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Implementation of a national system for best practice delivery of paediatric infusions

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Abstract

Background

Standard concentration infusions and ‘smart-pumps’ are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children’s Health Ireland (CHI) developed a paediatric ‘smart-pump’ drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions.

Aim

To expand best paediatric infusion practices by nationalising use of the CHI drug library.

Setting

Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland.

Development

The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 ‘care-unit’) was substantially expanded (223 drug lines, 6 ‘care-units’). A neonatal sub-library was created.

Implementation

Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites.

Evaluation

A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety.

Conclusion

Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.

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References

  1. Institute for Safe Medication Practices, ISMP. Avoid Preparing Infusions Using the Rule of 6 or Broselow Tape. Medication Safety Alert 2005;10(4). Available from: https://www.medscape.com/viewarticle/501053#. Accessed 09 Oct 2023.

  2. Rich DS. New JCAHO medication management standards for 2004. Am J Health Syst Pharm. 2004;61(13):1349–58.

    Article  PubMed  Google Scholar 

  3. American Society of Health-System Pharmacists. Standardize 4 Safety Initiative - Pediatric Continuous Infusion Standards 2020. Available from: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.pdf. Accessed 08 Sept 2023.

  4. Jessurun JG, Hunfeld NGM, van Rosmalen J, et al. Prevalence and determinants of intravenous admixture preparation errors: a prospective observational study in a university hospital. Int J Clin Pharm. 2022;44(1):44–52.

    Article  CAS  PubMed  Google Scholar 

  5. Rashed AN, Tomlin S, Aguado V, et al. Sources and magnitude of error in preparing morphine infusions for nurse-patient controlled analgesia in a UK paediatric hospital. Int J Clin Pharm. 2016;38(5):1069–74.

    Article  CAS  PubMed  Google Scholar 

  6. Campino A, Arranz C, Unceta M, et al. Medicine preparation errors in ten Spanish neonatal intensive care units. Eur J Pediatr. 2016;175(2):203–10.

    Article  PubMed  Google Scholar 

  7. Aguado-Lorenzo V, Weeks K, Tunstell P, et al. Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit. Arch Dis Child. 2013;98(12):975–9.

    Article  PubMed  Google Scholar 

  8. Parshuram CS, To T, Seto W, et al. Systematic evaluation of errors occurring during the preparation of intravenous medication. CMAJ. 2008;178(1):42–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ohashi K, Dalleur O, Dykes PC, et al. Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Saf. 2014;37(12):1011–20.

    Article  PubMed  Google Scholar 

  10. Institute for Safe Medication Practices, ISMP. Guidelines for Optimizing Safe Implementation and Use of Smart Infusion Pumps 2020. Available from: https://www.ismp.org/guidelines/safe-implementation-and-use-smart-pumps. Accessed 08 Sept 2023.

  11. Oskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol. 2018;70(10):1324–31.

    Article  CAS  PubMed  Google Scholar 

  12. Schneider PJ, Pedersen CA, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration-2017. Am J Health Syst Pharm. 2018;75(16):1203–26.

    Article  PubMed  Google Scholar 

  13. Sutherland A, Jones MD, Howlett M, et al. Developing strategic recommendations for implementing smart pumps in advanced healthcare systems to improve intravenous medication safety. Drug Saf. 2022;45:881–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Neonatal Paediatric Pharmacists Group. Standardising intravenous infusion concentrations in children in the UK 2023. Available from: https://www.rcpch.ac.uk/resources/standardising-intravenous-infusion-concentrations-children-uk. Accessed 08 Sept 2023.

  15. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.

    Article  PubMed  Google Scholar 

  16. Howlett MM, Breatnach CV, Brereton E, et al. Direct observational study of interfaced smart-pumps in pediatric intensive care. Appl Clin Inform. 2020;11(4):659–70.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Howlett MM, Butler E, Lavelle KM, et al. The impact of technology on prescribing errors in pediatric intensive care: a before and after study. Appl Clin Inform. 2020;11(2):323–35.

    Article  PubMed  PubMed Central  Google Scholar 

  18. World Health Organization. Medication safety in transitions of care: technical report. World Health Organization. https://apps.who.int/iris/handle/10665/325453. License: CC BY-NC-SA 3.0 IGO. 2019. Accessed 09 Oct 2023.

  19. The Health Information and Quality Authority (HIQA). Overview report of five years of HIQA monitoring in Irish public acute hospitals against national standards: 2015–2019. 2020. Available from: https://www.hiqa.ie/sites/default/files/2020-08/Healthcare-Overview-report-2015-2019.pdf. Accessed 08 Sept 2023.

  20. National Clinical Effectiveness Committee (NCEC). Framework for Endorsement of National Clinical Guidelines 2015. Available from: https://www.gov.ie/pdf/?file=https://assets.gov.ie/11511/f498a946f1e147fd94429df362d07c2d.pdf#page=1. Accessed 08 Sept 2023.

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Acknowledgements

We would like to thank all the very many staff internal and external to Children’s Health Ireland (CHI) who contributed to the development of this initiative by engaging with working groups, giving feedback during evaluation, and providing ongoing support in a multitude of ways. We would also like to extend our appreciation to the CHI Executive and the Health Service Executive Chief Clinical Officer’s forum for their support.

Funding

No specific funding was received.

Author information

Authors and Affiliations

  1. Children’s Health Ireland, Dublin 2, D12 N512, Ireland

    Moninne M. Howlett, Sharon Sutton, Eimear L. McGrath & Cormac V. Breatnach

  2. Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland

    Moninne M. Howlett & Sharon Sutton

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  1. Moninne M. Howlett
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  2. Sharon Sutton
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  3. Eimear L. McGrath
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Correspondence to Moninne M. Howlett.

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Howlett, M.M., Sutton, S., McGrath, E.L. et al. Implementation of a national system for best practice delivery of paediatric infusions. Int J Clin Pharm 46, 4–13 (2024). https://doi.org/10.1007/s11096-023-01652-3

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  • DOI: https://doi.org/10.1007/s11096-023-01652-3

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