Background Parenteral medication administration by continuous infusion has become a common practice in end-of-life home care settings because portable infusion pumps are well tolerated and maintain more nearly constant drug plasma levels.
Purpose To ensure safe and quality home care in paediatric patients nearing end-of-life in the community setting, by establishing a standard operating procedure based on elaboration by dose banding.
Material and Methods First, most commonly used drugs and administration routes reported in the paediatric palliative care literature were identified. Second, a literature review was performed in order to assess the compatibility and stability of drug solutions prepared under aseptic conditions in polyvinyl chloride medication cassette reservoirs. Finally, a drug library (drug, patient weight range, concentration) to be used in end-of-life home care settings was drawn up and the main results regarding its implementation were analysed.
Results Five patient weight ranges (<6 kg, 6<11 kg, 11<20 kg, 20<30 kg,≥30 kg) were established. According to these, solutions with standardised drug concentrations were defined as follows: diluted morphine 0.1, 0.2, 0.4, 0.8, 1.2 mg/ml, concentrated morphine (alone or combined) 0.4, 0.8, 1.6, 2.4, 4.0 mg/ml and haloperidol 0.02, 0.04, 0.08, 0.12, 0.2 mg/ml, respectively. Fentanyl and midazolam cassettes were set to contain 0.02, 0.04, 0.05 mg/ml and 1, 2.5, 5 mg/ml for weight ranges corresponding to <6 kg, 6<11 kg and ≥11 kg. The shelf-life of all reservoirs was defined to be 14 days. A minimum infusion rate of 0.1 ml/h was established, except when using subcutaneous reservoir catheters (0.5 ml/h), and an unlimited maximum rate, except for subcutaneous route (5 ml/h).
During the first 10 months, six patients were included: mean age 7.1 years (4 months – 19 years), weights 6 kg – 40 kg. Twenty-two solutions were elaborated (54% morphine, 21% morphine-haloperidol, 25% midazolam), of which 12 were necessary. The rest were discarded due to previous death (two) or satisfactory symptom management by oral route (eight). No medication error or incident related to the infusion was recorded.
Conclusions The standardisation of drug solutions containing morphine, haloperidol, midazolam or fentanyl permits the establishment of a rational programme to ensure safe and quality end-of-life home care in paediatric palliative patients.
References and/or acknowledgements None.
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