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Current practice of preparing morphine infusions for nurse/patient-controlled analgesia in a UK paediatric hospital: healthcare professionals’ views and experiences
  1. Asia N Rashed1,2,
  2. Stephen Tomlin1,2,
  3. Ben Forbes1,
  4. Cate Whittlesea3
  1. 1Institute of Pharmaceutical Science, King's College London, King's Health Partners, London, UK
  2. 2Pharmacy Department, Evelina London Children's Hospital, Guy's & St Thomas’ NHS Foundation Trust, King's Health Partners, London, UK
  3. 3School of Medicine, Pharmacy and Health, Durham University, Durham, UK
  1. Correspondence to Dr Asia Rashed, Institue of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK; asia.rashed{at}kcl.ac.uk Stephen Tomlin, Pharmacy Department, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust Westminster Bridge Road, London SE1 7EH; Stephen.Tomlin{at}gstt.nhs.uk

Abstract

Objective To explore the views and experiences of healthcare professionals (HCPs) regarding the preparation of morphine infusions for nurse/patient-controlled analgesia (N/PCA).

Methods Three focus groups were conducted with HCPs (anaesthetists, nurses in theatres and wards) at one UK children's hospital. Focus groups were transcribed verbatim and content analysis was used to identify themes.

Results A variety of approaches are used to prepare morphine infusions. A lack of appreciation of the excess volume present in morphine ampoules that nominally contain 1 or 2 mL was identified. Other sources of error were miscalculation, complexity of the multistep procedure, distractions and time pressure. Participants suggested that ‘ready-to-use’ prefilled syringes and preprogrammed syringe pumps would improve practice and minimise the risk of error.

Conclusions Risks associated with the preparation of infusions for paediatric N/PCA, in particular non-appreciation of the overage (excess volume) in morphine ampoules, raise concerns about the accuracy of current practices.

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