reduce and prevent these errors include computerised prescribing and ordering, ‘smart’ pumps, and the use of standard concentration infusions (SCI) . The use of centrally prepared (CP) SCI is also recommended to maximise medication safety by reducing the need for near‐patient manipulation . However, the availability of CP SCI is variable depending on the facilities and capacity available to each centre.…”

Section: Introductionmentioning

confidence: 99%

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

Oskarsdottir

Harris

Sutherland

et al. 2018

Journal of Pharmacy and Pharmacology

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The majority of paediatric and neonatal units in the UK used traditional weight-based methods for IV infusions and only 40% of responding units had established SCI. This local implementation of SCI resulted in a wide variation of presentations and concentrations and thus there is no true 'standardisation'. Further research should be conducted on harmonising these SCI across neonatal and paediatric care to facilitate adoption across all units.

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Section: Introductionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Oskarsdottir

Harris

Sutherland

et al. 2018

Journal of Pharmacy and Pharmacology

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“…Standard concentrations for morphine and milrinone have already been introduced successfully over the past 7 years in our PICU. At present, our unit is in the process of introducing the rest of the agreed drug standard concentrations on Table on a step approach following the model described on our recent publication …”

Section: Discussionmentioning

confidence: 99%

“…A core team was established consisting initially on a PICU consultant and a senior PICU pharmacist who designed a matrix to be used with all the commonly used PICU infusions as described in our recent publication . The matrix would allow us to balance the concentration, dose and infusion volume across a range of weights from 1.5 to 50 kg.…”

Section: Methodsmentioning

confidence: 99%

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Standard concentration infusions in paediatric intensive care: the clinical approach

Perkins

Aguado-Lorenzo

Arenas-López

2016

Journal of Pharmacy and Pharmacology

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The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability. Objective To identify the most appropriate clinical concentrations required by our paediatric intensive care unit (PICU) population with regard to accuracy of delivery and overall fluid allowance. Methods Firstly a matrix was used to balance the concentration, dose and infusion volume (weight range 1.5–50 kg). Results were further refined considering: patient fluid allowance based on fluid volume targets, infusion pump accuracy and challenging each infusion against clinical scenarios requiring administration of multiple drug infusions found in PICU. Consideration was given to the standard concentrations routinely used in adults, in order to assess whether alignment with paediatrics was possible for some of the concentrations proposed. Finally a risk assessment of the infusions was conducted using the NPSA 20 tool. Key findings Twenty‐five drugs identified as the most commonly used intravenous infusions in the unit. For the majority of the medicines, three weight bands of standard concentrations were necessary to cover the children's weight ranges and kept within predefined fluid requirements and accuracy of delivery. Conclusions This work shows a patient focused systematic approach for defining and evaluating standardised concentrations in intensive care children.

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Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

et al. 2022

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Avoidable harm associated with medication is a persistent problem in health systems and the use of preprogrammed infusion devices ('smart pumps') and data monitoring is seen as a core approach to mitigating and reducing the incidence of these harms. However, smart pumps are costly to procure, configure and maintain (in both human and financial terms) and are often poorly implemented. Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, and a strategic human-centred approach is needed to support their implementation. A symposium of 36 clinical and academic medication safety experts met virtually to discuss the current 'state of the art' and to propose strategic recommendations to support the implementation of medication administration technology to improve medication safety. The recommendations were that health systems (1) standardise infusion concentrations to facilitate the development of ready-to-administer formulations of frequently used medicines, and support 'out of the box' programming of infusion devices; (2) develop and implement drug libraries using human-centred approaches and the aforementioned standard concentrations, with a theoretical understanding of how devices are used in practice; (3) develop standardised metrics and outcomes to support the interpretation of data produced by infusion devices; (4) involve all stakeholders in the development of drug libraries and metrics to ensure broad understanding of the devices, their benefits and limitations; and (5) leverage input into device design, working with manufacturers and users. Using this strategic approach, it is then possible to envisage and plan real-world implementation studies using a uniform approach to quantify improvements in safety, efficiency and cost effectiveness.

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Safe implementation of standard concentration infusions in paediatric intensive care

Abstract: Introduction of standard infusions is safe and effective. We are exploring ways to further refine safety and extending to other drugs.

Cited by 16 publications

References 16 publications

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

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

Standard concentration infusions in paediatric intensive care: the clinical approach

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

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