Background & Overview
The majority of units (neonatal and paediatric) still use weight-based infusion calculations that are variations of the “Rule-of-6 (Ro6)” – this is a method of standardised calculation that produces a unique concentration for a patient and ensures that a given dose of medication is administered in a fixed rate of infusion.
Individualised concentration is error-prone and a time-consuming process and therefore may be a source of preventable medication errors (Hilmas et al. 2010; Irwin et al. 2008). It is also likely to lead to inaccurate medication concentrations (Parhsuram et al. 2004; Parhsuram et al. 2008). Errors have been shown to decrease with the elimination of Ro6 and establishing standard IV infusion concentrations among other interventions (MacKay et al 2009; Jung et al. 2014; Arenas-Lopez et al 2016)
The Carter report (2016) encourages the NHS to standardise processes and products as much as possible to improve efficiency, safety and reduce waste. In the initial scoping survey for this project, 40% of centres used standard concentrations in some way, but there was evidence of variation: 43 drugs and 143 concentrations were reported as in use around the country. Other centres have expressed a desire to move to standardised concentrations, but cite issues of consensus and support in implementation.
There is general agreement that the continued use of weight-based dosing of continuously infused medicines should be phased out of routine paediatric practice because it is inaccurate, inefficient and incompatible with future information technology developments.
Many organisations are already reviewing the feasibility of moving to fixed concentration (standardised) infusions however implementation and adoption has been inconsistent.
A key benefit of using standard concentrations is access to ready-prepared infusions. Unfortunately this is not cost-effective in the current health environment which is an obstacle to on-going adoption. The manufacturing sector view ready-prepared infusions as a growth area, however the diversity of paediatric concentrations prevents them from producing suitable products for use in paediatric care.
Key stakeholders (the Neonatal and Paediatric Pharmacists Group (NPPG), the Paediatric Chief Pharmacists Group (PCPG) and the Royal College of Paediatrics and Child Health (RCPCH)) are committed to improving medication safety for children and improving access to good quality medicines for children (MedsIQ). They view standardisation as a strategic goal and a consensus of concentrations highly desirable in stimulating implementation, developing ready-to-use formulations and reducing variation between centres. All three have endorsed the aims of a single standardisation project.
The MiST collaborative adopted standardisation of infusions as a core projects at their meeting in January 2016.More information on the evidence base regarding safety and efficiency can be found in this presentation.
The project plan can be downloaded here. Please direct feedback and comments to standard [dot] infusions [at] mist-collaborative [dot] net