Infusion Standardisation – Autumn 2016 Update

This is the second report from the standardisation working group, and we’re pleased to report that we have now completed stage 1 of the project with the initial literature review and scoping survey completed in July 2016. A brief summary of results will be presented below. We are now beginning to bring together the first consultation which will be released to stakeholder groups in October. This is slightly behind schedule but we have found the analysis of the scoping data somewhat more complex than we anticipated, and August is always bad for getting groups together.

Our heartfelt thanks and acknowledgement goes to Thorunn Oskarsdottir for her tireless work in producing and analysing this data on our behalf as part of her MSc. Project at the University of London.

Scoping Results

The purpose of the scoping exercise was to identify practice within units, therefore while the survey was distributed among intensivists, neonatologists, paediatricians, nurses and pharmacists the denominator was agreed as “Number of Units.” In order to focus analysis, the group also focussed on NICU and PICU as these are the areas that consume the majority of continuous infusions.

Data was collected over six weeks (16/6 to 31/7) and 127 responses were received from all types of unit, though predominantly from Intensive Care areas (Table 1). 39 responses were incomplete at close of data collection therefore 88 responses were analysed. Responses were geographically representative (Table 2).

Table 2 1 response had incomplete data.

Table 1

To calculate response rate, it was only possible to derive meaningful data from PICU and NICU responses. The response rate for PICU was 75% (data for 18/24 units). For neonatal care overall the response rate was 32.9% (55/167) with level 3 NICU response rate 55% (27/49) and level 1/2 response rate was 23.7% (28/118). 67% (59/88) of responses came from pharmacists, 29.5% (26/88) from medical practitioners and the remainder (3/88, 3.4%) from nurses.

Of respondents, 85.9% (67/88) stated that standardised concentration infusions WERE an important patient safety issue. 94.6% (83/88) of units used weight based dosing (including the rule of six) for

infusions, though 39.7% (35/88) units use standard concentration infusions at least partially. 51.6% (16/35) of these units had been doing so for >5 years. Only 9 of these units used pre-prepared solutions (pre-filled syringes or pharmacy centralised preparation.)

These results support the position that infusion practice in UK paediatric and neonatal intensive care units is highly variable. They also suggest that there is a desire to move to standardised concentrations (given almost all respondents agreed that it was an important safety issue), but that there may be substantial obstacles to adopting and implementing such an intervention (given that only 40% of units currently use standard concentrations in some way, and more than half of those have been doing so for more than 5 years.) Further research into these reasons is required.

The results of the scoping survey also include extremely detailed information on standard concentrations currently in use. 46 drugs with 143 different concentrations were identified. There were an average of 3 (1-15) concentrations per drug with dopamine being the most variable (15 variations). However it must be noted that many of these variations were differences of 0.1- 0.5dose-units/mL.

Moving on…

The working group are working with the Expert Advisory Group (EAG) to agree a range of concentrations and clinical scenarios to present to clinicians, nurses and pharmacists in the first consultation round.

An abstract of this work has been submitted for consideration to the 22nd NPPG conference in November and we will be producing a manuscript for publication over the winter.

Other work…

Congratulations to Sara Arenas-Lopez for publishing her two methodological papers on introducing standard concentrations into paediatric care:

Standard concentration infusions in paediatric intensive care: the clinical approach

Safe implementation of standard concentration infusions in paediatric intensive care