Background Delivering infusions in paediatric and neonatal intensive care units (PICU/NICU) is a high-risk process. In our institution, IV drugs are prepared on a weight-based equation (rule of 6), which standardises infusion rates by varying the concentration of the active ingredient. Transition to standardised concentrations (StdC) and smart pumps is advised in the USA to reduce risks of preparation errors.
Purpose To conduct a European survey to assess current preparation and administration practices in PICU/NICU, as well as the level of implementation of StdC and smart pumps.
Materials and methods An electronic standardised questionnaire (SurveyMonkey) was sent by email (May 2013, reminder at 6 weeks) to all members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the Swiss associations of hospital pharmacists (GSASA), as well as to the country delegates of the European Association of Hospital Pharmacists (EAHP), with a request to forward the survey to everyone involved. Criteria:% of infusions prepared as StdC (StdC >80%, StdC 20–80%, StdC <20%), type of drugs prepared as StdC, use of smart pumps.
Results 97 answers (physicians: 45.3%, hospital pharmacists: 37.9%, nurses: 16.8%) were recorded from 21 countries (mainly Germany (15%), England (11%), Netherlands (11%), Spain (10%)). 41.5% concerned PICU, 19.1% NICU and 39.4% PICU/NICU.
23/97 (23.7%) reported using StdC for > 80% of infusions prepared, 31/97 (32.0%) for 20–80% and 45/97 (46.4%) for <20%. The use of smart pumps was reported in 37/74 (50%) of the institutions. StdC >80% was mainly used in PICU (16/23), for drugs such as adrenergic agonists, analgesics, sedatives and insulin. StdC were based on concentrations routinely used in the institution in 16/21 (76.2%) of the cases and used since more than 5 years in 14/21 (66.7%).
In StdC 20–80% responders, 20/26 (76.9%) thought that total implementation of StdC would reduce medication errors.
In StdC <20% group, 23/34 (77.3%) with no experience in StdC thought that moving to StdC would reduce medication errors. Ten centres reported the failure of StdC implementation because of fluid balance problems, the need for too many concentrations to cover all patients’ needs and nurse resistance.
Conclusions Standardised concentrations and smart pumps are in use in 25% and 50% of the answering European centres, respectively. StdC are used for high-risk medicines and are perceived as a safety strategy. Factors associated with implementation failure have been fluid balance, logistics and human factors and should be considered before moving to StdC.
No conflict of interest.
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